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CP3 SURGERY > UGI/CR - Colon part 2 > Flashcards

UGI/CR - Colon part 2 Flashcards

1
Q

Def Diverticulosis

A

Presence of diverticula

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2
Q

Def Diverticulitis

A

Inflammation of the diverticula

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3
Q

Def Diverticular disease

A

Symptomatic diverticula

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4
Q

What % people over 50 have diverticula

A

50%

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5
Q

Which part of the bowel are 95% diverticula

A

sigmoid

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6
Q

Most common cause diverticula

A

low fibre diet

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7
Q

3 rarer conditions diverticula are associated with

A

Marfans
PKD
Ehlers Danlos

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8
Q

Pathogenesis diverticula

A

hypertrophy of mm propria

Diverticula occur at sites of potential weakness in bowel wall

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9
Q

What is a ‘true’ diverticulum

A

Just mucosa

No muscle covering

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10
Q

Def diverticula

A

Outpouching of mucosa and submucosa that herniate through to colonic mm layers

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11
Q

What % of diverticulae are asymp

A

95%

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12
Q

If diverticulae are symptomatic, what do they mimic

A

Colon cancer

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13
Q

Complications of diverticulae (6)

A 
Bleeding 
Perforation 
Ulceration 
Abscess 
Fistulae
Strictures
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14
Q

Sx of diverticular disease (5)

A 
Sudden painelss bleeding 
Nausea
Flatulence 
Changes in bowel habit 
Left sided colic relieved by defacation
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15
Q

Sx diverticulitis (6)

A 
LIF pain 
Localised peritonism 
Fever 
TachyC
Nausea + vomiting 
Sometimes palpable mass
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16
Q

RF Diverticular disease (4)

A

Low fibre diet
High fat diet
Age
Constipation

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17
Q

Ix diverticular disease (4)

A

PR
Sigmoidoscopy/colonoscopy
Barium enema
CT

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18
Q

When should you be wary of doing a sigmoidoscopy diverticular disease

A

If bowel is inflamed

Due to risk of perforation

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19
Q

Mx diverticular disease

A

Mebeverine

+ laxatives + lifestyle advice

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20
Q

Why does diverticulitis occur?

A

Because of stagnation of contents of diverticula

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21
Q

Mx of mild diverticulitis (3)

A

Bowel rest @ home

PO Co-amoxiclav +/- metronidazole

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22
Q

Mx of severe attack diverticulitis (4)

A 
Admit if pain not controlled 
Analgesia 
IV fl 
IV cefuroxine + metronidazole 
Keep NBM
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23
Q

Ix severe attack diverticulitis (3)

A

CXR
AXR
+ CT contrast
(to assess for complications)

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24
Q

What must you NOT do in an acute diverticulitis attack

A

Scope

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25
Q

Complications of diverticulae (6)

A 
Perforation 
Bleeding 
Stricture 
Abscess
Fistulae 
Intestinal obstruction
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26
Q

What can perforation lead to in acute diverticulitis (3)

A

Paracolic/pelvic abscess
Fistulae
Generalised peritonitis

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27
Q

PS perforation from diverticulitis (3)

A

Ileus
Peritonitis
Shock

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28
Q

Mortality rate perforation from diverticulitis

A

40%

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29
Q

Mx perforation from diverticulitis

A

Laparotomy +/- Hartmanns procedure

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30
Q

PS - abscess from diverticulitis (3)

A

Swinging fever
Leucocytosis
Localised booggy rectal mass

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31
Q

PS - bleed from diverticulitis

A

Sudden painless bleeding

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32
Q

Mx bleed from divertilculitis

A

Stop w/ bed rest
If doesn’t stop - locate w/ angiography + Tx w/ embolisation
+/- adrenaline + diathermy

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33
Q

2 types of fistulae from diverticulitis

A

Colovesical

Colovaginal

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34
Q

PS colovesical fistula

A

UTI + pneumaturia

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35
Q

PS colovaginal fistulae

A

Foul discharge

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36
Q

Where can obstruction occur as a result of repeated eps of diverticulitis

A

Sigmoid colon

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37
Q

Signs + Sx of malabsorption (8)

