Colon diseases Flashcards
(125 cards)
1
Q
Define intestinal failure
A
An inability to maintain adequate nutrition/fluid status via intestines
2
Q
What are possible causes of intestinal failure (5)
A
obstruction
Dysmotility
Surgical resection
Congenital defect
Loss of absorption (disease-associated)
3
Q
What are the types of intestinal failure
A
short term, medium term, and one term
4
Q
How is type one intestinal failure managed(4)
A
Replacing fluid, correcting electrolytes
Possibly intravenous nutrition
Acid suppression (PPI)
Enteral feeding if possible
5
Q
How is type two intestinal failure managed
A
Parenteral nutrition ± enteral feeding
6
Q
how is type three intestinal failure managed (4)
A
parenteral nutrition
Intestinal transplantation
Glucagon-like-peptide2
Bowel lengthening
7
Q
What are the types of Parenteral nutrition (2)
A
peripheral - lipid free
Central - contains lipids
8
Q
What is enterobius vermiculiris
A
A parasitic infection that presents with pruritus ani, congestion, and fibrinopurulent exudate
9
Q
What are the types of appendix tumours (3)
A
neuroendocrine neoplasms
Appeniceal mucinous neoplasms
Sessile serrated mucosal lesions
10
Q
Describe appendiceal mucinous neoplasms
A
proliferation of mucinous epithelial cells
11
Q
Describe sessile serrated mucosal lesions
A
appendix tumours consisting of flat polyps with serrated architecture
12
Q
Describe the clinical presentation of appendicitis (6)
A
Peri-umbilical pain (radiates to right iliac fossa)
Anorexia
Nausea and vomiting
Diarrhoea
Fever
Raised CRP and white blood cells
13
Q
What are examples of primary tumours of the small bowel (3)
A
Lymphoma
Neuroendocrine neoplasms
Carcinoma
14
Q
What methods are used to treat lymphoma (2)
A
Surgery
Chemotherapy
15
Q
Where do neuroendocrine neoplasms commonly appear
A
Appendix
16
Q
Describe neuroendocrine tumours
A
mesenteric masses which cause buckling/tethering of the bowel
17
Q
What are the symptoms of neuroendocrine neoplasms (3)
A
Diarrhoea
Flushing
Right heart fibrosis
18
Q
What can cause acute obstruction of the mesenteric vessels
A
thrombus/embolism
19
Q
What can cause chronic obstruction of mesenteric vessels (2)
A
Atherosclerosis
Vasculitis
20
Q
What are the risk factors for small bowel ischaemia (3)
A
atherosclerosis
Thromboses
Abdominal aortic aneurysm
21
Q
What are features of small bowel ischaemia (3)
A
colour change of serosa and mucosa
Ulceration
Haemorrhage
22
Q
Which type of small bowel ischaemia is transmural
A
acute
23
Q
Describe coeliac disease
A
an immune-mediate disorder triggered by ingestion of gluten
24
Q
Describe the pathology of coeliac disease (3)
A
gliadin triggers abnormal immune reaction
T lymphocytes are activated and proliferate
T cell damage enterocytes and reduce absorptive capacity
25
What are the symptoms of coeliac disease (3)
Diarrhoea
Bloating
Fatigue
26
What are the signs of coeliac disease (4)
anaemia
Vitamin malabsorption
Dermatitis herpetiformis
IgA antibodies
27
how is coeliac disease managed
gluten-free diet
28
What are the symptoms of ischaemic colitis (3)
lower abdominal pain
Blood
Loose stool
29
What are the types of inflammatory bowel disease (2)
Crohn’s disease
Ulcerative colitis
30
Describe Crohn’s disease
a chronic inflammatory and ulcerating condition of the GI tract commonly affecting the terminal ileum and colon
31
What are the symptoms of inflammatory bowel disease (3)
Abdominal pain
Diarrhoea
PR bleeding
32
What are the signs of inflammatory bowel disease (6)
anaemia
Small bowel strictures
Transmural inflammation
Ulceration
Granulomas
Weight loss
33
Describe the distribution of inflammatory bowel disease
patchy
Skip lesions
34
Describe features specific to inflammatory bowel disease in the anus (4)
sinuses between anal canal and skin
Fissures
Skin tags
Damaged sphincters
Abscesses
35
Describe the pathophysiology of inflammatory bowel disease (3)
persistent activation of T cells and macrophages
Excess production of pro-inflammatory cytokines
Exaggerated response to changes in gut microflora
36
Describe ulcerative colitis
a chronic inflammatory disorder involving the mucosa and submucosa of the colon and rectum
37
What are the symptoms of ulcerative colitis (3)
Diarrhoea
Mucus
PR bleeding
38
What are the possible clinical courses of ulcerative colitis (4)
exacerbation/remission
Continuous, low grade
Single episode
Acute fulminant colitis
39
Describe the endoscopic appearance of ulcerative colitis (2)
Diffuse and continuous
Ulcerated mucosa in rectum and colon
40
What is found in the lamina propria in cases of ulcerative colitis
an influx of inflammatory cells
41
What is the pathophysiology of ulcerative colitis (4)
Persistent activation of T cells/macrophages
Auto-antibodies present
Excessive production of pro-inflammatory cytokines
Excessive response to changes in internal microbiome
42
