Week 13 - Cases 1 and 2 Flashcards
Which symptoms or patient characteristics, with new constipation or diarrhoea, would make you more concerned about a diagnosis of malignancy?
Cancer symptoms may be minor or non-existent during the early stages of the disease, although there may be some early warning signs. The symptoms of colorectal cancer may not develop until the disease has progressed.
Early warning signs of cancer include:
- Rectal bleeding, either bright or dark red in colour
- Tenesmus, which is the feeling that you have to empty your bowel but nothing passes
- Anaemia caused by iron deficiency
- Persistent abdominal pain or distension
- Unexplained weight loss
- Unexplained appetite
Other vague systemic symptoms can include fatigue, nausea, vomiting and jaundice.
what tests should be arranged if ovarian cancer is suspected
pelvic ultrasound and a CA125 blood test should be arranged to get more information.
what confirms the diagnoses of diverticular disease
a colonoscopy
what sort of anaemia is found in occult bleeding
low Hb, ferritin and MCV are low
this indicates a microcytic iron-deficient anaemia
Which types of staging criteria are used for bowel cancer?
Both TNM and Dukes’ Criteria
what is Duke’s staging system
The Dukes’ staging system is divided into 4 groups – A, B, C and D. Dukes’ A is an early bowel cancer and Dukes’ D is advanced.
Dukes’ A The cancer is only in the innermost lining of the bowel or slightly growing into the muscle layer.
Dukes’ B The cancer has grown through the muscle layer of the bowel.
Dukes’ C The cancer has spread to at least one lymph node in the area close to the bowel.
Dukes’ D The cancer has spread to somewhere else in the body, such as the liver or lungs.
what is given to assess for primary and metastatic disease
CT-CAP
A 75-year-old woman calls her GP with a 24-hour history of severe colicky abdominal pain, and a 12-hour history of nausea and diarrhoea. She has a history of a left hip replacement 8 years ago and atrial fibrillation. She takes paracetamol regularly and codeine as required which have made no difference to her symptoms, and bisoprolol and rivaroxaban for her AF. She recently missed a week of her medication due to a delay in ordering it. What is the most likely diagnosis?
Mesenteric ischaemia
History of AF increases the change of blood clots forming in the left atria of the heart and being embolised. This risk is further increased by her missing her rivaroxaban tablets for a week. Embolism to the bowel can cause acute mesenteric ischaemia which presents abruptly, with severe pain and minimal findings on clinical examination.
A 43-year-old man presents to his GP with diarrhoea and very concerned about colon cancer after his father died of cancer in his 50s. He has suffered with constipation and diarrhoea on and off for several years and it has been worse recently since he was made redundant. He also experiences cramping abdominal pain, relieved by opening his bowels and is intermittently bloated, especially when his symptoms are more pronounced. Approximately 6 months ago he had one or two episodes of bleeding when wiping after opening his bowels during a period of constipation but this self-resolved. His stools sometimes contain mucus. Worrying about this prompted him to call the GP. Which of the following would you do next (you may select more than one)?
Blood tests and a FIT test
Routine referral to colorectal surgery
A 69-year-old man was recently discharged from hospital back to his nursing home after being treated for severe community acquired pneumonia with a long course of antibiotics. He now feels unwell and complains of abdominal pain associated with diarrhoea. He also has slight cough. Which of the following could be the working diagnosis listening to the current history?
Clostridium difficile colitis
Diff colitis is also called antibiotic associated colitis. It occurs after antibiotic use.
A 25-year-old woman presents to her GP with a prolonged history of diarrhoea. She has previously been diagnosed with Inflammatory Bowel Syndrome. The frequency of stools have now increased. There is no blood with the stools but there is mucus. PMH includes Type 1 Diabetes. Patient also reports weight loss despite normal appetite. Detailed history reveals that the diarrhoea worsens after eating a certain type of food (specially wheat products). Based on the current history, which investigation would be diagnostic if positive?
Serum immunoglobulin tissue transglutaminase antibody
A 32-year-old man presents to the GP with alternating constipation and diarrhoea. He has had a long-standing history of constipation which then follows and episode of diarrhoea which sometimes soils his clothes. He has also noticed that sometimes during straining he can feel ‘’something coming out of the anus which then goes back in after some time’. He has also noticed some fresh blood on the tissue paper when he wipes himself. No history of weight loss. On PR examination, you notice a bluish bulge when you ask the patient to strain. Based on the current history provided, which of these is the most probable diagnosis?
Haemorrhoids
