Lower GI Disease Flashcards
1
Q
Define IBD
A
A chronic, relapsing, remitting inflammatory condition of the GI tract.
2
Q
What are the common types of IBD seen ?
A
Crohn’s disease and Ulcerative Colitis are the two main types of IBD.
3
Q
What extra-intestinal manifestations are seen in those individuals with IBD ?
A
Uveitis/scleritis
Erythema nodosum
Ulcers in the mouth
4
Q
What is the typical presentation of UC ?
A
Bloody diarrhoea Abdominal pain Anaemia Weight loss Fatigue
5
Q
How would you investigate UC ? (4)
A
Bloods - CRP, albumin and ferritin
FIT testing
Stool culture to rule out infection
Colonoscopy and biopsy
6
Q
How is UC graded ?
A
Mild <4 stools/day
Moderate 4-6 stools/day
Severe >6 stools/day
Fulminant >10 stools/day
7
Q
What is proctitis ?
A
Inflammation of the rectum
8
Q
How does proctitis present ?
A
Incontinence Tenesmus Increased frequency Soreness around anus Pus and discharge Diarrhoea
9
Q
How is proctitis treated ?
A
Topical therapies, suppositories
10
Q
What is acute severe colitis ?
A
> 10 stools per day for more than 10 days and symptoms of regular colitis.
11
Q
How do you treat acute severe colitis ?
A
IV Corticosteroids IV hydration Enteral feeding Immunotherapy Urgent surgical review and psychological support
12
Q
How is acute severe colitis diagnosed ?
A
Bloods - CRP, Ferritin
Colonoscopy with biopsy
Stool sample for culture
13
Q
What may be seen on an AXR in colitis ?
A
Toxic dilation
Lead pipe sign
Oedema
14
Q
How can you distinguish between Crohn’s and UC ?
A
Crohn’s can affect the entire GI tract whereas UC only the large intestine, Crohn’s may therefore cause vomiting if near the stomach.
15
Q
What stool test can be done to differentiate between IBD and IBS ?
A
Faecal calprotectin
16
Q
Out of CD and UC which ones has …
Granulomas
Transmural infarction
Abscesses ?
A
CD
CD
Both
17
Q
How is perianal Crohn’s disease investigated ?
A
MRI or pelvis and an examination
18
Q
How is perianal Crohn’s disease treated ?
A
Drainage of pus
Antibiotics
Biologic therapy
19
Q
What is the treatment for UC ?
A
Flare ups :
- Steroids with Vit D and calcium
- 5ASA’s
Maintenance :
- 5ASA’S
- Thiopurines
Biologics help keep patient in remission
20
Q
What is the treatment for CD ?
A
Flare ups :
- Steroids with Vit D and calcium
- Methotraxate
Maintenance :
- Thiopurines
- Methotrexate
Biologics help keep patient in remission
21
Q
What are the side effects of thiopurines ? (4)
A
Pancreatitis
Hepatotoxicity
Leukopenia
Increased lymphoma risk
22
Q
What are biologics ?
A
Monoclonal antibodies
23
Q
What causes therapy to fail in UC/CD ?
A
Relapses or recurrent courses of steroids
Unacceptable side effects
24
Q
If treatment of UC/CD fails what is the other option ?
A
Surgery
25
What might form in CD that needs fixing via surgery ?
Fistulas
| Obstruction
26
What is a pouch procedure ?
Small bowel or part of GI that was preserve is reattached to rectal stump so no need for stoma after.
27
What is refractory colitis ?
UC main remain active though patient is receiving appropriate treatment.
28
Which parts of the duodenum are intraperitoneal and which bits retroperitoneal ?
The first part is intraperitoneal and the rest retroperitoneal
29
What cells are found in the crypts of the small intestine ? (4)
Endocrine cells
Paneth cells
Goblet cells
Stem cells
30
What is the intrinsic plexus of the intestine ?
Myenteric plexus
31
What is the extrinsic plexus of the intestine ?
Autonomic plexus
32
What diseases other than UC and CD does IBD include ?
Appendicitis
Ischaemic colitis
Radiation colitis
33
What is NOD2 associated with ?
CD
34
What is HLA and pANCA associated with ?
UC
35
Pseudopolyps and ulceration are commonly seen in which IBD disease ?
UC
36
Which IBD disease presents with a thickened, oedematous mesentery ?
CD
37
Which drugs increase risk of ischaemia ?
OCP
Atherosclerotic drugs
Vasoconstrictive drugs (propranolol)
38
Which part of the GI tract has a high risk of ischaemia ?
The splenic flexure
39
How does ischaemia affect gut wall ?
```
Haemorrhages
Oedema
Necrosis
Perforation
Ulceration
Inflammation
Fibrosis
```
40
How does ischaemia present ? (4)
Pain, cramping
Nausea
Blood
Diarrhoea
41
How does radiation colitis present ? (4)
Weight loss
Malabroption
Diarrhoea
Abdominal pain
42
How does appendicitis present ?
Pain
Nausea
Lack of appetite
Fever
43
How is appendicitis diagnosed ?
History and examination
USS
CT
44
Which 3 shapes can polys be ?
Villous
Tubular
Tubulovillous
45
What are the risk factors for adenocarcinoma of the colon ?
Family/genetics
Alcohol/red meat
Low fibre diet
IBD
46
How does right sided adenocarcinoma of the colon present ?
Anemia
Vague pain
Obstructions
Polypoid
47
How does left sided adenocarcinoma of the colon present ?
Annular
Obstruction
Fresh blood
Altered bowel habit
48
How do you stage bowel cancer ? (2)
TNM staging and Duke's
49
```
Duke stages ?
A
B
C
D
```
A - The cancer is in the inner lining of the bowel. Or it is slightly growing into the muscle layer.
B - The cancer has grown through the muscle layer of the bowel.
C - The cancer has spread to at least 1 lymph node close to the bowel.
D - The cancer has spread to another part of the body, such as the liver, lungs or bones.
50
Which polyps are most likely to turn malignant ?
Villous
51
Name an oncogene
k-ras
52
Name a tumour suppressor gene
APC, p53
53
How does colorectal cancer usually present ?
```
Diarrhoea/constipation
Blood in stool
Weight loss
Anaemia
Palpable mass
```
54
How is colon cancer investigated ?
Colonoscopy with biopsy
| Blood tests
55
How is colon cancer staged using imaging ?
CT of the abdomen/pelvis
PET scans
MRI rectal
56
What is used to mop up lymph node metastases ?
Chemotherapy
57
What is radiotherapy used for ?
Rectal cancer only
58
What is used for palliation in colon cancer ?
Chemotherapy and stenting
59
What does FIT stand for ?
Faecal immunochemical testing
60
What does FOBT stand for ?
Faecal occult blood test
61
When is FIT testing started and how often is it done ?
When you reach 50 every 2 years till 74 years.
62
Which groups of patient are seen at high risk for the development of colon cancer ?
```
Previous colon cancer
IBD
FAP
HNPCC
Family member had it
```
63
What gene is defected in FAP ?
APC gene
64
How are people with FAP screened ?
Yearly
65
When do people with FAP usually have a proctocolectomy ?
16-25 years old
66
What genes are abnormal in HNPCC ?
Mismatch repair genes
67
How is HNPCC diagnosed ?
Amsterdam criteria and genetic testing
68
How often are those with HNPCC screened ?
Every 2 years
69
How often are those with a family history of colorectal cancers screened and what age does screening begin ?
Every 5 years from 50
70
People with IBD when does screening begin and how often between colonoscopies ?
10 years after diagnosis and every 5 years
71
What are haemorrhoids ?
Swellings containing enlarged blood vessels that are found inside or around the bottom
72
What are the symptoms of haemorrhoids ?
- Bright red blood after you poo
- An itchy anus
- Mucus
- Lumps around your anus
- Pain around your anus
73
Why do haemorrhoids occur ?
They occur due to chronic constipation, chronic diarrhoea, lifting heavy weights, pregnancy, or straining when passing a stool.
74
How are haemorrhoids diagnosed ?
- Visual examination
- Rectal examination
- Colonoscopy
75
How are haemorrhoids treated ?
- Topical steroids
- High fibre foods
- Laxative if constipated and FODMAP if diarrhoea
- Analgesics
76
What are anal fissures ?
An anal fissure is a small tear in the thin, moist tissue (mucosa) that lines the anus.
77
How do anal fissures occur ?
An anal fissure may occur when you pass hard or large stools during a bowel movement. Diarrhoea and other conditions such as CD, UC can cause them too.
78
How do anal fissures present ?
- Painful bowel movements
| - Rectal bleeding
79
How are anal fissures investigated ?
Digital rectal examination
| Examination with anaesthesia
80
How can anal fissures be prevented and treated ?
- Give laxative
- GTN or botox to relax muscle
- Most will heel of there own but surgery may be needed if they persist
To prevent increase fibre intake, exercise, defecate when need arises and stay well hydrated.
81
How do perianal abscesses present ?
- Pain
- Palpable mass
- Fever and chills
82
What are the risk factors for a perianal abscess ?
DM and obesity
83
How do you treat a perianal abscess ?
Antibiotics and drainage
84
What is a fistula in ano ?
An anal fistula can be described as a narrow tunnel with its internal opening in the anal canal and its external opening in the skin near the anus.
85
How do you manage/treat anal fistulas ?
The most common type of surgery for anal fistulas is a fistulotomy. This involves cutting along the whole length of the fistula to open it up so it heals as a flat scar.
If your fistula passes through a significant portion of anal sphincter muscle, the surgeon may initially recommend inserting a seton.A seton is a piece of surgical thread that's left in the fistula for several weeks to keep it open. This allows it to drain and helps it heal, while avoiding the need to cut the sphincter muscles. Loose setons allow fistulas to drain, but do not cure them. To cure a fistula, tighter setons may be used to cut through the fistula slowly.
86
How does anorectal cancer present ?
- Bleeding from the anus or rectum
- Pain in the area of the anus
- A mass or growth in the anal canal
- Anal itching
87
How would anal cancer be investigated ?
Examination
USS
Biopsy and microscopy
88
What are the risk factors for anal cancer ?
- HIV
- Other cancers
- Anal sex
- Smoking
89
How is anal cancer treated ?
```
Chemotherapy
Radiotherapy
Surgery
Immunotherapy
Analgesics
```
90
How is faecal incontinence investigated ?
```
USS
Clinical examination
Anal manometry
Defaecating proctogram
EMG
```
91
How is faecal incontinence managed ?
- Diet
- Bowel habits
- Antidiarrhoeals
- Anal plugs
- Pelvic floor strengthening
92
What is rectal prolapse ?
Rectal prolapse is when part of the rectum protrudes from the anus.
93
What are the symptoms of rectal prolapse ?
- Feeling a bulge outside your anus.
- Seeing a red mass outside your anal opening.
- Pain in the anus or rectum.
- Bleeding from the rectum.
- Leaking blood, poop, or mucus from the anus.
94
How is rectal prolapse treated ?
Surgery is the only way to effectively treat rectal prolapse and relieve symptoms. The surgeon can do the surgery through the abdomen or through the area around the anus. Surgery through the abdomen is performed to pull the rectum back up and into its proper position.
95
What is pruritus ani ?
Pruritus ani is the irritation of the skin at the exit of the rectum, known as the anus, causing the desire to scratch.
96
What is the main cause of pruritus ani in children ?
Threadworms
97
How is pruritus ani treated ?
- Steroids ointments
- Antihistamines
- Mebendazole to treat threadworm
98
What is the name of the artery at the point where the SMA and IMA anastomose ?
The marginal artery
99
Which artery supplies the rectum from the IMA ?
Superior rectal artery
100
Where does the middle rectal artery come from ?
The internal iliac artery
101
Where does the inferior rectal artery come from ?
The internal pudendal artery
102
What are the 4 groups of abdominal lymph nodes called ?
Epicolic
Paracolic
Central
Intermediate
103
What are the indications of surgical resection of the bowel ?
```
Ischemia
Polpys
Obstruction
Perforations
Tumours
```
104
What does TME stand for ?
Total mesorectal excision
105
What is TME used for ?
To remove the entire mesorectum with rectum and lymph nodes.
106
Which vitamins are produced in the large intestine ?
B and K
107
Define screening
Presumptive identification of unrecognised disease in an asymptomatic individual. Uses tests, examinations and other procedures that can be applied rapidly and easily.
108
At what age is a flexible sigmoidoscopy done in England ?
55
109
How are polyps usually removed ?
Polypectomy with a hot snare
110
How do colonic polyps present ?
```
Weight loss
Bleeding
Change in bowel habits
Fatigue
Abdominal pain
```
111
How are polyps investigated ?
Colongraphy
| CT Colonoscopy
112
What does CRM stand for ?
Circumferential resection margin
113
What investigate is done prior to colorectal surgery for cancer ?
MRI of rectum to look if TME is needed and if there's a clear margin
114
What are the 4 bowel anastomosis principles ?
No tension
Clear surgical site
Well perfused/oxygenation
Acceptable systemic state
115
Is a colostomy or ileostomy spouted ?
An ileostomy
116
What is the contents of the stoma like in an colostomy/ileostomy ?
Ileostomy - Liquid
| Colostomy - Solid
117
What are the complications associated with a stoma ?
Infection
Bleeding
Anastomotic leak
118
Damage to which structures in a lower resection are at risk and what problems can this cause ?
Pelvis nerves - Incontinence and sexual dysfunction
119
What are the signs of bowel obstruction ?
Abdominal pain
N/V
Abdominal distension
Constipation
120
Define shock lung
Rapid onset and widespread inflammation of the lungs
121
Define acute abdomen
Intense abdominal pain that presents <24 hours from onset, requires urgent surgical review
122
Define tubal pregnancy
A pregnancy that occurs in the fallopian tube
123
What should you consider when a patient presents with acute abdomen ? (4)
Ischaemia
Obstruction
Peritonitis
Appendicitis
124
What are the 4 common routes of infection in peritonitis ?
Abdominal wall perforation
Female genital tract
GI wall perforation
Via bloodstream
125
What is the common presentation of peritonitis ?
```
N/V
Abdominal pain
Fever
Fatigue
Constipation
Distension
```
126
What is borborygmi ?
Stomach rumbles
127
How is ischemic bowel diagnosed ?
Endoscopy/colonoscopy
Bloods - ABG
CT/MRI scans
Angiogram
128
Where are somatic pain receptors found ?
Parietal peritoneum
| Abdominal wall
129
Where are visceral pain receptors found ?
Walls of the organs
130
How does peritonitis lead to death ?
Sepsis, circulatory collapse (shock) then death.
131
How is peritonitis managed ?
Need to assess/resuscitate
Bloods - WBC/culture
Paracentesis
CT/X-Ray
132
Define active observation
Used when diagnosis is uncertain and risk of alternative intervention is greater