What are neoplastic pathologies of the colon (3)
Polyps
Carcinomas
Benign colonic disease
43
What are non-neoplastic pathologies of the colon (5)
diverticular disease
Ischaemia
Antibiotic-induced colitis
Microscopic colitis
Radiation colitis
44
What are polyps
tumours that protrude above the epithelial surface
45
What are the types of polyps (4)
adenomas
Serrated polyps
Inflammatory polyps
Polyploid carcinomas
46
what kinds of architecture can be involved in adenomas (3)
tubular
Villus
Tubulovillous
47
Describe Adenomas (3)
Tumours of colonic glands
Benign
Dysplastic
48
How do Adenomas evolve into Adenocarcinoma
normal mucosa > low-grade dysplasia > high grade dysplasia > adenocarcinoma
49
Which side of the colon is more commonly affected by carcinomas
left side
50
What are symptoms/signs of left side colon carcinoma (3)
PR bleeding
Altered bowel habits
Obstruction
51
What is the sign of right sided colon carcinoma
anaemia
52
What treatment is most often used for carcinomas of the colon
Surgery
53
Describe TNM staging of colon carcinomas (4)
sub mucosa
Muscularis propria
Beyond Muscularis propria (subserosal fat)
Serosa
54
What patterns of spread can carcinomas of the colon use (3)
local invasion
Lymphatic
Haematogenous
55
What are examples of inherited pathologies of the colon (2)
Lynch syndrome (DNA mismatch repair deficiency)
Familial adenomatous polyposis (defective APC gene)
56
Describe diverticular disease
outpouching of the colonic mucosa
57
Which side of the colon does ischaemia affect more frequently
left side
58
What are the risk factors for ischaemia of the colon (5)
age
Cardiovascular disease
Atrial fibrillation
Vasculitis
Systemic hypotension
59
Describe the pathophysiology of antibiotic-induced colitis (2)
caused by broad spectrum antibiotics
C.diff attack epithelium and endothelium
60
What are the symptoms of antibiotic-induced colitis (2)
diarrhoea
PR bleeding
61
What is used to treat antibiotic-induced colitis (3)
Metronidazole
Vancomycin
Colectomy in some cases
62
What else is antibiotic-induced colitis known as
pseudomembranous colitis
63
Describe the histology of pseudomembranous colitis
Adherent membranous exudate on mucosal surface
64
What is the major symptom of microscopic colitis
chronic diarrhoea
65
What are the types of microscopic colitis (2)
collagenous colitis
Lymphocyte colitis
66
Describe collagenous colitis (2)
Thickening of mucosal basement membrane
Intra-epithelial inflammatory cells
67
Describe lymphocytic colitis (2)
Intra-epithelial lymphocytes
No thickening of the basement membrane
68
What investigations can be carried out for Crohn’s disease
Clinical examination
Bloods (CRP, albumin, platelets, FBC etc)
Colonoscopy
Histology
CT abdomen and pelvis
MRI (pelvis/small bowel)
Technetium labelled white cell scan
Barium
69
Describe acute management of Crohn’s
steroids
70
Describe maintenance management of Crohn’s (3)
Immunosuppressants
Biologics
JAK inhibitors
71
What lifestyle changes can be made to aid management of Crohn’s (4)
smoking cessation
Low fibre diet
Elemental diet
Strict gut rest
72
What can be used for acute management of ulcerative colitis
Steroids
73
What can be used for maintenance treatment of ulcerative colitis (4)
5-ASA
Immunosuppressants
Biologics
JAK inhibitors
74
What is the mode of action of 5-ASA (2)
Decrease cycloxygenase and lipoxygenase pathways
Reduces formation of pro-inflammatory prostaglandins and leukotreines molecules
75
Action of anti-TNFα therapy
promote apoptosis of activated T lymphocytes
76
Action of JAK inhibitors
block phosphorylation and activation of STAT of cytokines
77
When is emergency surgery used for IBD (4)
Failure to respond to medical therapy
Small bowel obstruction
Abscess
Fistulae
78
When is elective surgery used to treat IBD (2)
Failure to response to medical therapy
Dysplasia of colon mucosa
79
Which type of IBD is surgery curative for
ulcerative colitis only
80
What are the types of bowel obstruction (2)
Upper small bowel obstruction
Distal small bowel/large bowel obstruction
81
Which type of bowel obstruction has an acute presentation
upper small bowel obstruction
82
What are the possible causes of bowel obstruction (7)
adhesions/bands
Hernia
Volvulus
Tumour
Inflammatory strictures
Bolus
Intussception
83
What are the symptoms of bowel obstruction (3)
vomiting
Pain
Constipation
84
What are the signs of bowel obstruction
Dehydration
Abdominal distension
Relative lack of abdominal tenderness
Resonant abdomen on percussion
Visible peristalsis
Abnormal bowel sounds
85
What does early development of vomiting suggest about bowel obstruction
The obstruction is proximal
86
What suggests gastric outlet obstruction
Vomiting of semi-digested food eaten 1-2 days ago
87
What suggests upper small bowel obstruction (in relation to vomiting)
copious bile-stained fluid
88