A 
Diarrhoea/steatorrhoea 
W loss 
Lethargy 
Anaemia 
Bleeding disorders 
Oedema 
Osteomalacia
Neuropathy
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38
Q

3 most common causes of malabsorption (Cs)

A

Coeliac
Crohn’s
Chronic pancreatitis

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39
Q

Rarer causes of malabsorption (3)

A

Reduced bile
Pancreatic insufficiency
Bacterial overgrowth

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40
Q

Ix Malabsoprtion - bloods (12)

A 
FBC
Fe studies 
B12/folate
Ca
Mg
PO4
Lipid profile 
LFT
TFT
inflammatory markers 
Clotting 
Coeliac serology
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41
Q

Ix Malabsoprtion - stool studies (3)

A

MCS
Faecal elastase
Calprotectin

42
Q

Pathology coeliac disease

A

inflammation of jejunum

Alpha gilandin = modified by TTG which activates autoimmune reaction against the mucosa

43
Q

Biopsy findings coeliac (3)

A

Flattened mucosa b/c loss of villi
Hyperplasia of crypts
increased intraepithilial lymphocytes

44
Q

PS coeiliac (10)

A 
1/3 = asymp 
Non specific  IDA, 
W loss
Fatigue 
Apthous ulcers 
Diarrhoea
Abdopain/bloating 
N+V
Dermatitis heraptiformis
45
Q

Ix coeliac (7)

A 
FBC
Clotting 
Bone profile 
EMA
TTG antibodies 
Duodenal biopsy
Done densitometry
46
Q

What is gold standard Ix coeliac

A

Duodenal biopsy

47
Q

WHy do bone densitometry coeliac Ix

A

B/c of increased risk OP

48
Q

Which cancers are people w/ coeliac at a small increased risk of ? (2)

A

Small bowel lymphoma

Adenocarcinoma

49
Q

Most common cause Chronic pancreatitis

A

Increased alcohol intake

50
Q

Pathology chronic pancreatitis

A

Plugging pancreatic ducts –> space for infection/calcification –> ductal HTN –> fibrosis parenchyma + disturbed endocrine fct

51
Q

PS chronic pancreatitis (8)

A 
Epigastric pain radiating to back 
Relieved by sitting forward/hot water bottle 
W loss
Bloating 
Steatorrhoea 
Brittle DM
Obstructive jaundice 
Sx = relapsing + progressively worse
52
Q

Ix chronic pancreatitis (5)

A 
Faecal elastase elevated 
Trypsinogen > 10 = diagnostic 
Signs alcohol abuse 
TA USS
Contrast CT/MRCP = diagnostic
53
Q

What is seen on CT/MRCP chronic pancreatitis

A

Calcification

54
Q

Mx chronic pancreatitis (5)

A 
Analgesia 
Creon (lipase) 
Mutlivite (fat soluble vitamins) 
Monitor glucose 
Tx alcohol abuse 
Low fat diet
55
Q

What is melaena due to?

A

Break down of blood in small intestine for an UGI bleed

56
Q

What % of pt w/ CRC PS w/ mets on diagnosis

A

20%

57
Q

RF CRC (10)

A 
FHx 
Age
Western diet
Obesity 
Physical inactivity 
UC
DM
Smoking 
Alcohol XS
Personal Hx bowel cancer
58
Q

Protective factors CRC (4)

A

Healthy diet
Exercise
HRT
Aspirin/NSAIDs

59
Q

What % of CRC is caused by FAP

A

Familial adenomatous polyposis

<1%

60
Q

Genes assoc w/ CRC (3)

A

FAP
HNPCC
BRCA1

61
Q

Histology CRC

A

Signet ring cells

62
Q

What part of the colon has the highest prevalence for CRC

A

25% sigmoid

63
Q

How many polyps in colon = likely to be malignant

A

> 5

64
Q

Appearance of CRC on colonoscopy

A

Polypoid mass w/ ulceration

65
Q

Spread CRC

A

Direct infiltration through bowel wall

Lymphatics/BV

66
Q

mets of CRC (6)

