Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 > MedEd lower GI > Flashcards

MedEd lower GI Flashcards

1
Q

What lower GI cancer is screened for in the UK?

A

Colonic cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the most common type of colon cancer?

A

Adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does colon cancer arise from?

A

Dysplastic adenomatous polyps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What sequence does colon cancer follow?

A

Adenoma carcinoma sequence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What genes are associated with colonic cancer?

A

HNPCC (lynch syndrome)
FAP
Peutz- Jeghers syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What syndrome is associated with colonic cancer?

A

Lynch syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are RF for colonic cancer?

A 
Age
obesity
IBD- especially UC
Acromegaly 
Poor diet
Males
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What IBD is associated with colon cancer?

A

UC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What sex is colon cancer more common in?

A

Males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How does colon cancer present?

A

Change in bowel habits- any deviation from norm
Rectal bleeding mixed IN the stool- not bright red blood
Weight loss (lots)
FLAWS
Tenesmus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is blood in the stool in colon cancer?

A

Mixed in with the stool and not bright red

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What will you see on examination in someone with colon cancer

A

Anemia features
Palpable mass
Distention/ascites if lever mets
Lymphadenopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is done first if you suspect colon cancer?

A

2 week referral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What ix might you do for colon cncer? What is GS

A

DRE
Bloods- anaemia, LFTs to check mets
GS- colonoscopy and biopsy
CT abdo pelvis for mets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is diagnostic imaging for colon cancer and what do you see?

A

Double contrast barium enema, you will see apple core lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is dx and GS ix for colon cancer?

A 
dx= double contrast barium enema 
GS= colonoscopy with biopsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What special staging criteria is used for colorectal cancer?

A

Duke’s criteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How is colorectal cancer managed?

A

Surgical resection- hemicolectomy/lower anterior resection

Neoadjuvant chemo or radiotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Where does colon cancer metastasise to? What acronym can be used to remember this?

A 
LLBB: 
liver- most common
lung
brain
bone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the common site of metastasise for colon cancer?

A

Liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the pattern of inflammation in crohns disease?

A

Transmural

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What lesions are seen in crohns?

A

Skip lesions or patch lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the most commonly affected sights in crohns?

A

Terminal ileum- ileocaecal valve

Peri anal area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What does transmural inflammation mean and in what condition is it seen?

A

It means inflammation of all layers

It is seen in the gut in crohns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are characteristic features of crohns?

A 
Skip lesions
Mouth to anus affected
Transmural inflammation
Non caseating granulomas 
Involves terminal ileum or peri anal area
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What does inflammation cause in crohns?

A

Non caseating granulomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are RF for crohns?

A 
Smoking
OCP
Bad diet
Fhx
Ashkenazi jews 
Bimodal age distrib: 15-40 and 60-80y/o
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How does crohns present?

A

Crampy abdo pain RLQ and peri umbilical
Diarrhoea- involves mucus, blood and pus (10-15x day), nocturnal
Peri anal lesions- skin tags, fistulae, abscess
Apthous ulcers (oral)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What areas is abdo pain in crohns?

A

RLQ

Peri umbilical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are extra articular features of crohns?

A

Joint pain
Skin lesions- erytherma nodosum, pyoderma gangrenosum
Ocular symptoms- uveitis and episcleritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Where is pyoderma gangrenosum found and what does it look like?

A

usually affects legs

Is red and purple

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Where is erythema nodosum found and what does it look like?

A

Affects shins and is red

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is seen on examination in crohns?

A

Tender abdomen- most lower right (terminal ileum)
Apthous ulcers in mouth
Skin lesions eg skin tags, fistula etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What ix are done in crohns? What do you see

A

Bloods- FBC, iron studies (low), vitamin and folate levels, CRP/ESR may be raised
Plain x ray- bowel dilation
CT- bowel wall thickening and skip lesions
Bowel series- rose thorn ulcers (deep ulceration) and string sign of kantor (fibrosis and strictures)
Colonoscopy and biospy- ulcers, cobblestone appearance, skip lesions
Histology- transmural involvement and non caseating granulomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is seen on x ray in crohns?

A

Bowel dilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is seen on CT in crohns?

A

Bowel wall thickening

Skip lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is seen on bowel series (x ray and barium enema in crohns? Why do these arise

A

Rose thorn ulcers- ulceration is deep

String sign of kantor- due to fibrosis and sclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is seen on colonoscopy and biopsy in crohns?

A

Ulcers
Cobblestones appearance
Skip leasions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is seen on histology in crohns?

A

Transmural involvement with non caseating granulomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are buzzwords for crohns?

A

Skip lesions
Rose thorn ulcers
String sign of kantor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

How is crohns managed?

A

First line oral/IV/topical steroids- prednisolone
Immunomodulators oral/IV- azathioprine most commonly but also mercaptopurine or methotrexate
Biological therapy IV- adalimumab most commonly but also infliximab or vedolizumab
Surgery for severe disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Name the steroids, immunomodulators and biological therapies used in crohns disease

A

Steroid- prednisolone
Immunomodulators- azathioprine most commonly, otherwise mercaptopurine oe methotrexate
Biological therapies- adalimumab most commonly, otherwise infliximab or vedolizumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

How is remission maintained in crohns?

A

Same as normal treatment but remove steroids- give immunomodulators and biologic therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

How does management for inducing remission in crohns differ from maintaining remission?

A

Induce remission= steroid first line+ immunomodulator+ biologic agent
Maintain remission= immunomodulator+ biologic agent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is UC?

A

Diffuse inflammation of colonic mucosa affects only rectum and colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Where does crohns start and continue?

A

Starts at rectum and extends proximally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What gene is associated with UC?

A

HLA B27

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What conditions is HLA b27 associated with?

A

Ankylosing spondylitis

UC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What are RF for UC?

A 
HLA b27
Fhx 
Not smoking (smoking is protective) 
Western countries
Male sex
Bimodal peak 20-40 then >60
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

In what disease is smoking actually good?

A

UC- it has a protective affect for some reason

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

How does UC present?

A 
Blood diarrhoea
Rectal bleeding and mucus
Abdominal pain and cramps
Tenesmus
Weight loss
52
Q

How will they differentiate diarrhoea in UC vs crohns in SBAs?

A

Bloody diarrhoea= UC

Diffuse diarrhoea with crampy abdo pain= Crohns

53
Q

What are extra articular features of UC?

A 
Skin= erythema nodosum and pyoderma gangrenosum
Joints= peripheral arthritis and ankylosing spondylitis
Ocular= episcleritis is more common than uveitis
54
Q

What extra articular eye manifestation is more common in UC then in crohns?

A

Episcleritis

55
Q

What might you see on examination in UC?

A

Anaemia signs
DRE- gross or occult blood
Abdominal tenderness

56
Q

What ix are done for UC and what will you see?

A

Bloods- FBC (anaemia), LFTs (primary sclerosing cholangitis), CRP/ESR raised
Stool sample- increased faecal calprotectin
pANCA positive
Abdo x ray- dilated bowel (if over 6cm= toxic megacolon) and thumbprinting sign
Double contrast barium enema- lead pipe appearance
Colonoscopy and biospy- continuous erythema, bleeding and ulcers
Histology- crypt abscesses, depletion of goblet cell mucin

57
Q

What might be raised in a stool sample in UC?

A

Faecal calprotectin

58
Q

What antibody might be positive in UC?

A

pANCA

59
Q

What is seen in LFTs in UC?

A

Primary sclerosing cholangitis

60
Q

What is seen on abdo x ray in UC?

A

Dilated bowel with thumbprinting sign

61
Q

What is seen on double barium contrast enema in UC?

A

Lead pipe appearance

62
Q

What are some buzzwords for UC?

A

Abdo x ray- thumbprinting sign

Double contrast barium enema- lead pipe appearance

63
Q

How dilated does the bowel have to be to diagnose toxic megacolon?

A

More than 6cm

64
Q

What does a bowel thats dilated more than 6cm suggest?

A

Toxic megacolon

65
Q

What is seen on colonoscopy in UC?

A

Continuous erythema, bleeding and ulcers

66
Q

What is seen on histology in UC?

A

Crypt abscesses, depletion of goblet cell mucin

67
Q

How is remission induced in UC?

A

Mesalazine (5-ASA)

Steroids- beclamethasone

68
Q

How is remission maintained in UC?

A

Immunosupressants- azathoprine
Biologics (anti TNF alpha)- infliximab
Biologics (integrin receptor antagonists)- vedolizumab
Ciclosporin

69
Q

How can UC be cured?

A

Total colectomy via J puch surgery

70
Q

What anti TNF alpha and integrin receptor antagonists biologics and used to maintian remission in UC?

A

anti TNF alpha= infliximab

integrin receptor antagonists= vedolizumab

71
Q

What are the main complications of UC?

A

Toxic megacolon
Primary sclerosing cholangitis
Colonic adenocarcinoma
Strictures, obstruction and perforation

72
Q

What dietary gluten peptide causes coealiacs?

A

Gliadin

73
Q

What does coeliacs disease cause?

A

Villous atrophy

Hypertrophy of crypts

74
Q

What is there atrophy and hypertrophy of in coeliacs?

A 
Atrophy= of villi
Hypertrophy= of intestinal crypts
75
Q

What are RF for coeliacs?

A 
Fhx
IgA deficiency
T1DM
Autoimmune thyroid disease
Female sex
Western countries
76
Q

What antibody is deficient in coeliacs?

A

IgA

77
Q

How does coeliacs disease present?

A 
Diarrhoea
Bloating 
Abdo pain
Fatigue
Weight loss
Dermatitis herpetiformis
78
Q

What skin rash is associated with coeliacs, what does it look like and where is it found?

A

Dermatitis herpetiformis

Is red and found on elbows

79
Q

What ix are done for coeliacs and what is seen?

A

IgA tTG= elevated titre
EMA= elevated titre
endoscopy= villous atrophy and crypt hyperplasia

80
Q

How is coeliacs managed?

A

Gluten free diet
Vitamin and mineral supplements
refer to specialist if needed

81
Q

What is IBS?

A

Chronic condition characterised by recurrent abdo pain associated with bowel dysfunction

82
Q

What are the classifications of IBS?

A

With diarrhoea
With constipation
Mixed

83
Q

What are RF for IBS

A 
Physical/sexual abuse
PTSD
Pmhx of acute gastroenteritis
Fhx
Female sex
Younger ages
84
Q

How does IBS present?

A

Cramping
Diarrhoea
Constipation
Defecation relieves pain/discomfort

85
Q

What key feature of defecation is seen in IBS?

A

Defecation relieves pain in IBS

86
Q

How is IBS diagnosed?

A

Theres no test

Its a diagnosis of exclusion

87
Q

What conditions do you need to exclude for IBS diagnosis? What ix should you do to exlcude these

A

Coeliacs- anti tTG
IBD- faecal calprotectin, CRP, colonoscopy
Colorectal cancer- FBC (is there anaemia?), FOB test

88
Q

What stool test is done for colorectal cancer?

A

Faecal occult blood test

89
Q

How is IBD managed?

A

Lifestyle- high fibre, low caffiene/fructose/lactose, stress management, education/reassurance, probiotics maybe
Medical- laxatives, antispasmodics, antidiarrhoeals

90
Q

When an SBA asks what will confirm the diagnosis what should you immediately think to help you answer it?

A

Think about your top differential

Then think about which test is used to definitively diagnose it

91
Q

What are haemorrhoids?

A

Vascular rich tissue cushions located within the anal canal

92
Q

Describe the 4 grades of haemorrhoids

A

Grade 1= no prolapse just prominent blood vessels, only bleeds
Grade 2= prolapse upon bearing down but spontaneously reduce
Grade 3= prolapse upon bearing down and require manual reduction
Grade 4= permanent prolapse and cannot be manually reduced

93
Q

If a haemorrhoid is described as ‘no prolapse just prominent blood vessels, only bleeds’ what grade is it?

