Brainscape's Knowledge GenomeTM

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


See full index

MBChB Finals > Rectal bleeding > Flashcards

Rectal bleeding Flashcards

1
Q

What conditions cause ‘mixed’ blood in stool?

A

Colon cancer
Inflammatory bowel disease
Diverticulitis
Bacillary dysentery

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

Clinically differentiate colon cancer from IBD

A

IBD more associated with increased frequency
Mass may be felt in CRC
CRC tends to present in >60s rather than 20-40s

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

Who gets screened via FIT testing in Scotland? how often

A

All men and women
50-74 years old
Every 2 years

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

If a FIT test is abnormal, what investigation should be performed? What happens if this doesn’t work?

A

Colonoscopy
CT colonography alternative

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

Who gets a 2 week referral for suspected colorectal cancer?

A

40 yrs…
Abdo pain + weight loss
50 yrs
unexpected rectal bleeding
>60 yrs
change in bowel habit/microcytic anaemia

Consider if mass or other red flag symptoms

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

Name the resection and anastamosis
caecal –> proximal transverse

A

Right hemicolectomy
Ileo-colic

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

Name the resection and anastamosis
Distal transverse –> descending colon

A

Left hemicolectomy
Colo-colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Name the resection and anastamosis
Sigmoid

A

High anterior
Colorectal

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

Name the resection and anastamosis:
Upper rectum

A

Anterior resection
Colorectal

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

Name the resection and anastamosis
Lower rectum

A

Anterior resection +/- defunctioning stoma bag

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

Name the resection and anastamosis
Anal verge

A

Abdomino-perineal rectal excision
None

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

What complication of surgery increases the risk of anastomosis? If this occurs what is the safest treatment option?

A

Bowel perforation
End colostomy

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

Differentiate ileostomy and colostomy based on location, appearance and output

A

Ileostomy // Colostomy
RIF // Varies but likely left
Spouted // Flushed
Liquid // Solid

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

Classify bowel cancer according to Duke’s Criteria

A

A: Limited to muscularis
B: Extends beyond muscularis
C: Regional Lymph Node Involvement
D: Distant metastases

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

How do you monitor treatment response in colorectal cancer?

A

Blood CEA

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

What criteria can help with diagnosing Lynch Syndrome

A

>=3 cases colorectal (or endometrial, small bowel, ureter or pelvis)
>=2 generations affected
>=1 of affected is first degree relative and/or <50yrs at diagnosis
FAP should be excluded

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How does HNPCC and FAP differ in terms of
Incidence
Implicated genes
Cancer site

A

HNPCC // FAP
More vs less common
MSH2/MLH1 vs APC
Proximal colon vs throughout

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

FAP features + retinal pigmentation/head osteomas/thyroid caricinomas/epidermoid cysts a indicates what

A

Gardner’s syndrome
Variant of FAP

19
Q

Why are you worried about a teen with darkly pigmented mouth and GI polyps

A

Peutz-Jeugher’s syndrome
Small chance of malignant conversion to CRC so surveillance needed.

20
Q

24 year old male presents with mixed rectal bleeding, abdominal pain and increased frequency of stool passage. Likely diagnosis?

A

Inflammatory Bowel Disease

21
Q

How can the pain differ in IBD?

A

CD: Right as affects whole tract
UC: LIF as colon affected

22
Q

What IBD is associated with gallstones?

A

Crohn’s

23
Q

What IBD is more associated with primary sclerosing cholangitis?

A

UC

24
Q

What feature is this and which IBD is it more common in?

A

Thumbprinting

UC due to thickening of colon

25
Q

What is the imaging below and which IBD do you see it in?

A

Drainpipe/lead pipe colon

Seen in AXR for UC

Chronic inflammation causes muscularis hypertrophy, resulting in haustral loss

26
Q

‘Deep skip lesions’

‘Widespread, continuous ulceration’

Match the IBD to the above endscopy report

A

Deep skip lesions (‘Cobblestoning’) —> Crohn’s

Widespread contiuous disease –> UC

27
Q

What happens to goblet cells in the IBDs?

A

Crohn’s: Increased goblet cells

Ulcerative Colitis: Reduced goblet cells

28
Q

Crypt abcesses

Granulomas

Match the features to their IBDs

A

Crypt abscesses –> UC

Granulomas –> CD

29
Q

What induction agents are used for Crohn’s?

A
  1. Glucocorticoids/budenoside
  2. 5-ASA (mesalazine)

+ Azathioprine/mercaptopurine

30
Q

If induction agents don’t work in Crohn’s what can you give?

A

>5 days without improvement

Consider infliximab/adalimumab

31
Q

What induction agents are used for UC?

A

Mild-mod (4-6 stools)

1st: topical 5-ASA (-salazine) +/- oral 5-ASA or corticosteroid if proctitis

Severe (>6 stools)

IV steroids + ciclosporin if no improvement

32
Q

What maintenance agent is used in Crohn’s?

A

STOP SMOKING

Azathioprine/mercaptopurine

33
Q

What maintenance agents are used in UC?

A

Mild-mod: Top/oral/both AS

Severe (systemic unwell)/>2 relapses: Azathioprine/mercaptopurine

34
Q

Since they both have rectal bleeding and LIF pain, clinically differentiate diverticulitis and UC

A

RIF pain more likely if Asian

Patients tend to be over 40

N+V, low fever present

35
Q

How do you investigate for suspected diverticulitis? Whst should be avoided?

A

1st line: AXR shows dilated bowel, obstruction, abscesses

GS: CT

DON’T DO COLONOSCOPY DUE TO PERFORATION RISK

36
Q

How is suspected diverticulitis managed?

A

mild: oral Co-amoxiclav and non-NSAID analgesia

Severe/>72 hours: Admit for IV antibiotics

37
Q

What cause of rectal bleeding is most associated with AKI?

A

Bacillary dysentery

38
Q

How do you investigate and treat bacillary dysentery?

A

Stool culture to confirm

Supportive; Abx if unwell/vulnerable

39
Q

What 4Cs increase C diff?

A

Cephalosporins

Co-amoxiclav

Clindamycin

Ciprofloxacin

40
Q

What causes painful fresh rectal bleeding?

A

Fissure in ano

Thrombosed Haemorrhoids

41
Q

Where are anal fissures found vs haemorrhoids?

A

Fissures: 6 and 12 O clock

Haemorrhoids: 3, 7 and 11 O clock

42
Q

Apart from stool softeners, how do you treat haemorrhoids?

A

Rubber band ligation > sclerotherapy

Surgery if large or <72 hour thrombosis history

43
Q

Faecal incontinence, perianal pain and bleeding are seen in which cancer?

A

Rectal cancer

44
Q
A

MBChB Finals (31 decks)

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