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Y4 GI / Surgery > Bowel, Rectum, Anus > Flashcards

Bowel, Rectum, Anus Flashcards

1
Q

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

A

Weight loss
Age >50
PR bleeding

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2
Q

What is the 1st line management for IBS?

A

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

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3
Q

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

A

Loperamide

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4
Q

What antispasmodics are used in the management of IBS?

A

Meberevine
Peppermint oil
Alverine

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5
Q

UC or Crohn’s - which is granulomatous?

A

Crohn’s

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6
Q

UC or Crohn’s - which is transmural infalmmation?

A

Crohn’s

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7
Q

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

A

UC protected by smoking

Crohn’s aggravated by smoking

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8
Q

UC or Crohn’s - which has crypt abscesses?

A

UC

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9
Q

UC or Crohn’s - which has skip lesions?

A

Crohn’s

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10
Q

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

A

Crohn’s any part of GIT

UC colon

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11
Q

UC or Crohn’s - which is cobble stoning?

A

Crohn’s

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12
Q

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

A

Crohn’s

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13
Q

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

A

UC

Loss of haustration

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14
Q

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

A

UC

Thickened haustra

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15
Q

What is fulminant disease?

A

Severe + rapid

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16
Q

UC or Crohn’s - which has perianal disease?

A

Crohn’s only

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17
Q

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

A

UC

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18
Q

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

A

Fecal calprotectin

Also inflam markers

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19
Q

UC or Crohn’s - which gets toxic megacolon?

A

UC

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20
Q

Where is first effected in UC?

A

Starts at rectum + progressed upwards

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21
Q 
Ulcerative colitis
Define:
-Proctitis
-Proctosigmoiditis
-Left sided colitis
-Extensive colitis
-Panproctocolitis
-Backwash ileitis
A

-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

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22
Q

What effect does IBD have on:

  • Hb
  • WCC
  • Neutrophils
  • CRP
  • Potassium
  • Albumin
  • Fecal calprotectin
A
  • 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)

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23
Q

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

A

Toxic megacolon

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24
Q

What is the risk in toxic megacolon?

A

Perforation

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25
Q

How is toxic megacolon diagnosed?

A

AXR

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26
Q

What is the management of toxic megacolon?

A

Surgical decompression if no improvement at 24hr

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27
Q

What HLA type is associated with inflammatory bowel disease?

A

HLA B27

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28
Q

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

A

Rectum

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29
Q

What dermatological complaint is associated with IBD?

A

Erythema nodosum

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30
Q

What autoimmune hepatitic condition is associated with IBD?

A

Primary sclerosing cholangitis

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31
Q

How do you classify mild, moderate and severe UC?

A

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

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32
Q

How is inflammatory bowel disease diagnosed?

A 
Colonoscopy biopsy
(see crypt abscesses, psuedopolyps, widespread ulceration, depletion of goblet cells)
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33
Q

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

A

Colonoscopy every 2yr from 10yr post Dx

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34
Q

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

A

Crohn’s transmural inflammation

UC mucosa + submucosa

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35
Q

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

A

Thickened bowel wall due to inflammation

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36
Q

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

A

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

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37
Q

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

A

Either oral 5-ASA or steroids

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38
Q

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

A

Oral azathioprine if 2 exacerbations in 1 yr requiring oral steroids

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39
Q

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

A

True

40
Q

What are the elective surgical 3 options in UC?

A

Ileoanal pouch
Protocolectomy with end ileostomy
Protocolectomy with ileorectal anastomosis

41
Q

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

A

Topical / rectal / combined 5 ASA

42
Q

What perianal disease is seen in Crohn’s disease?

A

Fissure, ulcers, abscesses, tags

43
Q

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

A

True

44
Q

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

A

Seronegative large joint arthropathy

45
Q

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

A

MRI

46
Q

How is remission induced in Crohn’s disease?

A

Steroids IV / PO depending on severity

47
Q

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

A

Infliximab monoclonal antibody anti-TNF

48
Q

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

A

1st azathioprine

2nd mercaptopurine

49
Q

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

A

Short gut syndrome

50
Q

What is short gut syndrome?