What suggests distal bowel obstruction (in relation to vomiting)
thicker, brown, foul smelling vomit
89
In obstruction of that large bowel, what occurs if the ileo-caecal valve remains competent (3)
backward flow of accumulated bowel contents is prevented
Caecum progressively distends with swallowed air and may eventually rupture
Closed loop obstruction
90
In large bowel obstruction, what occurs if the ileo-caecal valve is incompetent (2)
the small bowel distends
This delays onset of symptoms
91
How does incomplete bowel obstruction affect clinical presentation (4)
clinical features are less defined
Vomiting may be intermittent
Bowel habit may be erratic
Pain may be colicky due to persitaltic activity of hypertrophic muscle (chronic)
92
What investigations are carried out for bowel obstruction (2)
supine abdominal x-ray
CT scan
93
Where are distended small bowel loops often seen
Central position
With valvulae conniventes
94
where are distended large bowels often seen
Anatomical position
With haustra coli
95
How is bowel obstruction managed (4)
nil by mouth
IV cannula for blood
Resuscitate with IV fluids to replace electrolyte losses
NG tube to decompress stomach
96
What happens in cases of bowel strangulation (3)
A segment of bowel becomes trapped
Venous return is obstructed
Atrial inflow is compromised
97
How is bowel strangulation managed
urgent surgical intervention
98
What are the types of adynamic bowel obstruction (2)
paralytic ileus
Pseudo-obstruction
99
What is paralytic ileus
when there is a disruption of the normal propulsive activity of the GI tract due to a failure in peristalsis
100
What are the risk factors for paralytic ileus (3)
Recent GI surgery
Inflammation with peritonitis
Diabetic keto acidosis
101
How is paralytic ileus managed
Drip and suck while awaiting restoration of peristalsis
102
What is pseudo-obstruction
Acute dilation of the colon is absence of colonic obstruction
103
What investigation can be used for pseudo-obstruction (2)
abdominal X-ray ±CT
104
What can be used to manage pseudo-obstruction
colonic decompression if there is pain/respiratory depression
105
What are the risk factors for colorectal cancer (6)
old age
Low fibre
High fat/sugar/alcohol/red or processed meat
Obesity
Smoking
Lack of physical exercise
106
What conditions predispose someone to colorectal cancer
IBD (esp UC)
107
How can colorectal cancer spread (4)
direct
Lymphatic
Blood
Transcolomic
108
Describe the clinical presentation of right sided colorectal cancer (6)
persistent tiredness
Persistent, unexplained change in bowel habits
Unexplained weight loss
Unexplained iron deficiency anaemia
Abdominal pain
Lump in abdomen
109
Describe the clinical presentation of left sided colorectal cancer (3)
rectal bleeding
Worsening constipation
Feeling of incomplete emptying
110
What investigations can be used for colorectal cancer (3)
sigmoidoscopy
Colonoscopy
CT colonography
111
How can colorectal cancer be managed (5)
surgery
Palliation
Chemotherapy/radiotherapy
Follow-up monitoring
Resection (advanced)
112
Who is more likely to be affected by IBS: males or females
Females
113
What are some features of IBS (5)
Disturbed GI motility
High-amplitude propagating contractions
Exaggerated gastro-colic reflex
Pain
Visceral hypersensitivity
114
What are the Rome IV criteria for diagnosis of IBS (3)
recurrent abdominal pain (1/7days for 3 months)
Change in stool frequency
Change in stool form
115
What are symptoms of IBS (4)
bloating
Mucus via rectum
Urgency
Sensation of incomplete emptying
116
What are patterns of IBS symptoms (2)
Nocturnal
Aggravated by stress
117
What illnesses can be associated with IBS (5)
fibromyalgia
Chronic fatigue syndrome
Temporomandibular joint dysfunction
Chronic pelvic pain
Psychiatric conditions
118
What investigations are carried out for IBS (3)
blood s(FBC, CRP, antibody testing for coeliac)
FIT tests (faecal haemoglobin)
Faecal calprotectin
119
How can IBS be managed (lifestyle) (2)
Regular meal times
Reduction in fibre intake
120
How can IBS be managed (pharmacological) (4)
Stopping opiate analgesics
Anti-diarrhoea drugs
Anti-spasmodic
Anti-depressants
121
If a patient has a small bowel length of 70cm following resection, what measure is appropriate for their long-term nutritional needs
Total parenteral nutrition support
122
Which form of IBD involves transmural inflammation
Crohn’s
123
If a patient presents with diarrhoea and abdominal pain (4days) and has Crohn’s disease, what pathological future is most characteristic of Crohn’s disease
Ideal stricture
124
What can help when assessing prognosis of colorectal adenocarcinoma
Tumour depth
125
If a lump is found just below and lateral to the pubic tubercle and disappears went the patient lies down, what is the most likely diagnosis (there is also a positive cough impulse)
Right femoral hernia
