Other GI disorders Flashcards
What is Pilonidal disease?
Pilonidal disease is a condition that involves the formation of a pilonidal cyst or abscess near the sacrococcygeal area (at the base of the spine, near the tailbone). It often occurs when hair and debris become trapped in the skin, leading to inflammation, infection, and sometimes the formation of a cyst.
What are causes, symtoms and treatment of Pilonidal disease?
Cause: The condition is thought to be caused by ingrown hair or debris that gets trapped in the skin, leading to infection. It may also be related to friction from prolonged sitting, especially in individuals with excess body hair. Obesity and persistent irritation can predispose individuals to developing a pilonidal sinus.
Symptoms: It typically presents as a painful, swollen lump near the tailbone, which may become infected and form an abscess. Symptoms can include redness, pus or blood drainage, and severe pain, especially when sitting.
Treatment: Early stages may be treated with antibiotics and proper hygiene. In more severe cases, surgical drainage or removal of the cyst and surrounding tissue may be required.
What are hernias?
Aherniais theprotrusion of an organ or tissuethrough an abnormal opening in the surrounding muscle or connective tissue.
What are the different types of hernias?
Inguinal (most common):
- Groin (above inguinal ligament)
- More common in men; can bedirect(weakness in Hesselbach’s triangle) orindirect(through deep inguinal ring)
Femoral:
- Below inguinal ligament, medial to femoral vein
- More common in women, high risk of strangulation
Umbilical:
- Umbilicus
- Congenital (infants) or acquired (obesity, pregnancy, ascites)
Epigastric:
- Midline between xiphoid & umbilicus
- Defect in linea alba
Incisional:
- Site of previous surgery
- More common with poor wound healing, obesity
Obturator:
- Obturator canal (pelvis)
- Rare, presents withHowship-Romberg sign(medial thigh pain)
Spigelian:
Lateral abdominal wall
High risk of strangulation
What is the classical presentation of Hernias ?
- Bulge/swelling at the site, often reducible
- Discomfort or pain, worse with coughing, lifting, standing
- Bowel obstruction symptoms(if strangulated): nausea, vomiting, abdominal distension
What are the red flags of Hernias?
Red Flags (Strangulation/Incarceration) – Urgent Referral!
- Sudden severe pain
- Irreducible mass
- Skin changes (erythema, tenderness)
- Bowel obstruction symptoms
What are the investigations for Hernias?
Clinical examination: Cough impulse, reducibility, location
Ultrasound: First-line if diagnosis is unclear
CT scan: If suspectedcomplications(e.g., strangulation, bowel obstruction)
What is the management of hernias?
Uncomplicated:
Watchful waiting if asymptomatic; elective repair for symptomatic cases
Strangulated/Incarcerated:
Emergency surgery(open or laparoscopic)
Femoral hernias:
High risk of complications →early surgical repair advised
What are Haemorrhoids?
Haemorrhoids areenlarged vascular cushionsin the anal canal, classified as:
- internal(above dentate line)
- external(below dentate line).
What is the classification of haemorrhoids?
Grade I
No prolapse, just prominent vessels
Grade II
Prolapse with straining, spontaneously reduces
Grade III
Prolapse requiring manual reduction
Grade IV
Irreducible prolapse, risk of strangulation
What are the risk factors of haemorrhoids/piles?
Chronic constipation and straining during bowel movements.
Pregnancy due to pressure from the uterus and hormonal changes.
Age, as tissue supporting rectal veins weakens with time.
Obesity and prolonged sitting/standing which increase pressure on rectal veins.
Heavy lifting, chronic diarrhea, and a low-fiber diet.
Family history and a sedentary lifestyle.
What are the symptoms of haemorrhoids?
Anal pain
Soiling of underwear
Anal and rectal itching
Difficulty cleaning after bowel movement
Bulging tissue from rectum
Painless bright red rectal bleeding on toilet paper or dripping into bowl
Prolapse (may be reducible or irreducible)
Perianal discomfort
What is the investigation of Haemorrhoids?
Clinical exam: Perianal inspection
Digital rectal exam (DRE)Proctoscopy: Confirms diagnosis
Colonoscopy: If red flags (e.g., weight loss, altered bowel habits, anaemia
What is the management of haemorrhoid’s?
Lifestyle: High-fibre diet, hydration, avoid straining
Medical: Topical corticosteroids, analgesia
Procedural: Rubber band ligation (grade II-III), sclerotherapy
Surgical: Haemorrhoidectomy (grade IV, recurrent)
What is an anal fissure?
Apainful longitudinal tearin the anal canal, often in theposterior midline.
What are the risk factors and clinical features of anal fissures?
Risk Factors:
Chronic constipation, hard stools
Trauma (childbirth, anal intercourse)
IBD (Crohn’s disease)
Clinical Features:
Severe anal pain during and after defecation
Bright red rectal bleeding
Sentinel pile (chronic cases)
What are the investigations and management of anal fissures?
Investigations:
Clinical exam: Perianal inspection (avoid DRE if painful)
Scope : If tolerated
Management:
Acute (<6 weeks): Stool softeners, topical GTN/diltiazem, analgesia
Chronic (>6 weeks): referral for Botulinum toxin, lateral sphincterotomy (if refractory)
What is Rectal neoplasm?
Cancers affecting therectum(last 15cm of large bowel). The most common type isadenocarcinoma
What are the risk factors and clinical features if rectal cancer?
Risk factors:
Age >50
Family history of colorectal cancer
Inflammatory bowel disease (Crohn’s, UC)
Obesity, smoking, processed meat diet
Clinical features:
Rectal bleeding(often mixed with stool)
Change in bowel habits(diarrhoea/constipation)
Tenesmus(persistent urge to defecate)
Weight loss, anaemia
What are the investigations and management of rectal cancer?
Investigations:
Rectal bleeding(often mixed with stool)
Change in bowel habits(diarrhoea/constipation)
Tenesmus(persistent urge to defecate)
Weight loss, anaemia
Management:
Surgical: Resection if localised
Chemoradiotherapy: If advanced or locally invasive
What are the red flags of colorectal cancer?
Rectal bleeding + age >40
Unintentional weight loss
Iron-deficiency anaemia
Persistent change in bowel habits
