What effect does IBD have on: - Hb - WCC - Neutrophils - CRP - Potassium - Albumin - Fecal calprotectin

- Low Hb - High WCC - High neutrophils - High CRP - Low potassium - Low albumin - High fecal calprotectin (Crohn's can also cause low B12 and low vit D)

Bowel, Rectum, Anus Flashcards by Imogen Smedley

What are 3 red flag symptoms for a change in bowel habit that make functional disorders less likely?

Weight loss
Age >50
PR bleeding

How well did you know this?

Not at all

Perfectly

What is the 1st line management for IBS?

Antispasmodic or laxative or antimotility
(Antimotility for diarrhea)
(Avoid lactulose laxative)

How well did you know this?

Not at all

Perfectly

What antimotility agent is used in the management of diarrhea in IBS?

Loperamide

How well did you know this?

Not at all

Perfectly

What antispasmodics are used in the management of IBS?

Meberevine
Peppermint oil
Alverine

How well did you know this?

Not at all

Perfectly

UC or Crohn’s - which is granulomatous?

Crohn’s

How well did you know this?

Not at all

Perfectly

UC or Crohn’s - which is transmural infalmmation?

Crohn’s

How well did you know this?

Not at all

Perfectly

UC or Crohn’s - which is protected by smoking? which aggravated?

UC protected by smoking

Crohn’s aggravated by smoking

How well did you know this?

Not at all

Perfectly

UC or Crohn’s - which has crypt abscesses?

How well did you know this?

Not at all

Perfectly

UC or Crohn’s - which has skip lesions?

Crohn’s

How well did you know this?

Not at all

Perfectly

UC or Crohn’s - which is any part of GIT? which is limited to colon?

Crohn’s any part of GIT

UC colon

How well did you know this?

Not at all

Perfectly

UC or Crohn’s - which is cobble stoning?

Crohn’s

How well did you know this?

Not at all

Perfectly

UC or Crohn’s - which is rose thorn ulcers?

Crohn’s

How well did you know this?

Not at all

Perfectly

UC or Crohn’s - which has a lead pipe colon on AXR and what is that??

Loss of haustration

How well did you know this?

Not at all

Perfectly

UC or Crohn’s - which is thumbprinting on AXR and what is that?

Thickened haustra

How well did you know this?

Not at all

Perfectly

What is fulminant disease?

Severe + rapid

How well did you know this?

Not at all

Perfectly

UC or Crohn’s - which has perianal disease?

Crohn’s only

How well did you know this?

Not at all

Perfectly

UC or Crohn’s - which is aggravated by NSAIDs?

How well did you know this?

Not at all

Perfectly

What blood test can be used for differentiating IBS and IBD?

Fecal calprotectin

Also inflam markers

How well did you know this?

Not at all

Perfectly

UC or Crohn’s - which gets toxic megacolon?

How well did you know this?

Not at all

Perfectly

Where is first effected in UC?

Starts at rectum + progressed upwards

How well did you know this?

Not at all

Perfectly

Ulcerative colitis
Define:
-Proctitis
-Proctosigmoiditis
-Left sided colitis
-Extensive colitis
-Panproctocolitis
-Backwash ileitis

-Proctitis: rectum only
-Proctosigmoiditis: rectum + sigmoid
-Left sided colitis: up to splenic flexure
-Extensive colitis: to hepaitc flexure
-Panproctocolitis: whole colon
Backwash ileitis: terminal ileum

How well did you know this?

Not at all

Perfectly

What effect does IBD have on:

Hb
WCC
Neutrophils
CRP
Potassium
Albumin
Fecal calprotectin

Low Hb
High WCC
High neutrophils
High CRP
Low potassium
Low albumin
High fecal calprotectin

(Crohn’s can also cause low B12 and low vit D)

How well did you know this?

Not at all

Perfectly

A patient with UC has a distended tender abdomen and is septic - what is the Dx?

Toxic megacolon

How well did you know this?

Not at all

Perfectly

What is the risk in toxic megacolon?

Perforation

How well did you know this?

Not at all

Perfectly

How is toxic megacolon diagnosed?

AXR

What is the management of toxic megacolon?

