Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Yr3 Revision: Condensed Notes > Colorectal I > Flashcards

Colorectal I Flashcards

1
Q

What positions do you find haemorrhoids in? [3]

A

11, 7 and 3 o’clock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

A fistula is defined as an abnormal connection between two epithelial surfaces.

What are the two most common causes of fistulae? [2]

A

diverticular disease and Crohn’s.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe how you treat fistulae if:
- No IBD or distal obstruction? [1]
- High-output is excessive? [2]
- Secondary to Crohns? [1]

A

No IBD or distal obstruction: Conservative management
- High-output is excessive: octreotide (reduces pancreatic secretions); TPN
- Secondary to Crohns: drain acute sepsis; seton placement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Anal cancer is linked with an infection of which virus? [1]

A

HPV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe the difference in presentation of Lynch syndrome (HPNCC) and FAP [1]

A

Lynch syndrome:
- causes bowel cancer without adenomatous polyps

FAP:
- Poylpoidal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe the difference in screening for Lynch syndrome (HPNCC) and FAP [1]

A

Lynch: colonoscopy every 1 or 2 years from 25
FAP: annual sigmoidoscopy from 15 yrs – if no polyps - every 5 years; if polyps - resectional surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

FAP has a 90% of having polyps where? (outside of large bowel) [1]

A

Duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How do you differentiate between a strangulated and incarcerated indirect inguinal hernia? [2]

A

If a hernia cannot be reduced it is referred to as an incarcerated hernia - these are typically painless

if the patient had systemic features - would indicate strangulated and normally painfull

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How would Meckel’s diverticulitis present? [5]

A
  • most common: painless rectal bleeding
  • age < 2 years
  • passage of bright red blood per rectum (haematochezia)
  • intractable constipation (obstipation)
  • It is clinically indistinguishable from appendicitis: Right sided pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When do you perform an abdomino-perineal resection of a colorectal tumour? [2]

When do you perform an anterior resection? [2]

A

AP resection is the preferred surgical option for tumours < 5 cm from the anal verge or involving the distal 2/3 of the rectum

Anterior resection is the preferred surgical option for tumours >8 cm from the anal canal or involving the proximal 1/3 of the rectum.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

You suspect a patient has a biliary pathology, what is the first line of imaging used to diagnose this? [1]

A

Ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Bowel sounds are helpful in suspected obstruction. Describe how this can be helpful [2]

A

High pitched (tinkling): obstruction

Absent: ileus (non-mechanical obstruction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe a way of classifying bowel obstructions [3]
Name three suggestions for the each of the above [9]

A

Extramural: block bowel from outside
- Adhesions (congenital or aquired)
- Hernia
- Volvulus (caecal; sigmoid; small bowel)
- Compression from lymph nodes

Intramural: blockage from within the wall
- Tumours (adenocarcinoma, GISTs, lymphoma, leiomyosarcoma)
- Strictures bowel has narrowed due to: diverticular, ischaemic, IBD, post op,
- Intussusecption (wall of bowel moves into itself & blocks itself, most commonly at terminal ileum and caecum)

Intraluminal: within the wall
- Gall stones
- Bezoar
- Foreign body
- Meconium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the imaging that is the investigation of choice for bowel obstruction? [1]
State other imaging used [1]

A

CT: imaging of choice;
XR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is gastrograffin AXR? [1]
When is its use indicated? [1]

A

Gastrograffin:
* Water soluble contrast for small bowel adhesive obstruction.
* If gastrograffin has passed into colon then suggests that will resolve (if not then surgery is indicated)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What’s a pneumonic for remembering the causes of small bowel obstruction?

A

“HANG IVs”

Hernias 2%
Adhesions (from previous surgery with formation of intra abdominal adhesions, commonly colorectal and gynaecological surgery)
Neoplasms (malignant, benign, primary or secondary) (5%)
Gallstone ileus
Intussusception
Volvulus
Strictures (eg Crohn’s disease (6%), ischaemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Explain what VBG readings would you suspect with a patient with bowel obstruction? [2]

A

Metabolic alkalosis due to vomiting stomach acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the indications for surgery for SBO? [2]

A

Bowel compromise (e.g. ischaemia, perforation, necrosis), generally occurring in complete bowel obstructions

Surgically correctable causes (e.g. volvulus, incarcerated hernia, gallstone ileus, foreign body ingestion, tumour)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How would you surgically treat SBO? [4]

A
  • Exploratory surgery in patients with an unclear underlying cause
  • Adhesiolysis to treat adhesions
  • Hernia repair
  • Emergency resection of the obstructing tumour
  • If surgery is being undertaken, patients should have antibiotic prophylaxis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

If surgery is indicated for SBO, patients should be given antibiotic prophylaxis of which antibiotics? [3]

A

cefoxitin, or ampicillin plus gentamicin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is A?

Anal abscess
Anal fissure
Haemorrhoid
Anal fistula

A

What is A?

Anal abscess
Anal fissure
Haemorrhoid
Anal fistula

An anal fissure is a superficial tear in the skin distal to the dentate line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What does the following best describe?

abnormal tunnel under the skin that connects the anal canal in the colon to the skin of the buttocks

Anal abscess
Anal fissure
Haemorrhoid
Anal fistula

A

What does the following best describe?

abnormal tunnel under the skin that connects the anal canal in the colon to the skin of the buttocks

Anal abscess
Anal fissure
Haemorrhoid
Anal fistula

23
Q

What FBC / blood film finding would indicate acute diverticulitis? [1]

A

Polymorphonuclear leukocytosis

BMJ BP: First line invest.

24
Q

Describe the treatment algorithm for acute fissures

A

1st line: soften stool
- high fibre intak
- Bulk forming laxatives
- lubricants like petroleum jelly

2nd line:
- Glyceryl trinitrate

3rd line:
- topical diltiazem (if headaches from glyceryl trinitrate are too much)

25
Q

Describe the treatment algorithm for chronic anal fissures [3]

A

topical glyceryl trinitrate (GTN) is first-line treatment for a chronic anal fissure

Botulinum toxin or sphincterotomy is used after failure of topical treatment for 8 weeks

sphincterotomy:
The operation usually takes about 15 minutes. Your surgeon will make a small cut on the skin near your back passage. They will cut the lower part of the internal sphincter muscle. This will relieve the spasm in the sphincter, allowing a better blood supply to heal the fissure.

26
Q

almost all diverticula are found in the []

A

almost all diverticula are found in the sigmoid colon

27
Q

Describe two symptoms of complications of diverticulitis [2]

A

pneumaturia or faecaluria may suggest a colovesical fistula
vaginal passage of faeces or flatus may suggest a colovaginal fistula

28
Q

What might an AXR show in diverticulosis? [3]

A

AXR: may show dilated bowel loops, obstruction or abscesses

29
Q

Describe the treatment regime for diverticulitis? [4]

A

mild cases of acute diverticulitis may be managed with oral antibiotics, liquid diet and analgesia CKS

dicycloverine: antispasmodic

if the symptoms don’t settle within 72 hours, or the patient initially presents with more severe symptoms, the patient should be admitted to hospital for IV antibiotics

Consider open or laparoscopic resection for patients who have recovered from complicated acute diverticulitis but have continuing symptoms (such as stricture or fistula)

30
Q

An anal longintudinal tear and fresh rectal bleeding is the diagnosis of? [1]

A

Anal fissure

31
Q

What are the three type of colon cancer? [3]

A

Sporadic (95%)
Hereditary non-polyposis colorectal carcinoma (5%)
Familial adenomatous polyposis (<1%)

32
Q

Describe the genetic influence of developing colorectal cancer [2]

A

Hereditary non-polyposis colorectal carcinoma (aka Lynch syndrome; HNPCC, 5%):
- Autosomal dominant
- DNA mismatch repair, effecting MSH2, MLH1, MHSH6, PMS2 genes
- Does not cause adenomas
- Tumours develop in isolation

Familiar adenomatous polyposis (FAP):
- autosomal dominant
- malfunction of tumour suppressor gene adenomatous polyposis coli (APC)
- causes many polyps in the large intestine

33
Q

What is the name for the staging criteria of colorectal cancer? [1]
Describe each stage [4]

A

Duke’s classification

34
Q

Describe how colorectal tumours can present via colonoscopy [3]

A

Ulcerating
Stenosing
Polypoidal

35
Q

What does this colonoscopy of colorectal cancer depict?

Ulcerating
Stenosing
Polypoidal

A

Ulcerating
Stenosing
Polypoidal

36
Q

What does this colonoscopy of colorectal cancer depict?

Ulcerating
Stenosing
Polypoidal

A

What does this colonoscopy of colorectal cancer depict?

Ulcerating
Stenosing
Polypoidal

37
Q

What does this colonoscopy of colorectal cancer depict?

Ulcerating
Stenosing
Polypoidal

A

What does this colonoscopy of colorectal cancer depict?

