Small Bowel and Colon Flashcards
1
Q
define Crohn’s disease
A
chronic inflammatory condition of anywhere in the GI tract, associated with NOD2 and TH1. Patchy, segmental disease with non-caveating granuloma formation. fistulas and strictures can lead to small bacterial overgrowth which causes malabsorption
2
Q
diagnosis of small bowel bacterial overgrowth
A
schilling test- B12
14C breath test
3
Q
presentation of Crohn’s
A
- oral lesions
- cobble-stoning mucosa (deep fissuring ulceration)
- abdominal pain
- diarrhoea
- perianal disease
4
Q
diagnosis of Crohn’s
A
bloods (anaemia, raised CRP) stool sample (faecal calciprotectin to distinguish from IBS) colonoscopy shows cobble-stoning mucosa with punched out lesions
5
Q
management of Crohn’s
A
smoking cessation
steroids e.g. prednisolone or budesonide
immunosuppressants e.g. azathioprine or methotrexate
anti-TNF e.g. infliximab or adalimumab
- surgery: resections can lead to short gut syndrome
6
Q
define UC
A
chronic inflammatory condition confined to the colon and rectum, associated with NOD2 and TH1 and TH2
7
Q
what does UC increase the risk of?
A
colorectal carcinoma
8
Q
presentation of UC
A
- PR bleeding
- diarrhoea
- tenesmus
- extra GI manifestations e.g. uveitis, PSC, arthritis
9
Q
diagnosis of UC
A
- Truelove and Witt criteria
- bloods
- AXR (toxic megacolon)
- colonoscopy with biopsy
10
Q
management of UC
A
- surveillance for colorectal carcinoma
- nutrition
- 5ASA e.g. mesalazine or sulphasalazine
- steroids e.g. prednisolone or budesonide
- immunosuppressants e.g. azathioprine or methotrexate
- anti-TNF
- surgery
11
Q
define IBS
A
altered bowel habit for a period of greater than 6 months
12
Q
presentation of IBS
A
- absence of red flag symptoms
- abdominal pain, bloating, diarrhoea, constipation (Bristol stool chart)
13
Q
diagnosis of IBS
A
- Rome II diagnostic criteria (3 per month)
- normal bloods
- rule out other
14
Q
management of IBS
A
- lifestyle: diet, stress, FODMAP, exercise
- anti-spasmodics, laxatives and antidiarrhoeals
15
Q
define coeliacs disease
A
autoimmune disease caused by an abnormal reaction to gluten (gliadin) with strong association with HLA-DQ2 and HLA-DQ8 which causes enterocyte loss
16
Q
presentation of coeliacs
A
- abdominal pain, bloating, diarrhoea
- weight loss
- anaemia, vitamin deficient
- dermatitis herpetiformis (vesicular rash)
17
Q
diagnosis of coeliacs
A
IgA anti-tissue transglutaminase test (tTGA)
18
Q
management of coeliacs
A
gluten-free diet to reverse villus atrophy
19
Q
define lactose intolerance
A
this is a deficiency in the enzyme lactase leading to an inability to digest lactose correctly
20
Q
presentation of lactose intolerance
A
abdominal pain, bloating, diarrhoea
21
Q
diagnosis of lactose intolerance
A
hydrogen breath test
oral lactose tolerance test
22
Q
management of lactose intolerance
A
lactose free diet
23
Q
define intestinal failure
A
this is an inability of the intestines to maintain adequate nutrition and fluid status
24
Q
presentation of intestinal failure
A
lack of energy
anaemia
vitamin deficiencies (glossitis for folate, B12 and iron)
25
management of intestinal failure
- nutrition
- PPIs
- octreotide (palliation)
- transplant for type 3
26
three types of small bowel cancer
1. lymphomas (non-hodgkins T cells) and maltomas (B cells)
2. carcinoid tumour (yellow, slow-growing, hormones)
3. carcinomas (coeliacs and UC)
27
define Meckel's diverticulum
this is a small bulge in the small intestine due to incomplete regression of the vietello-intestinal duct
28
presentation of Meckel's diverticulum
- before 2 years
| - mimics appendicitis
29
diagnosis of Meckel's diverticulum
colonoscopy
| CT
30
management of Meckel's diverticulum
resection
31
define appendicitis
inflammation of the appendix
32
presentation of an appendicitis
- central pain that migrates to RIF (McBurnery's point- worse on coughing)
- nausea and vomiting
- children won't eat or sleep
33
diagnosis of appendicitis
USS in women and children
bloods (increased WCC)
Alvarado score
CT
34
management of appendicitis
appendicectomy
35
how are carcinoids of the appendix diagnosed?