Surgical decompression if no improvement at 24hr

What HLA type is associated with inflammatory bowel disease?

HLA B27

What part of the body is always effected in ulcerative colitis?

Rectum

What dermatological complaint is associated with IBD?

Erythema nodosum

What autoimmune hepatitic condition is associated with IBD?

Primary sclerosing cholangitis

How do you classify mild, moderate and severe UC?

Mild <4 bloody stools / day, normal CRP Mod 4-6 bloody stools Severe >6 bloody stools per day + systemic upset

How is inflammatory bowel disease diagnosed?

``` Colonoscopy biopsy (see crypt abscesses, psuedopolyps, widespread ulceration, depletion of goblet cells) ```

There is an increased risk of adenocarcinoma in UC, how often and how do you monitor for this?

Colonoscopy every 2yr from 10yr post Dx

Which layers of the bowel wall are inflamed in Crohn's and in UC?

Crohn's transmural inflammation | UC mucosa + submucosa

If you were to CT a patient with IBD would you see thickening or atrophy of the bowel wall?

Thickened bowel wall due to inflammation

What drugs are used 1st line to induce remission in proctitis, proctosigmoiditis, mild/moderate extensive disease and severe extensive disease?

Proctitis: topical 5-ASA Proctosigmoiditis: topical 5-ASA Mild/moderate extensive disease: topical + oral 5-ASA Severe extensive disease: IV/PO steroids

In UC, if remission is not achieved after 4 weeks of topical 5-ASA, what is the next step in Mx?

Either oral 5-ASA or steroids

What DMARD is used in the management of Crohn's and what are the indications for it?

Oral azathioprine if 2 exacerbations in 1 yr requiring oral steroids

Growth retardation in children with ulcerative colitis is an indication for elective surgery. T or F

True

What are the elective surgical 3 options in UC?

Ileoanal pouch Protocolectomy with end ileostomy Protocolectomy with ileorectal anastomosis

What drug is used to maintain remission 1st line in UC?

Topical / rectal / combined 5 ASA

What perianal disease is seen in Crohn's disease?

Fissure, ulcers, abscesses, tags

Crohn's disease could present with acute bowel obstruction, T or F

True

Is IBD associated with seronegative or seropositive large or small joint arthropathy?

Seronegative large joint arthropathy

If you suspect a patient with Crohn's disease has a stricture or fistula, what test would you do?

MRI

How is remission induced in Crohn's disease?

Steroids IV / PO depending on severity

To induce remission in Crohn's disease, if a patient has no improvement after 3 days on IV steroids, what is the next step in management? Say drug name + class

Infliximab monoclonal antibody anti-TNF

What drug is 1st and 2nd line to maintain remission in Crohn's disease?

1st azathioprine | 2nd mercaptopurine

In Crohn's disease if a patient has many surgeries, what complication are they are risk of?

Short gut syndrome

What is short gut syndrome?

Insufficient bowel left for essential nutrient absorption <1m

What is a seton suture?

Surgical Mx of anal fistula in Crohn's disease

There is a risk of CRC in Crohn's disease, how and how often is this monitored for?

If have a colon at 10 yr post Dx (i.e. not surgically removed), colonoscopy every 2yr

Before initiating azathioprine in Crohn's disease, what blood test should you do to check for what potential side effect?

TPMT levels | Agranulocytosis

What HLA type is celiac disease?

HLA-DQ2

What is the 1st line investigation for celiac disease?

Anti-TTG

What test is diagnostic of celiac disease?

Duodenal biopsy shows villous atrophy

What vaccine is offered to those with celiac disease and why?

Pneumococcal vaccine due to hyposplenism

Which immunoglobulin is involved in celiac disease?

IgA

What dermatological presentation is associated with celiac disease?

Dermatitis herpetiformis

Can celiac disease cause bloody diarrhea?

Does celiac disease cause diarrhea or constipation?

Diarrhea

What is a colorectal adenoma?

Dysplastic polyp

What screening test is used for CRC?

qFIT

Define neoplasia

Abnormal uncoordinated growth

Name 2 genetic disorders associated with CRC?

FAP familial adenomatous polyposis | HNPCC hereditary non-polyposis colorectal cancer

What staging criteria is used for CRC? Name the components

``` Duke criteria A confined to mucosa B invades muscularis propria C regional LN D distant ```

Name the CRC tumour marker

Cea

What type of scan is used for staging CRC?

