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Y1 - Gatrointestinal > Structural Lower GI > Flashcards

Structural Lower GI Flashcards

1
Q

What is diverticulosis?

A

The presence of diverticula

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2
Q

What is diverticular disease?

A

Diverticular which are symptomatic

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3
Q

What is diverticulitis?

A

Inflammation of a diverticulum

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4
Q

Why does a low fibre diet lead to diverticular disease?

A

The colon works harder to move faeces.
This increases the pressure in the lumen
Diverticula form as the mucosa herniates through the muscle layer to form an outpouching

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5
Q

Where are diverticula most common?

A

Sigmoid colon

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6
Q

Who tend to present with diverticular disease?

A

Those with a western lifestyle - processed foods with low fibre diet
Older patients

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7
Q

What are the signs and symptoms of diverticular disease?

A

Change to normal bowel habit

Left iliac fossa colic

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8
Q

What are the signs and symptoms of diverticulitis?

A

Severe pain in LIF
Fever
Tachycardia
Tenderness and guarding of the left side of the abdomen on examination

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9
Q

What investigations can discover diverticula?

A

Colonoscopy or sigmoidoscopy

Barium enema

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10
Q

What investigations can help diagnose diverticulosis?

A

Increased ESR/CRP

CT is investigation of choice

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11
Q

What are the complications of diverticular disease?

A

Perforation
Haemorrhage
Fistula
Stricture

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12
Q

What can a perforation of a diverticulum cause?

A

Peritonitis

Abscess

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13
Q

What is the classification system for acute diverticulitis?

A

Hinchey classification

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14
Q

What are the four stages of the Hinchey classification of acute diverticulitis?

A
  1. Pericolic abscess
  2. Pelvic abscess
  3. Purulent peritonitis
  4. Faecal peritonitis
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15
Q

What is the treatment of diverticular disease?

A

Balanced diet with enough fibre

Analgesia and possibly bulking laxative for symptoms

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16
Q

What is done for uncomplicated diverticulitis?

A

Watchful waiting
Analgesia if necessary
Antibiotics if suspected infection
IV fluids, IV antibiotics, bowel rest

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17
Q

What is done for complicated diverticulitis?

A

Percutaneous drainage of large abscess
Laparoscopic peritoneal lavage and drainage
Hartmann’s procedure
Primary resection

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18
Q

What is Hartmann’s procedure?

A

Remove the sigmoid colon and use a colostomy

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19
Q

What are the types of colonic polyps?

A

Adenoma
Serrated
Inflammatory
Hamartomatous

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20
Q

What are the most common colonic polyps?

A

Adenomas

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21
Q

When do inflammatory polyps occur?

A

IBD

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22
Q

When fo hamartomatous polyps occur?

A

Peutz-Jeghers syndrome

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23
Q

Which mutation causes familial adenomatous polyposis?

A

Mutation in the APC tumour suppressor gene

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24
Q

What is the % risk of colon cancer for patients with FAP?

A

Almost 100%

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25
Q

Describe the polyps Lynch syndrome causes?

A

Adenomas
Right-sided
Not always colonic, can be gastric, endometrial

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26
Q

Which mutation causes Lynch syndrome?

A

DNA mismatch

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27
Q

What are the characteristics of Peutz-Jeghers syndrome?

A

Hyperpigmentation

Hamartomatous polyps

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28
Q

What are the risk factors for colonic polyps?

A

Patients with inherited conditions
IBD
Smoking and alcohol
Older age

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29
Q

What are the symptoms of colonic polyps?

A

Usually asymptomatic
Rectal bleeding causing anaemia
Mucus in stool
Diarrhoea and constipation

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30
Q

What investigations can help diagnose colonic polyps?

A

Family history
Genetic testing
Colonoscopy
Biopsy

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31
Q

Which patients with colonic polyps are at risk of colonic cancer?

A

FAP
Lynch syndrome
People who have had adenomatous polyps removed before
People who have had IBD for 10+ years

32
Q

What treatment is done for colonic polyps?

A

Screening
Adenomas are removed
FAP required prophylactic surgery in addition to screening

33
Q

What is a hernia?

A

Protrusion of an organ or tissue out of the body cavity it is supposed to be in

34
Q

What are the causes of hernias?

A

Structural weakness and increased pressure

35
Q

What can cause structural weakness leading to hernia?

A

Normal anatomical weakness
Congenital abnormality resulting in a weakness
Surgical scar

36
Q

What can cause increased pressure leading to hernia?

A

Strenuous activity
Chronic cough
Pregnancy
Straining bowel movements or urination

37
Q

What is a reducible hernia?

A

One that can be pushed back into the abdomen

38
Q

What is an irreducible hernia?

A

One that cannot be pushed back into the abdomen

39
Q

What is an incarcerated hernia?

A

One where the contents of the hernia are stuck inside it by adhesions and can’t be reduced

40
Q

What is an obstructed hernia?

A

Hernia causes bowel obstruction and bowel contents are unable to pass
Blood supply is still viable
Can progress to strangulation

41
Q

What is a strangulated hernia?

