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1st year GI > colon and rectum > Flashcards

colon and rectum Flashcards

1
Q

what is the definition of constipation

A

2 or more of the following for at least 3 months

  • infrequent passage of stool (<3 a week)
  • straining >25% of time
  • passage of hard stools in >25% defecations
  • incomplete evacuation and sensation of anorectal blockage un >25% defecations
  • manual manoeuvres to facilitate >25% defecations
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2
Q

what are the 3 categories of constipation

A
  • normal transit through the colon
  • defecatory disorders
  • slow transit
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3
Q

what is megacolon

A

used to describe a number of congenital and acquired conditions in which the colon is dilated

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4
Q

when does megacolon present

A

first years of life

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5
Q

what gives rise to constipation in megacolon

A

A ganglionic segment of the rectum (megarectum) gives rise to constipation and subacute obstruction

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6
Q

what is faecal incontenance

A

incontenance is classified as minor (inability to control flatus or liquid stool, causing soiling) or major (frequent and inadvertent evacuation of stool of normal consistency)

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7
Q

aetiology for feacal incontenance

A
  • congenital
  • anal sphincter dysfunction
  • rectal prolapse
  • faecal impaction with overflow diarrhoea
  • neurological and physcological disorders
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8
Q

what is initial management of faecal incontenance

A

Minor incontinence initial management is bowel habit regulation. Loperamide is the most potent antidiarrhoeal agent, which also increases sphincter tone

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9
Q

what is ischemic colitis

A

Ischemic colitis occurs when branches of the superior mesenteric artery or inferior mesenteric artery are occluded and there is reduced blood reaching the colon. Inflammation and injury of the large intestine result from inadequate blood supply.

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10
Q

what are clinical features of ischaemic colitis

A
  • sudden onset of abdominal pain
  • passage of bright red blood per rectum with or without diarrhoea
  • may be signs of shock and evidence of underlying cardiovascular disease
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11
Q

what is seen on examination of a patient with Ischemic colitis

A
  • the abdomen may be distended and tender
  • thumb printing at the splenic flexure seen on Xray
  • may have lactic acidosis
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12
Q

what investigations are carried out for patients with ischemic colitis

A
  • urgent CT scan to exclude perforation

- unprepared flexible sigmoidoscopy

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13
Q

how to manage ischaemic colitis

A
  • most patients settle on symptomatic treatment

- surgery is perforation

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14
Q

what are diverticula

A

Diverticula are small, bulging pouches that can form in the lining of your digestive system.

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15
Q

what does diverticulosis mean

A

indicates the presence of diverticula

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16
Q

what does diverticulitis mean

A

implies that these diverticula are inflamed

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17
Q

what does diverticular colitis mean

A

refers to crescentic inflammation on the fold in areas of diverticulosis

18
Q

how are diverticular formed

A

there is thickening of the muscle layer and because of high intraluminal pressures, punches of mucosa extrude through the muscular through weakened areas near blood vessels to form diverticula.

19
Q

when does diverticulitis occur

A

when faeces obstruct the neck of the diverticulum, causing stagnation and allowing bacteria to multiply and produce inflammation

20
Q

what can diverticulitis lead to

A
  • bowel perforation
  • abscess formation
  • fistulae into adjacent organs
21
Q

what are clinical features and investigations of diverticular disease

A
  • asymptomatic in 95% of cases
  • discovered accidentally on colonoscopy or barium enema
  • no treatment apart from increasing dietary fibre
  • in symptomatic patients intermittent left iliac fossa pain or discomfort and an erratic bowel habit commonly occur
  • colonoscopy and barium enema are investigations of choice
22
Q

how do you manage diverticular disease

A
  • well balanced fibre diet with smooth muscle relaxants if required
  • Hartmans procedure if perforation
  • surgery if fistula
  • antibiotics and drainage if abscess
23
Q

what is acute diverticulitis

A

when diverticula suddenly become inflamed

24
Q

clinical features of acute diverticulitis

A
  • severe pain in left iliac fossa
  • fever
  • constipation
  • febrile
  • tachycardia
25
Q

what does an abdominal exam show for actor diverticulitis

A
  • tenderness
  • guarding
  • rigidity
  • palpable left tender mass sometimes felt in the left iliac fossa