CT | MRI for rectal tumours

A 67 year old male has an incidental finding of iron deficiency anaemia. What tests should you do 1st and 2nd line to look for a cause?

1st IgA TTG + colonoscopy | 2nd OGD

When taking a history and a patient mentions they have bloody diarrhea, what should you ask about the blood?

Mixed in, on paper or on stool Colour Quantity

Where are CRC tumours most likely to cause obstrution?

Caecum

What procedure can be used palliatively to prevent bowel obstruction in CRC?

Palliative stenting

What test is used for diagnosis in CRC? What about in frail elderly patients?

Colonoscopy biopsy | If frail elderly patients just do CT colonography

The risk of anastomotic leak post bowel resection increases as you move [towards / away] from the rectum

Towards

What are the indications for screening for CRC with a 1-2 yearly colonoscopy from age 25?

3 first degree relatives with CRC/Lynch Ca with 1 aged under 50 Unless Lynch excluded in which case frequency of colonoscopy may be reduced

What are the indications for screening for CRC with 5 yearly colonoscopy aged 50 - 75yr?

3 first degree relatives degree relatives with CRC aged >50 OR 2 relatives with CRC with mean age <60

What are the indications for screening for CRC with a single colonoscopy age 55?

1 1st degree relative with CRC age <50 OR 2 relatives with mean age >60

In CRC pathogenesis, does a polyp progress to an adenoma or an adenoma progress to a polyp?

Polyp > adenoma > cancer

When should you refer a patient from primary care for suspected CRC?

``` For 2 week wait if Occult blood in their faeces OR >40yr + unexplained weight loss + abdo pain OR >50yr with unexplained rectal bleeding OR >60yr with Fe anaemia OR >60yr with change in bowel habit *SAW another diagram that kinda disagrees* ```

A remnant of the omphalomesenteric duct describes ...

Meckel's diverticulum

Where is Meckel's diverticulum located?

60cm from ileocaecal valve

Meckel's diverticulum has the rule of 2... expand

2% population 2% symptomatic Usually present before age 2

What is the management of symptomatic and incidental Meckel's diverticulum?

Symptomatic - laparoscopic resection | Incidental - leave alone

How does Meckel's diverticulum present if symptomatic?

Painless rectal bleeding in a toddler

What is occult bleeding?

Microscopic | detectable in investigations eg caecal tumour

Are haemorrhoids a consequence of portal hypertension?

What is the role of steroids in haemorrhoids?

There isn't one Steroids are used for inflammation Haemorrhoids aren't usually inflamed

Are internal haemorrhoids palpable?

No | PR exams to feel for mass or prostate not for haemorrhoids

Anal fissures - painful or painless - longitudinal or horizontal cut in mucosa - usually due to constipation of diarrhea - acute or chronic - blood on wiping or mixed in with stool - requires a PR exam yes or no

``` Painful Longitudinal cut Constipation May be acute or chronic Blood on wiping Doesn't require a PR exam ```

What anatomical landmark separates internal and external haemorrhoids?

Pectinate line

How are internal haemorrhoids visualised?

Proctoscopy

Do haemorrhoids cause blood mixed in with stool, coating stool or on wiping? What colour is the blood?

Bright red On wiping or coats stool May be mixed with stool if internal haemorrhoids

What is the 1st line management of haemorrhoids?

Conservative manage constipation - increase fluid / fibre intake Laxido / stool softener + analgesia

What is the 2nd line management of haemorrhoids?

Rubber band ligation or inject sclerosing agent

What is the last line management of haemorrhoids?

Surgical haemorrhoidectomy

What is the 1st + 2nd line management of an anal fissure?

1st line conservative lifestyle manage constipation | 2nd relieve contraction of anal sphincter - topical diltiazem or GTN ointment

Bowel, Rectum, Anus Flashcards

(96 cards)