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Year 1 - Gastrointestinal (DP) > The Colon > Flashcards

The Colon Flashcards

0
Q

What is a sigmoid volvulus?

A

Sigmoid colon twisting around itself

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1
Q

What are haustra?

A

Visible tonic contractions of teniae coli

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2
Q

What are the branches of the sup. mesenteric artery?

A 
Jejunal and ileal arteries
Inf. pancreaticoduodenal a.
Middle colic a.
Right colic a.
Ileocolic a.
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3
Q

What are the branches of the inf. mesenteric artery?

A

Left colic a.
Sigmoid arteries
Sup. rectal a.

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4
Q

What is the main anastomosis prevent bowel ischaemia?

A

Marginal artery (of Drummond)

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5
Q

What is the blood supply of the distal half of the anal canal?

A

Middle rectal a. (Branch of internal iliac a.)

Inf. rectal a. (Branch of pudendal a.)

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6
Q

Clinical presentation of portal hypertension?

A

Caput medusae - dilated collateral epigastric veins

Oesophageal/Rectal varices

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7
Q

What is the vertebral level of the pelvic cavity?

A

L5

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8
Q

What is the levator ani?

A

Pelvic floor muscle

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9
Q

At what vertebral level does the sigmoid colon become the rectum?

A

S3

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10
Q

When does the anal canal start?

A

Anterior to the tip of the coccyx

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11
Q

Where does the rectal ampulla lie?

A

Immediately sup. to levator ani

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12
Q

What is the role of the levator ani muscle?

A

Supports pelvic organs

  • Tonic contractions prevent prolapse
  • Increased contractions during coughing/sneezing
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13
Q

What is the levator ani supplied by?

A

Nerve to levator ani

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14
Q

What is the puborectalis muscle?

A

A muscle wrapped around anal canal

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15
Q

What is the nerve supply to the rectum and anal canal?

A 
SNS
- T12-L2
- Synapse at inf. mesenteric ganglia - periarterial plexuses
PNS
- S2-S4
- Via pelvic splanchnic nerves
Visceral afferents
- Enter at S2-S4
- Run along PNS fibres
Somatic motor
- Leave in pudendal nerve (S2-S4)
- Also in levator ani nerve (S3 and S4)
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16
Q

What makes diverticular disease complicated?

A 
Inflammation
Rupture
Abscess
Fistula
Massive bleed
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17
Q

What is diverticular disease related to?

A

Low fibre diet

High intralumenal pressure

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18
Q

Symptoms of colitis?

A 
Diarrhoea (+/- blood)
Abdo cramping
Dehydration
Sepsis
Weight loss
Anaemia
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19
Q

Clinical features of small bowel ischaemia and infarction

A

Severe, poorly localised pain
Elderly
Arteriopaths

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20
Q

What is the Rome III criteria for IBS?

A

Recurrent abdo pain/discomfort for >3 days per month for 3 months and two or more of the following:

  • Improvement on defecation
  • Onset associated with change in stool frequency
  • Onset associated with change in stool form
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21
Q

What symptoms are present in IBS?

A 
Bloating
Urgency
Tenesmus
PR mucus
Nocturia
Stress aggravation
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22
Q

Treatment of IBS

A

Regular meal times
Decreased fibre intake
Plenty of fluids (but not caffeine)
Try 4 weeks of probiotics

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23
Q

Common causes of small bowel obstruction

A

Adhesions
Hernias
Malignancy

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24
Q

What are the non-infectious causes of diarrhoea?

A 
GI bleed
Ischaemia
Diverticulitis
Endocrine disorder
Drugs
Toxins (fish)
Withdrawal
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25
Q

Infectious causes of bloody diarrhoea?

A

Campylobacter
Shigella
E. coli 0157
Amoebiasis

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26
Q

Treatment of campylobacter infection?

A

Clarithromycin

Azithromycin

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27
Q

Key features in the examination of infectious diarrhoea

A 
Fever
Rashes
Dehydration
- Pulse
- Mental state
- BP
Abdo tenderness
PR exam
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28
Q

What two causative agents is stool microscopy used to diagnose for?

A

Giardia

Amoeba

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29
Q

What organisms does stool culture test for in blood diarrhoea?

A

Salmonella
Campylobacter
Shigella

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30
Q

How do we test for E. coli and C. diff?

