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MedEd Tutorials > 9. Lower GI > Flashcards

9. Lower GI Flashcards

1
Q

Most common type of colonic cancer?

A

Adenocarcinoma. Commonly coming from polyps.

Related to peutz-jeugers syndrome.

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2
Q

Risk factors for colonic cancer?

A 
AGe
Obesity
IBD (esp UC)
Acromegaly
Poor fibre diet
Males
Limited activity
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3
Q

How does colonic cancer normally present?

A

Change in bowel habits
Rectal bleeding mixed in the stool that is not bright red
Weight loss (FLAWS)

Tenesmus and anaemia poss

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4
Q

Investigations for colonic cancer?

A

Bloods - FBC for anaemia and LFTs for mets
Colonoscopy and biopsy to visualise
Double contrast barium enema see apple core lesion (OSCE)
CT chest/abdo/pelvis for staging

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5
Q

How to manage colorectal cancer?

A

Surgical excision with/without neoadjuvant chemo/radiotherapy.
Commonly metastasises to liver, lung, bone and brain.

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6
Q

What is Crohn’s disease?

A

A disease characterised by transmural (all layers) inflammation of GI tract affecting anywhere from the mouth to the anus, it has skip lesions.

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7
Q

What can the chronic inflammation cause?

A

Non-caseating granuloma formation.

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8
Q

Risk factors for crohn’s?

A 
FHx
Smoking
OCP
Diet high in refined sugars
Genetics 
Ashkenazi jewish
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9
Q

How does crohn’s present?

A 
Crampy or constant pain
Right lower quadrant/peri-umbilical pain
Diarrhoea with mucus, blood or pus
Nocturnal diarrhoea possible
Peri-anal lesions

(weight loss, fatigue and oral lesions)

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10
Q

Extra-intestinal manifestations of crohns?

A

Arthropathy
Skin lesions - aphthous ulcers, pyoderma gangrenosum (red and purple) and erythema nodosum (red).
Ocular symptoms - uveitis, episcleritis

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11
Q

Examination of crohn’s?

A

Abdominal tenderness/mass
Aphthous ulcers
Peri-anal lesions like skin tags etc.

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12
Q

Crohn’s investigations?

A

FBC, iron studies, vitamin levels for malnourishment
CRP and ESR for inflammation
Plain AXR for bowl dilation
CT bowel wall thickening (often on ileocaecal valve) and skip lesions

Bowel series (barium enema and xray) with rose thorn ulcer (deep ulcerations) and string sign of kantor (fibrosis and strictures)

Colonoscopy and biopsy gold-standard. Gold standard, cobblestone appearance.

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13
Q

How to manage crohn’s?

A

Want to induce remission

  1. Steroids, IV, oral or topic (pred)
  2. Immunomodulators (oral or IV) (azathioprine)
  3. Biologic therapy (infliximab/adalimumab)
  4. Surgery (obstruction or really bad)

Once remission occurs, take away the steroids!

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14
Q

What is ulcerative colitis?

A

Diffuse inflammation of colonic MUCOSA ONLY. Only affecting rectum and colon. Starts from rectum and can spread.

Associated with HLA-B27 (also related to ankylosing spondylitis)

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15
Q

Risk factors for UC?

A

FHx
HLA-B27
Not-smoking

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16
Q

How does UC present?

A

Bloody diarrhoea
Rectal bleeding and mucus
Abdo pain and sometimes cramps
Tenesmus

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17
Q

Extra-intestinal manifestations of UC?

A 
Peripheral arthritis
Ankylosing spondylitis
Erythema nodosum
Pyoderma gangrenosum
Episcleritis more common than uveitis

Blood on DRE, abdo tenderness and pallor.

18
Q

Investigations for UC?

A 
FBC for anaemia
LFTs for primary sclerosing cholangitis
CRP and ESR
Faecal calprotectin 
pANCA

Plain AXR dilated bowel
Lead pipe appearance on an xray as haustra are lost

Colonoscopy and biopsy shows continuous erythema (gold).
Goblet cell depletion and crypt abscesses

19
Q

What may thumb printing show?

A

Toxic megacolon which may occur in UC.

20
Q

How to manage UC?

A

Remission

  1. Mesalazine (5-ASA)
  2. Steroids
To maintain give 
Immunosuppressive
(+/-Biologics
Another biologic type)
Ciclosporin
Total colectomy
21
Q

Complications of UC?

A

Toxic megacolon
Primary sclerosing cholangitis
Colorectal adenocarcinoma
Perforation

22
Q

What is coeliac’s disease?

A

A systemic autoimmune disease caused by gluten peptides known as gliadin.
It causes villous atrophy and hypertrophy of intestinal crypts.

23
Q

Risk factors for coeliac’s

A

FHx
IgA deficiency
T1DM
Other immune disorder

24
Q

Coeliac disease presentation

A

Diarrhoea
Bloating
Pain

Dermatitis herpetiformic on elbows

25
Q

Coeliac investigations?

A

IgA tTG elevated
Endomysial antibody
Endoscopy shows atrophy of villi and hypertrophy of intestinal crypts.

26
Q

How to manage coeliac’s?

A

Gluten free diet.

27
Q

What is IBS?

A

Chronic condition of abdominal pain.

28
Q

How does IBS present?

A 
Can have diarrhoea, constipation or both
Abdo cramping 
Alteration of stool consistency
Defecation relieves abdo pain/discomfort
It is a diagnosis of exclusion
29
Q

IBS risk factors?

A

History of physical or sexual abuse
PTSD
Family history
Acute bacterial gastroenteritis

30
Q

Investigations and management for IBS?

A

Exclude IBD, coeliac’s disease and colorectal disease

Avoid foods that trigger and symptomatic management.

31
Q

What are haemorrhoids

A

Vascular rich tissue within the anal canal caused from repetitive straining disrupting tissues.

32
Q

How does you grade haemorrhoids?

A
  1. Not prolapsing
  2. Prolapses when bears down but reduces alone
  3. Cannot reduce alone
  4. Can’t be reduced
33
Q

Risk factors for haemorrhoids?

A

Constipation
Pregnancy
Old age

34
Q

How do haemorrhoids present?

A

Bright red blood on defection that is not painful
discomfort

Anoscopic exam is diagnostic and first line.

35
Q

Managing haemorrhoids?

A 
Constipation advice
Lifestyle advice on straining
Grade...
1 - corticosteroids for itching
2+3 - Rubber band ligation
4. Surgical haemorrhoidectomy under general anaesthesia in 20 minutes.
36
Q

What is a rectal prolapse?

A

Rectum prolapsing through the anal canal from long-term straining and weakness (risk factors from that e.g. obesity etc.)

37
Q

Rectal prolapse presentation?

A

Painless protruding mass
Mucoid discharge
Incontinence
Not bleeding and much larger than haemorrhoids

38
Q

WORK FROM HERE DONE

What is an anal fissure?

A

Sharp pain on defecation with fresh bloods. They are a split in the mucosa.
Diagnosed clinically.
Conservative management and management of pain

39
Q

What is an anal fistula?

A

Fistulae, a canal between last part of bowl and skin around anus.
Abscesses, pus and pain around area.
Need MRI to see
Fistulotomy or seton procedure to fix

40
Q

What is an anal abscess?

A

Abscess of pus near rectum…

41
Q

What is a pilonidal sinus?

A

Hair follicles

MedEd Tutorials (32 decks)

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