Colorectal

Question 1

What are the symptoms of a bowel obstruction?

Answer 1

Constipation, vomiting green bile, diffuse abdominal pain and distention

Question 2

What is a closed loop obstruction?

Answer 2

there are 2 points of obstruction along the bowel, there is a middle section sandwiched in between the two points of obstruction

Question 3

give 3 examples of closed loop obstructions

Answer 3

volvulus (sigmoid and caecum)
hernias
adhesions

Question 4

What can be seen in an abdominal x ray in the small bowel?

Answer 4

the small bowel lies more central and has mucosal folds called valvulae conniventes

Question 5

What can be seen in abdominal x ray of the large bowel?

Answer 5

frames the small bowel, has small pouches called haustra

Question 6

What can be found upon ABG in a patient with a bowel obstruction?

Answer 6

metabolic alkalosis due to loss of hydrogen ions from vomiting stomach acid

raised lactate

Question 7

In an erect chest x ray, what does air under the diaphragm indicate?

Answer 7

a perforation

Question 8

What surgical treatments are available for bowel obstructions?

Answer 8

adhesiolysis, hernia repair and emergency resection (Depedent on the type of bowel obstruction) e.g. volvulus = hartmann’s,

Question 9

What is ileus?

Answer 9

The paralysis of peristalsis caused by handling of the bowel, inflammation and hypokalaemia

Question 10

What are the symptoms of ileus?

Answer 10

abdominal distention, absolute constipation and no flatulence as well as some abdominal pain

Question 11

How is ileus managed?

Answer 11

1. patient is nil by mouth
2. NG tube if vomiting
3. PEG feed while waiting for bowel function to return

Question 12

What are the 3 main types of hernia?

Answer 12

Indirect inguinal hernia
Direct inguinal hernia
Femoral hernia

Question 13

What causes an indirect inguinal hernia?

Answer 13

the incomplete closure of the processus vaginalis so bowel contents can move through the inguinal canal

Question 14

what makes indirect inguinal hernia distinctive?

Answer 14

it is reducible

Question 15

What is a direct inguinal hernia caused by?

Answer 15

an area of weakness called the Hesselbach’s triangle

Question 16

What is a femoral hernia?

Answer 16

movement of bowel throught femoral canal

Question 17

why is a femoral canal concerning?

Answer 17

it has a very narrow neck so is at risk of encarceration, strangulation and obstruction

Question 18

What is the difference between diverticulosis and diverticulitis?

Answer 18

Diverticulosis is the presence of diverticula (little sacs on the bowel wall) and diverticulitis is inflammation of these sacs

Question 19

How does diverticular disease occur?

Answer 19

Increased pressure over time from straining and over use allows for gaps to form in the bowel and allows for mucosa to push through

Question 20

Who gets diverticulosis

Answer 20

older patients with a low fibre diet, who use NSAIDs, obesity

Question 21

Presentation of diverticulosis symptoms

Answer 21

lower abdo pain on the left
constipation
rectal bleeding

Question 22

How is diverticulosis managed

Answer 22

stimulant laxatives e.g. senna and bulk forming laxatives e.g. isphagula husk

surgery to the sigmoid may be necessary too

Question 23

How does diverticulitis present?

Answer 23

1. pain, tenderness over left the iliac fossa
2. fever
3. diarrhoea
4. nausea
5. palpable abdo masses
6. raised CRP

Question 24

How is diverticulitis managed?

Answer 24

5 day course of co-amoxiclav, analgesia avoiding NSAIDs and opiates

Question 25

Possible complications of diverticulitis

Answer 25

perforation, peritonitis, ileus and peridiverticular abscess

Question 26

Mesenteric ischaemia - what is it?

Answer 26

the lack of blood flow through the mesenteric vessels supplying the intestines

Question 27

What is the difference between chronic and acute mesenteric ischaemia?

Answer 27

Chronic:
- narrowing of mesenteric vessels due to atherosclerosis and pain starts after eating

Acute:
caused by a thrombus or embolus that leads to rapid blockage in blood flow in the superior mesenteric artery

Question 28

What does the ABG of acute mesenteric ischaemia show?

Answer 28

metabolic acidosis and raised lactate level due to ischaemia

Question 29

What is the biggest risk factor for acute mesenteric ischaemia?

Answer 29

atrial fibrillation.

thrombus forms in the left atrium and mobilises down the aorta and into the superior mesenteric artery

Question 30

Which 2 congenital conditions increase the risk of bowel carcinoma

Answer 30

familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer

Question 31

What makes FAP dangerous and what can be done prophylactically?

Answer 31

adenomas have potential to become malignant before the age of 40. patients can have their entire intestine removed to prevent bowel cancer

Question 32

what symptoms would a person over 40 need to meet the urgent 2 week wait list?

Answer 32

abdo pain and unexplained weight loss

Question 33

what would a person over 50 need to present with to meet 2 week wait criteria

Answer 33

unexplained rectal bleeding

Question 34

what would a person over 60 need to present with to meet 2 ww criteria

Answer 34

change in bowel habit or iron deficiency anaemia

Question 35

What does Faecal immunochemical test look for?

Answer 35

the amount of human haemoglobin in the stool

Question 36

what is the gold standard test to investigate colon cancer

Answer 36

colonoscopy to visualise any lesions and take a biopsy

Question 37

What is the name of the tumour marker for colon cancer?

Answer 37

carcinoembryonic antigen tumour marker

Question 38

symptoms of bowel cancer

Answer 38

rectal bleeding
weight loss
iron deficiency
abdominal pain that is not specific
change in bowel habit
abdominal masses