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GI: Key Information > Small Bowel and Colon > Flashcards

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

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2
Q

diagnosis of small bowel bacterial overgrowth

A

schilling test- B12

14C breath test

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3
Q

presentation of Crohn’s

A
  • oral lesions
  • cobble-stoning mucosa (deep fissuring ulceration)
  • abdominal pain
  • diarrhoea
  • perianal disease
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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
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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

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6
Q

define UC

A

chronic inflammatory condition confined to the colon and rectum, associated with NOD2 and TH1 and TH2

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7
Q

what does UC increase the risk of?

A

colorectal carcinoma

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8
Q

presentation of UC

A
  • PR bleeding
  • diarrhoea
  • tenesmus
  • extra GI manifestations e.g. uveitis, PSC, arthritis
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9
Q

diagnosis of UC

A
  • Truelove and Witt criteria
  • bloods
  • AXR (toxic megacolon)
  • colonoscopy with biopsy
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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
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11
Q

define IBS

A

altered bowel habit for a period of greater than 6 months

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12
Q

presentation of IBS

A
  • absence of red flag symptoms

- abdominal pain, bloating, diarrhoea, constipation (Bristol stool chart)

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13
Q

diagnosis of IBS

A
  • Rome II diagnostic criteria (3 per month)
  • normal bloods
  • rule out other
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14
Q

management of IBS

A
  • lifestyle: diet, stress, FODMAP, exercise

- anti-spasmodics, laxatives and antidiarrhoeals

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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

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16
Q

presentation of coeliacs

A
  • abdominal pain, bloating, diarrhoea
  • weight loss
  • anaemia, vitamin deficient
  • dermatitis herpetiformis (vesicular rash)
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17
Q

diagnosis of coeliacs

A

IgA anti-tissue transglutaminase test (tTGA)

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18
Q

management of coeliacs

A

gluten-free diet to reverse villus atrophy

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19
Q

define lactose intolerance

A

this is a deficiency in the enzyme lactase leading to an inability to digest lactose correctly

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20
Q

presentation of lactose intolerance

A

abdominal pain, bloating, diarrhoea

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21
Q

diagnosis of lactose intolerance

A

hydrogen breath test

oral lactose tolerance test

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22
Q

management of lactose intolerance

A

lactose free diet

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23
Q

define intestinal failure

A

this is an inability of the intestines to maintain adequate nutrition and fluid status

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24
Q

presentation of intestinal failure

A

lack of energy
anaemia
vitamin deficiencies (glossitis for folate, B12 and iron)

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25
Q

management of intestinal failure

A
  • nutrition
  • PPIs
  • octreotide (palliation)
  • transplant for type 3
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26
Q

three types of small bowel cancer

A
  1. lymphomas (non-hodgkins T cells) and maltomas (B cells)
  2. carcinoid tumour (yellow, slow-growing, hormones)
  3. carcinomas (coeliacs and UC)
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27
Q

define Meckel’s diverticulum

A

this is a small bulge in the small intestine due to incomplete regression of the vietello-intestinal duct

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28
Q

presentation of Meckel’s diverticulum

A
  • before 2 years

- mimics appendicitis

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29
Q

diagnosis of Meckel’s diverticulum

A

colonoscopy

CT

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30
Q

management of Meckel’s diverticulum

A

resection

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31
Q

define appendicitis

A

inflammation of the appendix

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32
Q

presentation of an appendicitis

A
  • central pain that migrates to RIF (McBurnery’s point- worse on coughing)
  • nausea and vomiting
  • children won’t eat or sleep
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33
Q

diagnosis of appendicitis

A

USS in women and children
bloods (increased WCC)
Alvarado score
CT

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34
Q

management of appendicitis

A

appendicectomy

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35
Q

how are carcinoids of the appendix diagnosed?

A

chromagrannin stain

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36
Q

define ischaemia of the small bowel

A

lack of blood supply to the small bowel which leads to infarction. It can be occlusive or non-occlusive (damage on reperfusion)

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37
Q

presentation of ischaemia of the small bowel

A

sudden abdominal pain
bowel movements
abdominal tenderness and distension

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38
Q

diagnosis of ischaemia of the small bowel

A

angiography

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39
Q

define a hernia

A

abnormal protrusion of the cavity’s contents through a weakness in the wall of the cavity, can be reducible, incarcerate or strangulated

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40
Q

presentation of hernia

A

lump
sudden onset pain
vomiting

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41
Q

presentation of a small bowel obstruction

A

colicky pain
absolute constipation
vomiting with copious bile-stained fluid
distension

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42
Q

diagnosis of a small bowel obstruction

A

tinkling bowel sounds
AXR
CT contrast
gastrograffin studies

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43
Q

management of a small bowel obstruction

A
  • NG tube

fluids

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44
Q

define peritonitis

A

infection of ascites

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45
Q

who can peritonitis be fatal in?

A

elderly
immunosuppressed
diabetics
those without an momentum (previous surgery)

46
Q

presentation of peritonitis

A

foetal position, shallow respiration

guarding

47
Q

diagnosis of peritonitis

A

FBC

ascites fluid aspiration

48
Q

management of perionitis

A

amoxicillin + gentamicin + metronidazole

49
Q

define mesenteric ischaemia

A

lack of blood supply to the mesentery causing infarction

50
Q

presentation of mesenteric ischaemia

A

pain out of proportion with examination

51
Q

diagnosis of mesenteric ischaemia

A

acidotic ABGs
elevated lactase
CT
angiography

52
Q

management of mesenteric ischaemia

A

thrombolytics
resuscitation
endovascular repair (stenting)

53
Q

define diverticular disease

A

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
Q

presentation of diverticular disease

A

LIF pain/tenderness

altered bowel habit

55
Q

diagnosis of diverticular disease

A

bloods
sigmoidoscopy
Hinchey classification

56
Q

management of diverticular disease

A
  • antibiotics
  • if complicated Hartmann procedure (rectosigmoid colon removed and left with colostomy)
  • diet modification
57
Q

define colitis

A

inflammation of the inner lining of the colon

58
Q

different types of colitis

A

Crohns
UC
ischaemic
infective

59
Q

diagnosis of ischaemic colitis

A

thumb printing on AXR at the splenic flexure

60
Q

define colonic angiodysplasia

A

vascular malformations in the colon

61
Q

presentation of colonic angiodysplasia

A

submucosal lakes of blood, PR bleeding

62
Q

diagnosis of colonic angiodysplasia

A

angiography

colonscopy

63
Q

management of colonic angiodysplasia

A

embolisation
endoscopic ablation
surgical resection

64
Q

presentation of a large bowel obstruction

A
  • 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
Q

what does tenderness of an obstruction indicate?

A

strangulation

66
Q

what does an incomplete bowel obstruction cause?

A

hypertrophy of the bowel wall

67
Q

causes of dynamic bowel obstruction

A

paralytic ileus

pseudo-obstruction (Oglivie’s syndrome)

68
Q

define pseudo-obstruction

A

no mechanical obstruction (elderly and debilitated)

69
Q

diagnosis of large bowel obstruction

A
  • supine AXR

- tinkling bowel sounds

70
Q

management of large bowel obstruction

A
  • replace fluids and electrolytes
  • NG tube to decompress stomach
  • stenting and surgery
71
Q

define volvulus

A

the intestine and mesentery twists resulting in an obstruction

72
Q

presentation of volvulus

A

fever
tenderness
constipation
vomiting

73
Q

diagnosis of volvulus

A

AXR and rectal contrast

  • coffee-bean = sigmoid volvulus
  • haustra maintained= caecal volvulus
74
Q

management of volvulus

A 
surgery resection (Ladd procedure)
flatus tube
75
Q

two functional bowel disorders

A
  1. constipation
  2. faecal impaction
    presents with malaise from prolonged distension
76
Q

management of functional bowel disorders

A

laxatives
enemas
manual evacuation

77
Q

management of diarrhoea

A

anti-infectives
antidiarrhoeals
rehydration
replace potassium lost

78
Q

classification of colorectal carcinoma

A
  • polyps
  • adenomas (pre-malignant)
  • adenocarcinomas
79
Q

two hereditary colorectal carcinomas

A
  1. HNPCC/Lynch syndrome

2. FAP

80
Q

describe Lynch syndrome

A

this is less polyps than FAP, AD, right sided, mucinous tumours with Crohn’s-like inflammatory response

81
Q

describe FAP

A

more than 100 polyps, AD, left sided, defect in tumour suppressor and no inflammatory response

82
Q

right-sided tumour presentation

A 
anaemia
persistent tiredness
change in bowel habit
weight loss
colicky pain 
lump
83
Q

left-sided tumour presentation

A

PR bleeding
altered bowel habit
tenesmus
constipation

84
Q

diagnosis of colorectal carcinoma

A 
bowel screening (faecal antigen test)
CEA tumour marker
SOPD, endoscopy, sigmoidoscopy or CT colongraphy
85
Q

bowel prep for?

A

CT colonography with picolax and omnipaque

86
Q

management of colorectal carcinoma

A

palliation e.g. stenting with chemo/radio

surgery e.g. right hemicolectomy

87
Q

what should be screened for before using infliximab?

A

TB

88
Q

UC inducing remission mild/ moderate

A

aminosalicylates

corticosteroids (pred)

89
Q

UC inducing remission severe

A 
IV corticosteroids (hydrocortisone)
IV ciclosporin
90
Q

UC maintaining remission

A
  1. aminosalicylate
  2. azathioprine
  3. mercaptopurine
91
Q

which laxative to avoid in IBS?

A

lactulose as causes bloating

92
Q

what needs to be tested for in Coeliac’s?

A

IgA deficiency

T1DM

93
Q

what is mesenteric adenitis?

A

inflamed abdominal lymph nodes

94
Q

presentation of mesenteric adenitis

A

abdominal pain

95
Q

what is mesenteric adenitis associated with?

A

tonsilitis

URTI

96
Q

causes of small bowel obstruction

A 
intussusception
adhesions
incarcerated hernia
Meckel's diverticulum
strictures
tumours
gall stone ileus
foreign body
congenital atresia
97
Q

how does gallstone ileus come about?

A

fistula causes stone to get through and cause an obstruction

98
Q

what is a paralytic ileus?

A

temporary impairment of peristalsis in the absence of mechanical obstruction

99
Q

what is mesenteric ischaemia?

A

lack of blood supply to the mesentery through mesenteric vessels resulting in intestinal ischaemia and can lead to infarction

100
Q

vessels involved usually in mesenteric ischaemia

A

SMV
SMA
non-occlusive

101
Q

key RF for mesenteric ischaemia

A

AF

102
Q

what is chronic mesenteric ischaemia?

A

intestinal angina - low flow states due to atherosclerosis

103
Q

chronic mesenteric ischaemia triad

A
  1. central colicky abdominal pain after eating
  2. weight loss due to food avoidance
  3. abdominal bruit
104
Q

why are diverticula not in the rectum?

A

it only has longitudinal muscle and these are circular muscle

105
Q

diagnosis of mesenteric ischaemia

A

CT angiography or MR angiography

106
Q

management of mesenteric ischaemia

A 
angioplasty
stent insertion
statins
antiplatelets
RF reduction
107
Q

causes of large bowel obstruction

A 
cancer
stricture
volvulus
adhesions
hernia
bolus obstruction
faecal impaction
Hirschsprung's
meconium ileus
rectal atresia
intussusception
108
Q

what does an incomplete obstruction cause?

A

hypertrophy of the bowel wall

109
Q

special reasons for a stool culture in diarrhoea

A 
food poisoning outbreak
travel
recent antibiotic use
rectal intercourse
immunocompromised
raw seafood
110
Q

presentation of steatorrhoea

A

shiny
malodourous
hard to flush

111
Q

stain for fat in poo

A

sudan stain

112
Q

what is Hirschsprung’s?

A

explosive passage of stool following PR exam due to nerves in the colon not forming properly
needs biopsy

GI: Key Information (24 decks)

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