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CP3 SURGERY > UGI/CR - The Colon > Flashcards

UGI/CR - The Colon Flashcards

1
Q

CAuse of Meckels diverticulum

A

Remnant of embryological vitellointestinal duct

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2
Q

RUle of 2’s Meckel’s

A

2% pop
2% develop Sx
2cm long
20 inches from ileocecal valve

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3
Q

PS Meckels diverticulum

A

Usually asymp or can mimic other conditions

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4
Q

What other conditions can Meckels mimic? (4)

A

Caecal volvulus
Intussusception
Appendicits
Peptic ulceration

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5
Q

Why can Meckels mimic a caecal volvulus

A

Because if tethered to umbilicus, diverticulum may act as apex of volvulus

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6
Q

Why can Meckels mimic peptic ulceration

A

Ulceration of gastric acid secreting epithelium

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7
Q

Ix Meckels

A

Technetium scan

CT

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8
Q

Def of IBS

A

12 months previously, at least 12 consecutive weeks of abdo pain/discomfort w/ 2-3 of:
Relieved by defacation
Onset assoc w/ change freq stool
Assoc w/ change form of stool

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9
Q

Other Sx IBS

A 
Bloating 
Passage mucus 
Stool passage Sx
Gynae Sx
Urinary Sx
back pain
Headaches
Bad breath 
Poor sleep 
fatigue
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10
Q

Stool passage Sx assoc w/ IBS (2)

A

Tenesmus

Feeling of incomplete evacuation

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11
Q

Gynae Sx assoc w/ IBS (3)

A

Dysmenorrhoea
Dysparenuia
Premenstrual tension

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12
Q

Urinary Sx assoc w/ IBS (3)

A

Frequency
Urgency
Nocturia

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13
Q

Prevalnce IBS

A

10-20%

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14
Q

M:F IBS

A

1:2

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15
Q

Factors triggering onset IBS (7)

A 
Affecting disorders 
Psychological stress + trauma 
GI infection 
ABx 
Sexual/physical/verbal abuse 
Pelvic surgery 
Eating disorders
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16
Q

Ix IBS (3)

A

Hx - ensure no red flag Sx
O/E - anaemia/masses
Ix to rule out coeliac (CRP/ESR, foecal calprotectin) (TTG/anti-endomysial), (FBC)

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17
Q

Success rate IBS Mx

A

50%

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18
Q

Mx IBS

A 
Advice - exercise/relaxation/diet
Can try low FODMAP diet 
Antispasmodics 
Laxatives  avoid constipation 
Antimotility Dx
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19
Q

What is 1st line antispasmodic for Mx IBS

A

Mebeverine

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20
Q

Which laxative should not be used in Mx of IBS and why

A

Lactulose

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21
Q

1st line antimotility Dx IBS

A

Loperamide

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22
Q

2nd line Mx IBS

A

TCA once nightly

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23
Q

3rd line Mx IBS

A

SSRIs

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24
Q

Def Refractory IBS + Mx

A

Sx persisting after 12 months of anti-depressant meds - Rx to CBT

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25
Q

M:F Chrons

A

=

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26
Q

RF chrons (4)

A

Poor diet
FHx
Smoking
Altered immune state

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27
Q

WHere in the GIT is Chron’s most common (2)

A

Terminal ileum

Ascending colon

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28
Q

Chrons appearance XR

A

Rose thorn ulcers

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29
Q

Chrons appearance CT

A

Cobblestone appearance

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30
Q

Which layers of the bowel are affected in chrons

A

ALl layers

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31
Q

Clinical features Chrons (6)

A 
Abdo pain 
Diarrhoea 
W loss 
Severe aphthous ulcers mouth 
Anal complications 
Extra GI manifestations
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32
Q

Peak ages UC

A

15-30

60

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33
Q

Which RF for Chrons is protective in UC?

A

Smoking

34
Q

Pathology UC

A

Inflammation starts in rectum and ascends into colon

35
Q

What is UC called if in rectum alone

A

Proctitis

36
Q

What layers of the bowel does UC affect

A

Mucosa only

37
Q

PS UC (3)

A

Crampy lower abdo discomfort
Gradual onset diarrhoea (bloody)
Extra GI Sx

38
Q

XR appearance UC

A 
Thumb indents along colon
Mucosal islands (necrosis)
39
Q

Specific Sx: Proctitis + proctosigmoiditis (4)

A

Fresh bleeding
Mucus
Urgency
Tenesmus

40
Q

Specific Sx - extensive pancolitis (2)

A

Abdo pain

Blood diarrhoea

41
Q

Histology Chrons (3)

A

Transmural inflammation
Lymphoid hyperplasia
Granulomas

42
Q

Histology UC (3)

A

Mucosal inflammation
Crypt abscesses
Goblet cell depletion

43
Q

Chrons vs UC: Location

A

C: Mouth –> anus
UC: Colon only

44
Q

Chrons vs UC - anal involvement?