(on the left side of abdomen)

26
Q

what are investigation findings for acute diverticulitis

A
  • blood tests often revel polymorphonuclear leucocytosis. The ESR and CRP are raised
  • CT colonoscopy will show colonic wall thickening, diverticula and often pericolic collections and abscesses. There is usually a streaky increased density extending into the immediate periocolic fat with thickening of the pelvic fascial planes
  • US examination can demonstrate a thickened bowel and large pericolic collections
27
Q

how do you manage acute diverticulitis

A
  • oral antibiotics eg ciprofloxacin and metronidazole

- bowel rest, IV fluids and IV antibiotic therapies

28
Q

what are complications of diverticular disease

A
  • perforation
  • fistula
  • intestinal obstruction
  • bleeding
  • mucosal inflammation
29
Q

what is a colonic polyp

A

abnormal growth of tissue projecting from the colonic mucosa

they can be single/multiple, pedunculate, sessile or flat

30
Q

what are the classifications of colorectal polyps

A
  • hyperplastic
  • hamartoma
  • inflammatory
  • lymphoid
  • adenoma
31
Q

what are sporadic adenoma

A

an adenoma is benign, dysplastic tumour of columnar cells or glandular tissue. They have tubular, tubulovillous or villous morphology.

The vast majority are not inherited = sporadic

32
Q

what are signs and symptoms of right sided cancers

A
  • unexplained iron deficiency anaemia
  • persistant tiredness
  • a persistant and unexplained change in bowel habit
  • unexplained weight loss
  • abdominal pain (colicky in nature)
  • lump in the abdomen
33
Q

what are signs and symptoms of left sided colorectal cancer

A
  • rectal bleeding
  • feeling of incomplete emptying
  • worsening constipation
34
Q

what investigations for colorectal cancer

A
  • barium enema (widely abandoned)
  • sigmoidoscopy vs colonoscopy
  • CT colonography
35
Q

what are sessile polyps

A

Sessile polyps grow flat on the tissue lining the organ. Sessile polyps can blend in with the lining of the organ, so they’re sometimes tricky to find and treat. Sessile polyps are considered precancerous. They’re typically removed during a colonoscopy or follow-up surgery.

36
Q

what are predunculated polyps

A

Pedunculated polyps are easier to spot and can be removed in one piece. “The head is where the precancer would be, so by snaring the stalk, we know without a doubt that it’s gone,” he says.

37
Q

how do colorectal cancers develop

A

as a result of progression from normal mucosa to adenoma to invasive cancer

These are controlled by critical growth regulating genes and these can be grouped into 3 pathways

  1. chromosomal instability
  2. CpG island methylator phenotype 3. microsatellite instability
38
Q

what is the pathology of colorectal cancer

A
  • usually takes the form of a polypoid mass with ulceration, spreads by direct infiltration through the bowel walls
  • involves lymphatics and blood vessels with subsequent spread, most commonly to the liver and lung
39
Q

what are symptoms of colorectal cancer

A
  • change in bowel habit
  • looser more frequent stools
  • rectal bleeding
  • tenesmus and symptoms of anaemia
40
Q

what are investigations for colorectal cancer

A
  • colonoscopy
  • double contrast barium enema
  • endoanal ultrasound and pelvic PRI
  • chest, abdominal and pelvic CT
  • PET scanning
  • MRI
  • serum carcinoembryonic antigen
  • faecal occult blood test
41
Q

how do you manage colorectal cancer

A
  • total mesolectal excision - is required for rectal cancers and removes the entire package of mesolectal tissue surrounding it. A low rectal anastomoses is then carried out
  • segmental resection - and restorative anastomoses, with removal of draining lymph nodes
  • surgical or ablative treatment of liver and lung metastases

1st year GI (16 decks)

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