A

Stool toxins

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31
Q

How do we test for norovirus?

A

PCR

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32
Q

How is the severity of a C. diff infection calculated?

A

One or more of:

  • Pseudomembranous colitis/toxic megacolon/ileus/colonic dilation >6cm
  • WCC >15cells/mm3
  • Creatinine > 1.5xbaseline
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33
Q

Risk factors for a C. diff infection?

A

Antibiotics
PPIs/H2RAs
Age >65
Chemo/Renal disease/IBD

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34
Q

Therapy for Pseudomembranous colitis

A 
Metronidazole (non-severe)
PO vancomycin (if severe)
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35
Q

Clinical features of UC?

A 
Bloody diarrhoea
Urgency
Tenesmus
Incontinence
LIF pain
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36
Q

How do we assess UC?

A 
CRP
Albumin
AXR
Endoscopy
Histology
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37
Q

What signs of UC can be seen on an AXR?

A

No stool distribution
Thumb printing (mucosal oedema)
Toxic megacolon

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38
Q

What are the extra intestinal manifestations of UC?

A 
Arthritis
Uveitis
Deranged LFTs
Primary sclerosing cholangitis
- Itch
- Rigors
39
Q

Symptoms of CD?

A 
Cramps
Diarrhoea
Wgt loss
Mouth
- Painful ulcers
- Swollen lips
- Angular stomatitis
40
Q

How do we asses CD?

A 
Clinical exam
- Wgt loss
- RIF mass
- PR signs
Bloods
- CRP
- Albumin
- Platelets
- Vitamin B12
- Ferritin
41
Q

Drug therapy for UC?

A

5ASA (Mesalazine)
Steroids
Immunosuppressants
Anti-TNF

42
Q

Drug therapy for CD?

A

Steroids
Immunosuppressants
Anti-TNF

43
Q

What are the side effects of 5ASA?

A

Diarrhoea

Idiosyncratic nephritis

44
Q

Side effects of Azathioprine?

A

Pancreatitis
Leukopaenia
Hepatitis
Lymphoma

45
Q

What are the types and examples of Anti-TNF drugs?

A

Chimeric
- Infliximab (IV infusion)
Humanised
- Adalimumab (SC injection)

46
Q

When is Anti-TNF therapy recommended?

A 
If long term immunosuppression is needed:
- Surgery
- Support
In refractory or fistulating disease
If a current infection is excluded
47
Q

What do I cells secrete and where do they secrete it?

A

CCK

Duodenum and jejunum

48
Q

What do S cells secrete and where do they secrete it?

A

Secretin

Duodenum

49
Q

What do M cells secrete and where do they secrete it?

A

Motilin

Duodenum and jejunum

50
Q

What do K cells secrete and where do they secrete it?

A

Glucagon-like insulinotropic peptide

Duodenum and jejunum

51
Q

What do L cells secrete and where do they secrete it?

A

Glucagon-like peptide 1

52
Q

What is the migrating motor complex and what affects it?

A 
Peristalsis between meals
Inhibited by
- Feeding
- Vagal tone
Triggered by
- Motilin
Suppressed by
- Gastrin
- CCK
53
Q

What surgical operations can be carried out for Crohn’s disease?

A

Resection

Stricturoplasty

54
Q

What operations can be carried out in UC?

A

Protocolectomy +

  • End ileostomy
  • Ileorectal anastomosis
55
Q

Features of a colostomy

A

Usually left
Usually flush
Stool

56
Q

Features of an ileostomy

A

Usually right
Usually sprouted
Usually effluent

57
Q

Surgeries available for colonic Cancer?

A 
Right hemicolectomy
Transverse colectomy
Left hemicolectomy
Sigmoid colectomy
Subtotal colectomy
58
Q

What are the available surgeries for rectal Cancer?

A

Abdominal-perineal excision of the rectum (APER)

Anterior resection

59
Q

What is the commonest cause of food poisoning?

A

Campylobacter

60
Q

How is a campylobacter infection treated?

A

Ciprofloxacin

Erythromycin

61
Q

How is salmonella typed?

A

Via O-antigens and slide agglutination

62
Q

How is salmonella food poisoning treated?

A

Ciprofloxacin

63
Q

What can cause haemolytic ureamic syndrome?