A

C: Often
UC: Seldomn

45
Q

Chrons vs UC - Continuity

A

C: Discontinuous ‘skip lesions’

UC; Continuous from rectum

46
Q

Chrons vs UC - Fistulae

A

C: Common
UC: uncommon

47
Q

Chrons vs UC - smoking

A

C: Increases risk
UC: protective

48
Q

Chrons vs UC - cure

A

C: surgery to help Sx
UC: surgery is cure

49
Q

Ix - Chrons/UC - bloods (5)

A 
FBC
U+E
ESR
CRP
LFT
50
Q

FBC findings Chrons

A

Hypoalbuminaemia - severe Chrons

Se Fe/B12/folate anaemia common

51
Q

Stool studies - Chrons/UC (3)

A

Stool chart
MCS x 3
Calprotectin

52
Q

Use of endoscopy in UC/Chrons

A

Rigid/flexi sigmoidoscopy UC
Colonoscopy
Endoscopic rectal biopsy may be taken

53
Q

mx acute chrons flare - Mild

A

PO prednisolone

54
Q

mx acute chrons flare - severe (3)

A

IV HC 100mg//6h
NBM + parental nutrition
Once improved - PO pred

55
Q

What warrants admission - acute chrons flare (4)

A

Raised temp
Raised pulse
CRP/ESR raised
Low albumin

56
Q

2nd line Mx Severe acute chrons flare

A

Thiopurines

57
Q

What must be checked before prescribing thiopurines

A

TMPT

58
Q

Refractory disease Chrons acute flare up Mx

A

Biologics

59
Q

Chrons maintenance - 1st line

A

Thiopurines

60
Q

Chrons maintenance - 2nd line

A

methotrexate

61
Q

Which med is specifically useful for Chrons w/ anal disease

A

PO metronidazole

62
Q

Mx - mild mod acute UC flare up - proctitis/proctosigmoiditis

A

TO aminosalicylate +/- PO mesalazine

63
Q

Mx mild/mod acute UC flare up - paancolitis

A

PO mesalazine +/- PO beclomethasone

+ TO mesalazine

64
Q

2nd line mild/mod acute UC flare up

A

Add PO prednisolone

If not successful after 4 w

65
Q

3rd line mild/mod acute UC flare up

A

After another 2-4w

Add tacrolimus

66
Q

4th line mild/mod acute UC flare up

A

Biologics

67
Q

Acute severe/fulminating UC flare up Mx (4)

A

MDT
Start IV CCS
SC heparin
Avoid anti-motility Dx

68
Q

2nd line x - acute severe UC flare up Mx

A

IV ciclosporin

69
Q

3rd line Mx - acute severe UC flare up

A

biologics

70
Q

UC maintenance Mx - 1st line

A

5ASA derivatives
TO if proctosigmoiditis
PO if L sided

71
Q

E.g.s of 5ASA derivatives (2)

A

Sulfasalazine

Mesalazine

72
Q

2nd line Mx UC maintenance

A

PO thiopurines

73
Q

General IBD complications (4)

A

bowel perforation
Lower GI haemorrhage
Toxic dilatation
Colonic carcinoma

74
Q

20y risk of colon cancer - UC

A

115%

75
Q

PS toxic dilation (3)

A

Persistent fever
TachyC
Loose blood-stained stool

76
Q

Ix results toxic dilation (2)

A

Falling albumin + potassium

AXR - dilated >6cm colon w/ mucosal ilsands

77
Q

Mx toxic dilation

A

ER SURGERY

78
Q

Chrons specific complications (4)

A

SBO
Fistulae
Abscess formation
B12/folate/Fe deficiencies

79
Q

Extracolonic manifesations duing active phase IBD (6)

A 
Conjunctivitis/episcleritis/iritis 
Arthralgia large joints 
Erythema nodosum
Pyoderma gangrenosum 
Venous thrombosis 
Fatty liver
80
Q

Extracolonic manifesations at any time IBD (6)

A 
Autoimmune hepatitis 
Gallstones 
Renal calculi 
1SC
Cholangiocarcinoma 
AS

CP3 SURGERY (19 decks)

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