A 
Liver **
Lung
Bone
Brain
LN 
Ovaries
67
Q

Staging for CRC

A

Dukes

68
Q

Dukes A

A

Tumours invade submucosa +/- mm propria

69
Q

Dukes B

A

Tumours invade past mm propria (no nodal involvement )

70
Q

Dukes C

A

Regional LN involvement (C1 - local)

C2 = apical

71
Q

Dukes D

A

Distant mets

72
Q

What type of cancer are the majority of anal cancers

A

SCC

73
Q

RF anal cancer (4)

A

Anoreceptive sex
Syphillis
Anal warts/HPV
Immunosuppression

74
Q

Which line is v important in anal cance r

A

Pectinate line

75
Q

Pectinate line (dentate)

A

Embryological division between upper 2/3 and lower 1/3 of anal canal

76
Q

Features of anal cancers above pectinate line

A

Columnar epithelium

Lymph drainage to int iliac nodes + portal venous drainage

77
Q

Mets anal ca above pectinate line

A

Hepatic mets

78
Q

Features of anal ca below pectinate line

A

Squamous epithelium
Lymph drainage to superficial inguinal nodes
+ Caval vv drainage

79
Q

Mets anal ca below pectinate line

A

Pulmonary mets

80
Q

Who are anal ca above pectinate line more common in

A

F (+ worse prog)

81
Q

Who are anal ca below pectinate line > common in

A

M ( + better prog)

82
Q

Sx R sided CRC

A

Often asymp
W loss
Lethargy/malaise/non-specfiic

83
Q

Why do R sided CRC PS late

A

Because of large width of R colon

84
Q

Ix results R sided CRc (3)

A

IDA
Low Hb
+ Low MCV

85
Q

Sx L sided CRC (3)

A

Obstruction Sx
Changed in bowel habit
Blood streaked stools

86
Q

Sx Caecal CRC (5)

A 
Anaemia 
Obstruction --> faecalant vom 
Mass 
Dyspepsia
Appendicitis
87
Q

Sx Rectal CRC (5)

A 
Bright red PR bleed
Tenesmus 
Dull pain 
May be able to feel mass on PR
Bladder Sx
88
Q

Sx Anal cancer (5)

A 
Bleeding 
Pain 
Changes to bowel habit 
Pruritis ani 
Mass 
Stricture
89
Q

Indications for 2WW Rx pt >40 CRC (4)

A

Rectal bleed/change bowel habit for >6w
Persisitet rectal bleed >45 w/ no obvious ev benign anal disease
IDA w/o obvious cause
Palpable abdo/PR mass

90
Q

Ix CRC (6)

A 
FBC/LFT
Colonoscopy 
CT chest abdo pelvis (stage) 
EAU + pelvic MRI - rectal CA ONLY
CEA - monitor disease 
FTT test
91
Q

What FTT test result is normal

A

<10

92
Q

indication - right hemicolectomy (3)

A

Caecal tumours
Ascending colon tumours
proximal transverse colon tumours

93
Q

indication - left hemicolectomy

A

Distal transverse/descending colon tumours

94
Q

indications - sigmoid colectomy

A

Sigmoid tumours

95
Q

indications - anterior resection (2)

A

Low sigmoid tumours

High rectal tumours

96
Q

indication - AP resection

A

Tumours low in rectum

97
Q

Indication - Hartmanns procedure (2)

A

Bowel obstruction

Palliation

98
Q

Use of radiotherapy in rectal cancer

A

Pre-op to shrink tumour

99
Q

When to use radiotherapy post op (CRC)

A

If high risk local recurrence

100
Q

When is chemotherapy used in CRC

A

To reduce mortality of high stage tumours/palliation

101
Q

Tx of anal carcinoma (3)

A

Radiotherapy
5FU
Cisplatin chemo

102
Q

What % of pt post anal carcinoma Tx retain normal anal fct

A

75%

CP3 SURGERY (19 decks)

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