A

E. coli 0157

64
Q

Presentation of HUS?

A 
Symptoms
- Abdo pain
- Fever
- Pallor
- Petechiae
- Oliguria
Signs
- High WCC
- High urea
- Low platelets
- Low Hb
65
Q

What causes enteric Fever?

A

Salmonella typhi

Salmonella paratyphi

66
Q

What conditions result in both Fever and jaundice?

A 
Pre-hepatic:
- Malaria
- HUS
- Sickle cell crisis
Intra-hepatic:
- Hep A and E
- Leptospirosis - Weils diseases
- Malaria
- Enteric Fever
- Typhus
- Viral haemorrhagic Fever
Post-hepatic:
- Ascending cholangitis
- Helminths
67
Q

What is Chagas’ disease?

A

Trypanasoma cruzi infection
Results in PNS denervation of
- Colon
- Oesophagus

68
Q

What is the causative organism of rectal gonorrhoea?

A

Neisseria gonorrhoea

69
Q

Treatment of rectal gonorrhoea?

A

Cephalosporin
Chlamydia treatment
STI screen

70
Q

What is the cause of rectal chlamydia?

A

Chlamydia trachomatis

71
Q

Which is milder, rectal gonorrhoea or chlamydia?

A

Chlamydia

72
Q

How do we treat rectal chlamydia?

A

Azithromycin

Doxycycline

73
Q

What is telangiectasia visible in?

A

Radiation colitis

74
Q

What is the histological appearance of Crohn’s disease?

A

Patchy and segmented
Transmural (entire thickness)
Non-caseating granulomas

75
Q

What is the histological appearance of Ulcerative Colitis?

A 
Diffuse
Crypt branching
Irregular crypts
Cryptitis
Massive inflammatory cell influx
76
Q

True or false. Crohn’s disease can cause toxic megacolon (acute fulminant colitis).

A

False. UC can cause toxic megacolon

77
Q

What is the initial treatment of diverticulitis?

A

IV fluids
Rest
IV antibiotics

78
Q

Which of a proximal or distal small bowel obstruction causes distension?

A

Distal

79
Q

How do we diagnose meckels diverticulum?

A

Technicium Tc 99m scan (detects ectopic gastric mucosa)

80
Q

What is the empirical treatment for diarrhoea and at least one other symptom?

A

Ciprofloxacin 500mg BD for 3-5 days

81
Q

If rapid bowel clearing is needed, would a bulk or osmotic laxative be used?

A

Osmotic

82
Q

What type of laxative is methylcellulose?

A

A bulk laxative

83
Q

Examples of osmotic laxatives?

A

Lactulose
Sorbitol
Glycerin (Sodium Stearate) suppositories

84
Q

Examples of stimulant purgatives?

A

Bisacodyl
Senna
Sodium picasulfate

85
Q

What is oral dorcusate sodium?

A

Faecal softener

86
Q

What are some mechanisms of sodium reabsorption?

A 
Sodium/Glucose co-transport
Sodium/Amino acid co-transport
Sodium/H+ exchange
Parallel Sodium/H+ and Chloride/Bicarbonate exchange
Epithelial sodium channels (ENaC)
87
Q

Are sodium co-transporters regulated by cAMP or calcium ions?

A

Nope

88
Q

What effect does aldosterone have on epithelial sodium channels?

A

Increased rate

89
Q

Which is greater, chloride secretion or chloride absorption?

A

Absorption

90
Q

What is the role of CFTR?

A

Chloride conductance - secretory diarrhoea

91
Q

What bacterial infection causes secretory diarrhoea and how?

A

Cholera
Toxin inhibits GTPase resulting in increased cAMP and CFTR stimulation.
Chloride hypersecretion

92
Q

What is rigler’s sign?

A

Gas outside of the bowel wall in toxic megacolon

93
Q

What bacteria have short (1-6hr) incubation periods?

A

Staph aureus

Bacillus cereus

94
Q

What bacteria have 12-48hr incubation times (medium)?

A

Salmonella

Clostridium perfringens

95
Q

How long is the incubation period for Campylobacter and E. coli 0157?

A

2-14 days

96
Q

What is the incubation period of enteric Fever?

A

7-18 days

Year 1 - Gastrointestinal (DP) (8 decks)

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