chromagrannin stain
36
define ischaemia of the small bowel
lack of blood supply to the small bowel which leads to infarction. It can be occlusive or non-occlusive (damage on reperfusion)
37
presentation of ischaemia of the small bowel
sudden abdominal pain
bowel movements
abdominal tenderness and distension
38
diagnosis of ischaemia of the small bowel
angiography
39
define a hernia
abnormal protrusion of the cavity's contents through a weakness in the wall of the cavity, can be reducible, incarcerate or strangulated
40
presentation of hernia
lump
sudden onset pain
vomiting
41
presentation of a small bowel obstruction
colicky pain
absolute constipation
vomiting with copious bile-stained fluid
distension
42
diagnosis of a small bowel obstruction
tinkling bowel sounds
AXR
CT contrast
gastrograffin studies
43
management of a small bowel obstruction
- NG tube
| fluids
44
define peritonitis
infection of ascites
45
who can peritonitis be fatal in?
elderly
immunosuppressed
diabetics
those without an momentum (previous surgery)
46
presentation of peritonitis
foetal position, shallow respiration
| guarding
47
diagnosis of peritonitis
FBC
| ascites fluid aspiration
48
management of perionitis
amoxicillin + gentamicin + metronidazole
49
define mesenteric ischaemia
lack of blood supply to the mesentery causing infarction
50
presentation of mesenteric ischaemia
pain out of proportion with examination
51
diagnosis of mesenteric ischaemia
acidotic ABGs
elevated lactase
CT
angiography
52
management of mesenteric ischaemia
thrombolytics
resuscitation
endovascular repair (stenting)
53
define diverticular disease
Mucosal herniation through the wall of the colon forms diverticulosis and when they become infected it is diverticulitis. Often presents in the sigmoid colon due to a low fibre diet.
54
presentation of diverticular disease
LIF pain/tenderness
| altered bowel habit
55
diagnosis of diverticular disease
bloods
sigmoidoscopy
Hinchey classification
56
management of diverticular disease
- antibiotics
- if complicated Hartmann procedure (rectosigmoid colon removed and left with colostomy)
- diet modification
57
define colitis
inflammation of the inner lining of the colon
58
different types of colitis
Crohns
UC
ischaemic
infective
59
diagnosis of ischaemic colitis
thumb printing on AXR at the splenic flexure
60
define colonic angiodysplasia
vascular malformations in the colon
61
presentation of colonic angiodysplasia
submucosal lakes of blood, PR bleeding
62
diagnosis of colonic angiodysplasia
angiography
| colonscopy
63
management of colonic angiodysplasia
embolisation
endoscopic ablation
surgical resection
64
presentation of a large bowel obstruction
- symptoms develop gradually because of the large capacity of the colon
- the more proximal the obstruction the earlier the vomiting develops (faeculent)
- colicky pain with distension
- absolute constipation
65
what does tenderness of an obstruction indicate?
strangulation
66
what does an incomplete bowel obstruction cause?
hypertrophy of the bowel wall
67
causes of dynamic bowel obstruction
paralytic ileus
| pseudo-obstruction (Oglivie's syndrome)
68
define pseudo-obstruction
no mechanical obstruction (elderly and debilitated)
69
diagnosis of large bowel obstruction
- supine AXR
| - tinkling bowel sounds
70
management of large bowel obstruction
- replace fluids and electrolytes
- NG tube to decompress stomach
- stenting and surgery
71
define volvulus
the intestine and mesentery twists resulting in an obstruction
72
presentation of volvulus
fever
tenderness
constipation
vomiting
73
diagnosis of volvulus
AXR and rectal contrast
- coffee-bean = sigmoid volvulus
- haustra maintained= caecal volvulus
74
management of volvulus
```
surgery resection (Ladd procedure)
flatus tube
```
75
two functional bowel disorders
1. constipation
2. faecal impaction
presents with malaise from prolonged distension
76
management of functional bowel disorders
laxatives
enemas
manual evacuation
77
management of diarrhoea
anti-infectives
antidiarrhoeals
rehydration
replace potassium lost
78
classification of colorectal carcinoma
- polyps
- adenomas (pre-malignant)
- adenocarcinomas
79
two hereditary colorectal carcinomas
1. HNPCC/Lynch syndrome
| 2. FAP
80
describe Lynch syndrome
this is less polyps than FAP, AD, right sided, mucinous tumours with Crohn's-like inflammatory response
81
describe FAP
more than 100 polyps, AD, left sided, defect in tumour suppressor and no inflammatory response
82
right-sided tumour presentation
```
anaemia
persistent tiredness
change in bowel habit
weight loss
colicky pain
lump
```
83
left-sided tumour presentation
PR bleeding
altered bowel habit
tenesmus
constipation
84
diagnosis of colorectal carcinoma
```
bowel screening (faecal antigen test)
CEA tumour marker
SOPD, endoscopy, sigmoidoscopy or CT colongraphy
```
85
bowel prep for?
CT colonography with picolax and omnipaque
86
management of colorectal carcinoma
palliation e.g. stenting with chemo/radio
| surgery e.g. right hemicolectomy
87
what should be screened for before using infliximab?
TB
88
UC inducing remission mild/ moderate
aminosalicylates
| corticosteroids (pred)
89
UC inducing remission severe
```
IV corticosteroids (hydrocortisone)
IV ciclosporin
```
90
UC maintaining remission
1. aminosalicylate
2. azathioprine
3. mercaptopurine
91
which laxative to avoid in IBS?
lactulose as causes bloating
92
what needs to be tested for in Coeliac's?
IgA deficiency
| T1DM
93
what is mesenteric adenitis?
inflamed abdominal lymph nodes
94
presentation of mesenteric adenitis
abdominal pain
95
what is mesenteric adenitis associated with?
tonsilitis
| URTI
96
causes of small bowel obstruction
```
intussusception
adhesions
incarcerated hernia
Meckel's diverticulum
strictures
tumours
gall stone ileus
foreign body
congenital atresia
```
97
how does gallstone ileus come about?
fistula causes stone to get through and cause an obstruction
98
what is a paralytic ileus?
temporary impairment of peristalsis in the absence of mechanical obstruction
99
what is mesenteric ischaemia?
lack of blood supply to the mesentery through mesenteric vessels resulting in intestinal ischaemia and can lead to infarction
100
vessels involved usually in mesenteric ischaemia
SMV
SMA
non-occlusive
101
key RF for mesenteric ischaemia
AF
102
what is chronic mesenteric ischaemia?
intestinal angina - low flow states due to atherosclerosis
103
chronic mesenteric ischaemia triad
1. central colicky abdominal pain after eating
2. weight loss due to food avoidance
3. abdominal bruit
104
why are diverticula not in the rectum?
it only has longitudinal muscle and these are circular muscle
105
diagnosis of mesenteric ischaemia
CT angiography or MR angiography
106
management of mesenteric ischaemia
```
angioplasty
stent insertion
statins
antiplatelets
RF reduction
```
107
causes of large bowel obstruction
```
cancer
stricture
volvulus
adhesions
hernia
bolus obstruction
faecal impaction
Hirschsprung's
meconium ileus
rectal atresia
intussusception
```
108
what does an incomplete obstruction cause?
hypertrophy of the bowel wall
109
special reasons for a stool culture in diarrhoea
```
food poisoning outbreak
travel
recent antibiotic use
rectal intercourse
immunocompromised
raw seafood
```
110
presentation of steatorrhoea
shiny
malodourous
hard to flush
111
stain for fat in poo
sudan stain
112
what is Hirschsprung's?
explosive passage of stool following PR exam due to nerves in the colon not forming properly
needs biopsy