A

Vascular supply to the contents of the hernia is compromised, ischaemia occurs and surgery is needed

42
Q

What are the signs and symptoms of hernias?

A

Swelling an a particular location
May be reducible
May protrude on coughing or standing
Pain and tenderness at the site of the hernia in strangulation

43
Q

What investigations are done for hernias?

A

Examination of the swelling

Ultrasound scan sometimes

44
Q

What are the possible complications of hernias?

A

Hernia becomes irreducible
Incarceration
Strangulation
Obstruction

45
Q

What are the types of hernia?

A 
Hiatus
Epigastric
Umbilical
Paraumbilical
Spigelian
Inguinal
Femoral
Parastomal
Lumbar
Incisional
46
Q

What is an inguinal hernia?

A

Part of the abdominal contents protrudes through the inguinal canal

47
Q

What is a direct inguinal hernia?

A

The bowel herniates through a weakness in the floor of the inguinal canal and through Hasselback’s triangle to come out of the superficial ring
Reappears after reduction

48
Q

What is an indirect inguinal hernia?

A

Bowel herniates though the deep inguinal ring and out the superficial ring
Doesn’t reappear after reduction

49
Q

What is a hiatus hernia?

A

The herniation of the stomach through the diaphragm

50
Q

How does a hiatus hernia present?

A

Reflux die to reduced efficiency of the LOS which can lead to GORD

51
Q

What is the treatment for hernia?

A

Conservative or surgical dependent on type and presence of complications

52
Q

What is the treatment for hiatus hernia?

A

Conservative (lose weight, treat GORD) or surgical if symptoms persist

53
Q

What is a sliding hiatus hernia?

A

Gastro-oesophageal junction and part of the stomach slides up into the chest

54
Q

What is a para-oesophageal hernia?

A

Part of the stomach herniates up into the chest alongside the oesophagus

55
Q

What is an epigastric hernia?

A

Bowel herniates though a fascial defect in the lineament alba in the epigastric region of the abdomen
Usually symptomatic but can be painful

56
Q

What is a spigelian hernia?

A

Bowel herniates though the spigelian fascia

Looks like a lump below and lateral to the umbilicus

57
Q

What is a femoral hernia?

A

Bowel herniates though the femoral canal

Looks like a lump in the upper medial thigh that points down towards the leg

58
Q

Which hernias always require surgical treatment?

A 
Spigelian
Femoral
Lumbar
Incisional
Para-stomal
Para-umbilical
59
Q

What is a lumbar hernia?

A

Bowel herniates through the lumbar triangles

Looks like a lump in the back

60
Q

What is an incisional hernia?

A

Hernia post-surgery

Looks like a pump along the line of previous incision

61
Q

What is a para-stomal hernia?

A

Hernia through the abdominal wall defect created when a stoma is formed

62
Q

What is a para-umbilical hernia?

A

Bowel herniates through an acquired weakness of the abdominal wall around the umbilicus
Looks like a lump at/near the umbilicus
Often painful

63
Q

What are the risk factors for para-umbilical hernia?

A

Obesity
Ascites
Multiple pregnancies

64
Q

What is an umbilical hernia?

A

Bowel herniates due to congenital weakness from the persistence of an abdominal wall defect at the site of the umbilicus
Looks like a lump at the umbilicus
Usually resolve but may need treated

65
Q

Which hernia requires surgery because of the high incidence of incarceration and strangulation?

A

Para-umbilical

66
Q

Which inguinal hernia passes through the deep ring and which through the superficial ring?

A

Indirect hernias pass through the deep ring and the superficial ring
Direct hernias pass through Hasslebach’s triangle instead of the deep ring and pass through the superficial ring

67
Q

What are the types of inguinal hernia’s relationships to the inferior epigastric artery?

A

Direct - medial

Indirect - lateral

68
Q

What are the types of inguinal hernia’s relationships to the spermatic cord?

A

Direct - parallel

Indirect - within

69
Q

What is a haemorrhoid?

A

Enlargement of vascular cushions (rectal venous plexuses) in the wall of the anus and rectum due to increased pressure

70
Q

What are the signs and symptoms of haemorrhoids?

A

Painless bright red bleeding PR
Perianal itch
No change in bowel habit or weight

71
Q

What investigations are done for haemorrhoids?

A

PR exam
Proctoscopy
Rigid sigmoidoscopy
Flexible sigmoidoscopy to rule out malignancy

72
Q

What is the possible complication of haemorrhoids?

A

Can become strangulated and cause pain

73
Q

What is the conservative therapy for haemorrhoids?

A

Increased fluid and fibre to prevent constipation, with bulking laxatives and analgesia if necessary
Anal hygiene to aid healing

74
Q

What are the non-surgical therapy for haemorrhoids?

A

Sclerosation therapy

Rubber band ligation

75
Q

What are the surgical therapies for haemorrhoids?

A

Haemorrhoidectomy
Stapled haemorrhoidectomy
HALO/THD procedure to cut off blood supply

76
Q

What are rectal varies due to?

A

Portal hypertension

77
Q

What do rectal varies present with?

A

PR bleeding

Y1 - Gatrointestinal (31 decks)

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