A

Insufficient bowel left for essential nutrient absorption <1m

51
Q

What is a seton suture?

A

Surgical Mx of anal fistula in Crohn’s disease

52
Q

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

A

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

53
Q

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

A

TPMT levels

Agranulocytosis

54
Q

What HLA type is celiac disease?

A

HLA-DQ2

55
Q

What is the 1st line investigation for celiac disease?

A

Anti-TTG

56
Q

What test is diagnostic of celiac disease?

A

Duodenal biopsy shows villous atrophy

57
Q

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

A

Pneumococcal vaccine due to hyposplenism

58
Q

Which immunoglobulin is involved in celiac disease?

A

IgA

59
Q

What dermatological presentation is associated with celiac disease?

A

Dermatitis herpetiformis

60
Q

Can celiac disease cause bloody diarrhea?

A

No

61
Q

Does celiac disease cause diarrhea or constipation?

A

Diarrhea

62
Q

What is a colorectal adenoma?

A

Dysplastic polyp

63
Q

What screening test is used for CRC?

A

qFIT

64
Q

Define neoplasia

A

Abnormal uncoordinated growth

65
Q

Name 2 genetic disorders associated with CRC?

A

FAP familial adenomatous polyposis

HNPCC hereditary non-polyposis colorectal cancer

66
Q

What staging criteria is used for CRC? Name the components

A 
Duke criteria 
A confined to mucosa
B invades muscularis propria
C regional LN
D distant
67
Q

Name the CRC tumour marker

A

Cea

68
Q

What type of scan is used for staging CRC?

A

CT

MRI for rectal tumours

69
Q

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?

A

1st IgA TTG + colonoscopy

2nd OGD

70
Q

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

A

Mixed in, on paper or on stool
Colour
Quantity

71
Q

Where are CRC tumours most likely to cause obstrution?

A

Caecum

72
Q

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

A

Palliative stenting

73
Q

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

A

Colonoscopy biopsy

If frail elderly patients just do CT colonography

74
Q

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

A

Towards

75
Q

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

A

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

76
Q

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

A

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

77
Q

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

A

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

78
Q

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

A

Polyp > adenoma > cancer

79
Q

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

A 
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*
80
Q

A remnant of the omphalomesenteric duct describes …

A

Meckel’s diverticulum

81
Q

Where is Meckel’s diverticulum located?

A

60cm from ileocaecal valve

82
Q

Meckel’s diverticulum has the rule of 2… expand

A

2% population
2% symptomatic
Usually present before age 2

83
Q

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

A

Symptomatic - laparoscopic resection

Incidental - leave alone

84
Q

How does Meckel’s diverticulum present if symptomatic?

A

Painless rectal bleeding in a toddler

85
Q

What is occult bleeding?

A

Microscopic

detectable in investigations eg caecal tumour

86
Q

Are haemorrhoids a consequence of portal hypertension?

A

No

87
Q

What is the role of steroids in haemorrhoids?

A

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

88
Q

Are internal haemorrhoids palpable?

A

No

PR exams to feel for mass or prostate not for haemorrhoids

89
Q

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
A 
Painful
Longitudinal cut
Constipation
May be acute or chronic 
Blood on wiping
Doesn't require a PR exam
90
Q

What anatomical landmark separates internal and external haemorrhoids?

A

Pectinate line

91
Q

How are internal haemorrhoids visualised?

A

Proctoscopy

92
Q

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

A

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

93
Q

What is the 1st line management of haemorrhoids?

A

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

94
Q

What is the 2nd line management of haemorrhoids?

A

Rubber band ligation or inject sclerosing agent

95
Q

What is the last line management of haemorrhoids?

A

Surgical haemorrhoidectomy

96
Q

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

A

1st line conservative lifestyle manage constipation

2nd relieve contraction of anal sphincter - topical diltiazem or GTN ointment

Y4 GI / Surgery (11 decks)

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