A

1

94
Q

If a haemorrhoid is described as ‘prolapses upon bearing down but spontaneously reduces ‘ what stage is it?

A

2

95
Q

if a haemorrhoid is described as ‘prolapses upon bearing down and requires manual reduction’ what stage is it?

A

3

96
Q

if a haemorrhoid is described as ‘permanently prolapsed and cannot be manually reduced’ what stage is it?

A

4

97
Q

What does prolapse mean in terms of haemorrhoids?

A

Protrusion beyond the anal canal opening

98
Q

What are RF for haemorrhoids

A

Constipation
Pregnancy
Space occupying pelvic lesion

99
Q

How do haemorrhoids present?

A

Painless bright red blood associated with defecation
May be painful
May be itchy
May feel mass if prolapsed

100
Q

What ix are done for haemorrhoids? whats first line

A

Anoscopic examination- is diagnostic

101
Q

How are haemorrhoids managed?

A

Conservative= constipation, lifestyle eg discourage straining
Grade 1= topical cotricosteroids
Grade 2/3= rubber band ligation
Grade 4= surgical haemorrhoidectomy

102
Q

What is management for grade 1 haemorrhoids?

A

Topical corticosteroids

103
Q

What is management for grade 2 and 3 haemorrhoids?

A

Rubber band ligation

104
Q

What is management for grade 4 haemorrhoids?

A

haemorrhoiectomy

105
Q

How is haemorrhoiectomy performed?

A

Under general
20 mins
Surgeon can do open excision or use a stapler to remove it

106
Q

What is rectal prolapse?

A

When the rectum slides out of the anal canal

107
Q

What are RF for rectal prolapse?

A

Chronic constipation and straining
Weakened pelvic floor muscles- natural birth/surgery/trauma
Obesity
Older ages

108
Q

How does a prolapsed rectum present?

A

Painless protruding mass following defecation/ straining/coughing
Mucoid discharge
Incontinence

109
Q

Is rectal prolapse painful? Do they bleed?

A

No and no

110
Q

How is rectal prolapse managed?

A

DeLormes procedure

111
Q

How is rectal prolapse diagnosed?

A

Clincally, you just have to examine the patient

112
Q

How are anal fissures managed?

A

First line conservative management
Topical GTN- analgesia
Topical diltiazem- analgesia
if persistent then botox injections, anal sphincterectomy

113
Q

What is an anal fissure?

A

Split in the anal mucosa

114
Q

How is anal fistula managed?

A

Fistulotomy

Seton procedure

115
Q

What are anal fistulae?

A

Abnormal openings/canals between the last part of the bowel and skin around the anus

116
Q

How do anal fistulae present?

A

frequent abscesss, puss and pain round area

117
Q

What ix are done for anal fistulae?

A

EUA

MRI

118
Q

what is an anal abscess?

A

infection of soft tissue and collection of pus around the anus

119
Q

What are the 4 types of anal abscess? how are they classed

A 
They are classed by location: 
Intersphincteric
Perianal
Perirectal
Supra levator
120
Q

How is anal abscess managed?

A

Surgical drainage

121
Q

How does anal abscess present?

A

Anal pain not related to defecation

122
Q

How is anal abscess diagnosed?

A

Clinically by examining the patient

Can also do EUA or MRI

123
Q

What is a pilonidal sinus?

A

When hair follicles become inserted into the skin causing inflammation and a sinus- natal cleft

124
Q

How does pilonidal sinus present?

A

Pain, swelling, discharge

125
Q

How is pilonidal sinus diagnosed?

A

By history and visualise the lesion by examining the patient

126
Q

How is pilonodial sinus managed?

A

Surgical excision, ABx, hair removal and local hygiene advice

127
Q

How do you describe where a perianal lesion is?

A

Use a clock format, 12 oclock is right above the butthole

Year 3 (104 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions