Lower GI pathology Flashcards
When should a 2WW for colorectal cancer be considered?
> 40 with unexplained weight loss and abdominal pain
> 50 with unexplained rectal bleeding
> 60 with iron deficiency anaemia or change in bowel habit
What investigations should be carried out to diagnose a patient with colorectal cancer?
FOB testing if 2WW is not indicated
Bloods
What is ileus?
Condition affecting small bowel where peristalsis ceases to occur temporarily.
What is pseudo-obstruction?
A functional obstruction of the large bowel where patients present with intestinal obstruction but no mechanical cause is found.
What is the difference between ileus and pseudo obstruction?
Ileus is in the small bowel pseudo-obstruction is in the large bowel.
What can cause an ileus?
Open abdominal surgery - handling of the bowel ceases it’s function
Inflammation/infection in or near the bowel - e..g peritonitis, appendicitis, pancreatitis or pneumonia
Electrolyte imbalances - hyponatraemia or hypokalaemia
Clinical presentation of ileus?
Bilious vomiting
Abdominal distention
Diffuse abdominal pain
Constipation
Lack of flatulence
ABSENCE of bowel sounds
What is the management of ileus?
Treat underlying cause
Supportive care - NBM, inserting an NG tube, providing IV fluids to prevent dehydration and correct electrolyte imbalances, mobilise the patient, consider TPN.
What are haemorrhoids?
Enlargement of the anal vascular cushions
Where positions on a clock face are haemorrhoids usually located?
3, 7 and 11 o clock
Describe 2nd and 3rd degree haemorrhoids.
2nd degree: haemorrhoid protrudes on straining and spontaneously retracts on relaxing
3rd degree: haemorrhage protrudes on straining and requires reducing manually.
What procedure involves fitting a tight band around the base of a haemorrhoid to cut off the blood supply?
Rubber band ligation
What common medication increases the risk of diverticulosis and diverticular haemorrhage?
NSAID’s
What blood results may be deranged in acute diverticulitis?
Raised inflammatory markers
Raised white blood cell count
What oral antibiotic do the NICE clinical knowledge summaries suggest for uncomplicated acute diverticulitis?
Co-Amoxiclav
What dietary changes do the NICE clinical knowledge summaries suggest in the management of uncomplicated acute diverticulitis?
Only taking liquids (no oral solids) until symptoms improve
What section of the GI tract is included in the midgut?
Distal part of the duodenum to the first half of the transverse colon
What arteries supply the foregut, midgut and hindgut?
Foregut: coeliac artery, midgut: superior mesenteric artery and hindgut: inferior mesenteric artery
What is the “classic triad” of chronic mesenteric ischaemia?
Central colicky abdominal pain after eating, weight loss and abdominal bruit on auscultation
What is complicated diverticulitis?
Diverticular disease with inflammation AND a complication such as obstruction, bleeding, perforation, abscess, fistula
What cardiac condition is a key risk factor for acute mesenteric ischaemia?
Atrial fibrillation
What can be seen on a venous blood gas in acute mesenteric ischaemia?
Metabolic acidosis and a raised lactate
What three types of cancer are more prevalent than bowel cancer in the UK?
Breast, prostate and lung cancer
What is the inheritance pattern of familial adenomatous polyposis (FAP)?
autosomal dominant
What tumour suppressor gene is malfunctioning in FAP?
Adenomatous polyposis coli (APC)
What procedure involves removing the entire length of the large intestine?
Panproctocolectomy
What is the descriptive name for Lynch syndrome and how it is inherited?
Hereditary non polyposis colorectal cancer (HNPCC) and it is inherited in an autosomal dominant fashion.
What test is used in the bowel cancer screening program in England?
Faecal immunochemical tests
What is the gold standard investigation for suspected bowel cancer?
Colonoscopy
What tumour marker relates to bowel cancer?
Carcinoembryonic antigen (CEA)
What part of the colon is removed in a Hartmann’s procedure?
Rectosigmoid colon
What is formed from a section of small bowel in patients with a urostomy?
Iléal conduit