Ulcerating
Stenosing
Polypoidal

38
Q

Options for managing bowel cancer (in any combination) are? [4]

A

Surgical resection
Chemotherapy
Radiotherapy
Palliative care

39
Q

make sure you know about blood supply for colon bits (its different)

A
40
Q

All patients with newly diagnosed colorectal cancer should have which tests for staging? [3]

A

Entire colon evaluated with colonscopy or CT colonography

Carcinoembryonic antigen (CEA)

CT of the chest, abdomen and pelvis

41
Q

Describe the adjuvant chemotherapy given for colorectal cancer: [2]

Describe the biologicals used [3]

A

Dukes B if poor prognositic factors

Dukes C:
- Fluorouracil (5-FU)
- Capecitabine (first line)

Biologicals:
- Cetuximab (anti-EGFR)
- Panitumubab (anti-EGFR)
- Bevacizumab (anti-VEGF)

42
Q

Radiotherapy is used for pre-op. treatment of which specific type of colorectal cancer? [1]

A

Rectal cancer

43
Q

State 4 reasons why get referred to the two week cancer pathway for colorectal cancers [5]

A

Positive FIT test
Over 40 years with abdominal pain and unexplained weight loss
Over 50 years with unexplained rectal bleeding
Over 60 years with a change in bowel habit or iron deficiency anaemia
Any age with rectal or abdominal mass

44
Q

What type of treatment is radiotherapy generally used for in colorectal cancer? [2]

A

Palliative care
Rectal cancers with high risk of local reoccurence

45
Q

Under which conditions do you only perform abdominal-perineal excision of rectum?[1]

A

Abdominal-perineal excision of rectum is only used when the anus is involved.

46
Q

What is the FOLFOX regime of treating colorectal cancer? [3]

A

Chemotherapy regime of:
* 5-FU
* Folinic acid
* Oxaliplatin

47
Q

Which of the following involves removing the sigmoid colon and upper rectum but sparing the lower rectum and anus?

Hartmann’s procedure
High anterior resection
Left hemicolectomy
Low anterior resection
Right hemicolectomy

A

Which of the following involves removing the sigmoid colon and upper rectum but sparing the lower rectum and anus?

Hartmann’s procedure
High anterior resection
Left hemicolectomy
Low anterior resection
Right hemicolectomy

48
Q

What investigational method is used to properly ID a haemorrhoid? [1]

A

Proctoscopy

49
Q

Describe the topical treatments used for haemorrhoids? [3]

A

Anusol:
- Chemicals used to shrink

Anusol HC
- As above but with hydrocortisone

Germoloids:
- Lidocaine

50
Q

Describe the non-surgical treatments used for haemorrhoids? [4]

A

Rubber band ligation
Injection sclerotherapy
IR coagulation
Bipolar diathermy

PassMed: outpatient treatments: rubber band ligation is superior to injection sclerotherapy

51
Q

What are the surgical treatment options for haemorrhoids? [4]

A

Surgical haemorrhoidectomy
Haemorrhoid artery ligation
Staple haemorrhoidectomy

52
Q
A
53
Q
  1. A 45-year-old man presents with a carcinoma 10cm from the anal verge, he has completed a long course of chemoradiotherapy and has achieved downstaging with no evidence of threatened circumferential margin on MRI scanning.

What is the most appropriate colonic resction for this patient?

A

Anterior resection with covering loop ileostomy
- ‘carcinoma 10cm from the anal verge’ implies that the anus is unaffected by the cancer. Abdominal-perineal excision of rectum is only used when the anus is involved.

Low rectal cancer is usually treated with a low anterior resection. Contraindications to this include involvement of the sphincters (unlikely here) and poor sphincter function that would lead to unsatisfactory function post resection. Most colorectal surgeons defunction resections below the peritoneal reflection as they have an intrinsically high risk of anastomotic leak. A loop ileostomy provides a safe an satisfactory method of defunctioning these patients. A contrast enema should be performed prior to stoma reversal.

54
Q

After testing, he is found to be a carrier of the MSH2 gene and is subsequently diagnosed with HNPCC.

Aside from colorectal cancer, which of the following is the patient at greatest risk of developing?

Endometrial cancer
Lung cancer
Medulloblastoma
Pancreatic cancer
Thyroid cancer

A

After testing, he is found to be a carrier of the MSH2 gene and is subsequently diagnosed with HNPCC.

Aside from colorectal cancer, which of the following is the patient at greatest risk of developing?

Endometrial cancer
Lung cancer
Medulloblastoma
Pancreatic cancer
Thyroid cancer

HNPCC is associated with an increased risk of endometrial cancer, however this patient is male.

Yr3 Revision: Condensed Notes (46 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions