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Gastroenterology Flashcards

1
Q

Name the 2 types of IBD.

A
  • Ulcerative colitis
  • Crohn’s disease
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2
Q

What antibodies are associated with UC?

A

pANCA

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3
Q

What antibodies are associated with CD?

A

ASCA

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4
Q

Where does UC vs CD affect?

A
  • UC only affects the colon - mucosa and submucosa (superficial)
  • CD affects any part of the GI tract, from mouth to anus - mucosa, submucosa, muscularis propria and serosa (transmaural)
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5
Q

Which type of IBD is of a higher incidence?

A

UC

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6
Q

Which ethnic group are more prone to IBD?

A

Jewish

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7
Q

Which gene is associated with IBD?

A

HLA-B27

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8
Q

Name 2 things which are protective of UC.

A
  • Smoking
  • Appendicectomy
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9
Q

What are 7 risk factors for IBD?

A
  • Family history
  • Female
  • NSAIDs
  • Chronic stress
  • Depression
  • Smoking (CD only)
  • Appendicectomy (CD only)
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10
Q

What is the 1st line investigation for IBD?

A

Faecal calprotectin - elevated

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11
Q

What is the gold standard investigation for IBD?

A

Endoscopy (OGD and colonoscopy) and biopsy

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12
Q

What are the extra-intestinal manifestations of IBD?

A

A PIE SAC:
- Aphthous ulcers/ankylosing spondylitis
- Pyoderma gangenosum - painful ulcers which develop on the legs
- Iritis
- Erythema nodosum - red bumps under the skin
- Sclerosing cholangitis
- Arthritis
- Clubbing

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13
Q

What is the most common extra-intestinal manifestation of IBD?

A

Erythema nodosum

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14
Q

Name 3 macroscopic features of UC.

A
  • Begins in the rectum and extends
  • No skip lesions
  • Pseudopolyps
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15
Q

Name 3 macroscopic features of CD.

A
  • Any part of the GI tract may be affected
  • Skip lesions
  • Cobblestone appearance
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16
Q

Name 3 microscopic features of UC.

A
  • Granuloma formation is rare
  • Depleted goblet cells
  • Increased crypt abscesses
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17
Q

Name 3 microscopic features of CD.

A
  • Non-caseating granulomas
  • Goblet cells not depleted
  • Fewer crypt abscesses
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18
Q

What is commonly associated with UC?

A

PSC

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19
Q

What is commonly associated with CD?

A

Strictures and fistulas

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20
Q

Describe the presentation of UC (6).

A
  • Pain in left lower quadrant
  • Blood and mucus in the stool more likely
  • Diarrhoea
  • Nausea and vomiting
  • Weight loss
  • Anaemia
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21
Q

Describe the presentation of CD (6).

A
  • Pain in right lower quadrant - terminal ileum most likely affected
  • Blood and mucus in the stool less likely
  • Diarrhoea
  • Nausea and vomiting
  • Weight loss
  • Anaemia
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22
Q

What are the 3 types of UC?

A
  • Proctitis - inflammation of the rectum only
  • Left-sided colitis - inflammation of the rectum and left colon
  • Pancolitis - inflammation of the entire colon, up to the ileo-caecal valve
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23
Q

Name the criteria used for UC.

A

Truelove and Witt’s criteria

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24
Q

What is 1st and 2nd line in treating mild to moderate UC?

A

1st line - aminosalicyclates (5-ASAs) e.g mesalazine, sulfasalazine
2nd line - corticosteroids e.g prednisolone

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25
Q

What is 1st and 2nd line in treating severe UC?

A

1st line - IV corticosteroids e.g IV hydrocortisone
2nd line - IV ciclosporin

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26
Q

What can be used to maintain remission when treating UC (3)?

A
  • Aminosalicyclates
  • Azathioprine
  • Mercaptopurine
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27
Q

What may be curative of UC?

A

Surgery to remove the rectum and colon which is affected

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28
Q

How can CD be treated (4)?

A
  • Smoking cessation
  • 1st line - oral prednisolone/IV hydrocortisone
  • 2nd line - add an immunosuppressant e.g azathioprine, mercaptopurine, methotrexate, infliximab, adalimumab
  • Surgical resection
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29
Q

What can be used to maintain remission of CD (2)?

A
  • Azathioprine
  • Mercaptopurine
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30
Q

What is IBS? What are the 3 types?

A

A mixed group of abdominal symptoms for which no organic cause can be found:
- IBS-C - with constipation
- IBS-D - with diarrhoea
- IBS-M - mixed

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31
Q

What are 7 risk factors for IBS?

A
  • Female
  • Family history
  • Anxiety
  • Depression
  • Stress
  • Gastroenteritis
  • Menstruation
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32
Q

Describe the presentation of IBS.

A

A - abdominal pain relieved by defaecation
B - bloating
C - change in bowel habits
Others:
- Nausea and vomiting
- Urgency
- Worsening of symptoms after food

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33
Q

How is IBS diagnosed?

A

Diagnosed by exclusion - nothing to be found:
- Faecal calprotectin - exclude IBD
- Endoscopy - exclude IBD and colorectal cancer

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34
Q

How can mild IBS be treated (3)?

A
  • Education and reassurance
  • Alter fibre intake
  • Low FODMAP diet - cut out apples, artichokes, baked beans, cows milk
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35
Q

How can moderate IBS be treated (4)?

A
  • Laxatives - for constipation
  • Anti-motility agents - for diarrhoea
  • TCAs e.g amitriptyline
  • Psychological treatment
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36
Q

How can severe IBS be treated?

A

Refer to pain centre

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37
Q

Name an anti-motility agent that can be used for diarrhoea.

A

Loperamide

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38
Q

Name some laxatives that can be used for constipation (3).

A
  • Ispaghula husk
  • Senna
  • Movicol
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39
Q

Name drugs which can be used to treat pain/bloating/cramps associated with IBS.

A
  • Peppermint oil
  • Buscopan
  • Mebeverine hydrochloride
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40
Q

What is coeliac disease?

A

An autoimmune reaction to gluten

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41
Q

Which part of the GI tract is most affected in coeliac disease?

A

Duodenum

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42
Q

Name 2 genes associated with coeliac disease.

A

HLA-DQ2
HLA-DQ8

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43
Q

Name 2 auto-antibodies associated with coeliac disease.

A

Anti-tissue transglutaminase (anti-TTG) - IgA
Anti-endomysial (anti-EMA) - IgA

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44
Q

Which auto-antibody is sensitive to coeliac disease?

A

anti-TTG

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45
Q

Which auto-antibody is specific to coeliac disease?

A

anti-EMA

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46
Q

What are 6 risk factors for coeliac disease?

A
  • Family history
  • IgA deficiency
  • Really young or really old
  • Early exposure to gluten
  • Type 1 diabetes
  • Autoimmune thyroid disease
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47
Q

Describe the presentation of coeliac disease (9).

A
  • Failure to thrive in children
  • Steatorrhoea
  • Dermatitis herpetiformis - itchy, blistering rash on the abdomen
  • Abdominal pain
  • Bloating
  • Mouth ulcers
  • Angular stomatitis
  • Unintentional weight loss due to malabsorption
  • Anaemia
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48
Q

What is the 1st line investigation for coeliac disease?

A

Serology - look for anti-TTG and anti-EMA

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49
Q

What is it really important to ensure before making a diagnosis of coeliac disease?

A

Must be having gluten in their diet for the 6 weeks before a diagnosis is to be made

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50
Q

What is the gold standard investigation for coeliac disease?

A

Duodenal biopsy:
- Villous atrophy
- Crypt hyperplasia
- Lymphocyte infiltration

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51
Q

How is coeliac disease treated?

A

Life-long gluten free diet

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52
Q

What vitamin is someone with coeliac disease likely to be deficient in? Why?

A

Iron - it is absorbed in the duodenum

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53
Q

What type of reaction of coeliac disease?

A

Type 4 hypersensitivity reaction

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54
Q

Name a complication of coeliac disease. How can this be managed?

A

Hyposplenism - greater risk of infections:
- Annual flu vaccine
- Pneumococcal booster every 5 years

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55
Q

What is GORD?

A

Reflux of stomach contents into the oesophagus

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56
Q

What are the risk factors for GORD (10)?

A
  • LOS hypotension
  • Hiatus hernia
  • Gastric acid hypersecretion
  • Delayed gastric emptying
  • Over-eating
  • Pregnancy
  • Obesity
  • Smoking
  • Alcohol
  • Caffeine
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57
Q

Describe the presentation of GORD (4).

A
  • Heartburn - aggravated by bending or lying down, worsens with hot drinks or alcohol, seldom radiates to the arm
  • Sour/bitter taste in the mouth due to acid regurgitation into the mouth
  • Enamel erosion
  • Dysphagia
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58
Q

What is the 1st line investigation for GORD?

A

Therapeutic challenge - giving a PPI usually improves symptoms
- GORD is common and usually does not require investigation

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59
Q

What is the gold standard investigation for GORD?

A

24 hour PH monitoring of the lower oesophagus

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60
Q

Give 5 lifestyle changes for GORD.

A
  • Weight loss
  • Smoking cessation
  • Avoid alcohol, caffeine, spicy and fatty foods
  • Small, regular meals
  • Avoid eating 3 hours before going to bed
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61
Q

Name drugs which can be used to treat GORD (4).

A
  • PPIs e.g lansoprazole
  • H2 receptor antagonists e.g cimetidine
  • Antacids e.g aluminium hydroxide, magnesium trisilicate
  • Alginates e.g Gaviscon
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62
Q

What can be used as a last resort to treat GORD?

A

Nissen fundoplication - gastric fundus is wrapped around LOS to make it tighter

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63
Q

Name 3 complications of GORD.

A
  • Barrett’s oesophagus
  • Oesophagitis
  • Laryngitis
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64
Q

What happens in Barrett’s oesophagus?

A

Oesophageal epithelium undergoes metaplasia from stratified squamous epithelium to columnar epithelium, there is an increased risk of progression to oesophageal adenocarcinoma

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65
Q

What are peptic ulcers? Where can they occur?

A

A break in the mucosal lining of the stomach or duodenum:
- Gastric ulcers
- Duodenal ulcers

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66
Q

Which type of peptic ulcer is more common?

A

Duodenal ulcers

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67
Q

Where do gastric ulcers usually occur?

A

Lesser curvature of the stomach

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68
Q

Where do duodenal ulcers usually occur?

A

Duodenal cap - first part of the duodenum

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69
Q

What are the risk factors and causes of peptic ulcers (6)?

A
  • H. pylori
  • NSAIDs
  • Ischaemia
  • Gastric acid hypersecretion
  • Smoking
  • Stress
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70
Q

Describe the presentation of peptic ulcers (4).

A
  • Burning epigastric pain
  • Bloating
  • Nausea and vomiting
  • Weight changes
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71
Q

How can gastric vs duodenal ulcers be differentiated?

A
  • Gastric ulcers - pain increases whilst eating –> weight loss
  • Duodenal ulcers - pain decreases whilst eating –> weight gain
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72
Q

Name a complication of peptic ulcers.

A

Perforation - ulcer erodes the wall of the stomach or duodenum allowing contents to enter the sterile peritoneal cavity, this can lead to peritonitis

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73
Q

Name a complication of gastric ulcers.

A

Ulcer erodes the left gastric artery causing massive haemorrhage

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74
Q

Name a complication of duodenal ulcers.

A

Ulcer erodes the gastroduodenal artery causing massive haemorrhage

75
Q

How are peptic ulcers investigated?

A

Under 55 - non-invasive testing first - stool antigen test, urea breath test
Over 55/red flag symptoms - endoscopy and biopsy

76
Q

Why should endoscopy be repeated 6-8 weeks after peptic ulcers are treated (2)?

A
  • To check ulcer has healed
  • To ensure there is no malignancy
77
Q

What lifestyle changes can be made to treat peptic ulcers (4)?

A
  • Avoid irritating foods
  • Smoking cessation
  • Manage stress
  • Stop NSAIDs
78
Q

How is H. pylori treated?

A

Triple therapy:
- PPI - lansoprazole, omeprazole
- Amoxicillin
- Clarithromycin

79
Q

Where is the appendix located?

A

McBurney’s point - 2/3 of the way along a line running from the umbilicus to the right asis

80
Q

Who does appendicitis usually affect?

A
  • Males
  • Aged 10-20 years old
81
Q

What are the causes of appendicitis (4)?

A
  • Faecolith (stone made of faeces) - most common
  • Lymphoid hyperplasia
  • Undigested seeds
  • Fliarial worms
82
Q

What is a complication of appendicitis?

A

Appendix ruptures - faecal matter can enter the peritoneal cavity causing peritonitis

83
Q

Describe the presentation of appendicitis (5).

A
  • Abdominal pain that starts in the umbilicus then migrates to the right iliac fossa
  • Fever
  • Nausea and vomiting
  • Anorexia
  • Abdominal guarding
84
Q

What is the 1st line investigation for appendicitis?

A

Ultrasound

85
Q

What is the gold standard investigation for appendicitis?

A

CT

86
Q

How is appendicitis treated?

A

Laparoscopic appendicectomy

87
Q

What is McBurney’s sign (appendicitis)?

A

Pain at the right lower quadrant of the abdomen

88
Q

What is Rovsing’s sign (appendicitis)?

A

Right lower abdominal pain on palpation of the left lower abdomen

89
Q

What is Psoas sign (appendicitis)?

A

Patient is lying on their left side whilst right hip is extended which causes pain

90
Q

What is Obturator sign (appendicitis)?

A

Patient is supine and whilst the flexed right hip is being internally and externally rotated, this causes pain

91
Q

What are diverticula?

A

Outpouchings of the colon

92
Q

What is diverticulosis?

A

Presence of diverticula

93
Q

What is diverticular disease?

A

Diverticula cause symptoms

94
Q

What is diverticulitis?

A

Inflammation of the diverticula

95
Q

Where are diverticula most commonly found? Why?

A

Sigmoid colon - smallest lumen diameter

96
Q

Give some risk factors for diverticula forming (6).

A
  • Over 50
  • Obesity
  • Low fibre diet
  • NSAIDs
  • Smoking
  • Connective tissue disorders e.g Marfans syndrome, Ehlers Danlos syndrome
97
Q

Describe the presentation of diverticulitis (6).

A
  • Mostly asymptomatic
  • Left iliac fossa pain
  • Fever
  • Nausea and vomiting
  • Constipation
  • Rectal bleeding
98
Q

Give 2 complications of diverticulitis.

A
  • Diverticula can rupture causing peritonitis
  • Fistula formation with bladder causing stool and air to enter the bladder
99
Q

How should diverticulitis be diagnosed?

A

CT abdomen

100
Q

Why should a colonoscopy not be done if diverticulitis is suspected?

A

Risk of perforation

101
Q

How can diverticulitis be managed (3)?

A
  • Lifestyle changes e.g high-fibre diet, weight loss, smoking cessation, avoid NSAIDs
  • Paracetamol
  • Laxatives
102
Q

What antibiotics are usually used for diverticulitis?

A
  • Co-amoxiclav
  • Metronidazole
103
Q

What are oesophageal varices?

A

Dilated veins found at the lower end of the oesophagus

104
Q

What is the cause of oesophageal varices (4)?

A

Portal hypertension:
- Cirrhosis
- Alcoholic liver disease
- Schistosomiasis
- Hepatitis

105
Q

What is the most common complication of oesophageal varices?

A

Variceal bleeding due to rupture

106
Q

Describe the presentation of oesophageal varices rupture (6).

A
  • Haematemesis
  • Meleana
  • Haematochezia
  • Pallor
  • Tachycardia
  • Hypotension
    (Asymptomatic if not ruptured)
107
Q

How are oesophageal varices diagnosed?

A

Upper endoscopy

108
Q

How is bleeding from oesophageal varices managed (4)?

A
  • IV fluids
  • Blood transfusion
  • Terlipressin or octreotide
  • Band ligation
109
Q

What does low RBC count and high urea indicate?

A

GI bleed

110
Q

What is a Mallory-Weiss tear?

A

A tear in the lower oesophageal mucosa

111
Q

What condition is associated with Mallory-Weiss tears?

A

Bulimia nervosa

112
Q

What can cause a Mallory-Weiss tear?

A

Violent coughing and vomiting due to binge drinking and forceful eating

113
Q

How is a Mallory-Weiss tear diagnosed?

A

Gastroscopy

114
Q

How are Mallory-Weiss tears treated (2)?

A
  • Most bleeds heal on their own in 24 hours
  • Surgery to sew the tear together is rare
115
Q

What are the 2 types of bowel obstruction?

A
  • Small bowel obstruction
  • Large bowel obstruction
116
Q

What are the 2 types of causes of bowel obstruction?

A
  • Mechanical
  • Functional
117
Q

What is meant by a mechanical obstruction of the bowel?

A

An actual blockage in the large or small intestine which can be partial or complete

118
Q

What is meant by a functional obstruction of the bowel?

A

Disruption to the peristaltic contractions that move food through the intestines

119
Q

What is the most common cause of SBO?

A

Post-operative adhesions

120
Q

What is the most common cause of LBO?

A

Malignancy

121
Q

What are causes of mechanical bowel obstruction (6)?

A
  • Post-operative adhesions
  • Malignancy
  • Volvulus
  • Hernias
  • Inflammatory bowel disease
  • Ingestion of a foreign body which becomes lodged
122
Q

What are causes of functional bowel obstruction (5)?

A
  • Post-operative ileus - trauma during surgery causes paralysis of intestinal smooth muscle contractions
  • Infection e.g appendicitis, peritonitis
  • Hypothyroidism
  • Hypokalaemia
  • Hypercalcaemia
123
Q

Describe the presentation of bowel obstruction.

A
  • Abdominal pain
  • Abdominal distension
  • Nausea and vomiting
  • Constipation
124
Q

Give 3 features of SBO.

A
  • Vomiting is more common
  • Pain in umbilical region
  • Pain is more frequent, but only lasts a few minutes
125
Q

Give 3 features of LBO.

A
  • Vomiting is less common
  • Pain in lower abdomen
  • Pain is less frequent, but lasts longer
126
Q

What can be heard on auscultation in mechanical bowel obstruction?

A

High pitched tinkling bowel sounds

127
Q

What can be heard on auscultation in functional bowel obstruction?

A

Absence of normal bowel sounds

128
Q

What is the 1st line investigation for bowel obstruction? What will it show?

A

X-ray - distended loops of bowel proximal to obstruction

129
Q

What is the gold standard investigation for bowel obstruction?

A

CT scan of abdomen

130
Q

Why should a colonoscopy not be done for suspected bowel obstruction?

A

Due to risk of perforation

131
Q

How is bowel obstruction treated (3)?

A

Drip and suck:
- Nil by mouth
- IV fluids
- Nasogastric suction

132
Q

Which type of bowel obstruction is more common?

A

SBO

133
Q

What type of bowel obstruction is usually seen in children under 2? Explain

A

Intussusception - one part of the intestine slides into the adjacent part of the intestine like a telescope

134
Q

Explain the 3/6/9 rule for abdominal X-rays.

A

Upper limit of the normal diameter of the bowel:
- 3 cm for small bowel
- 6 cm for colon
- 9 cm for caecum

135
Q

Define diarrhoea.

A

Having 3 or more loose stools in 24 hours

136
Q

How can diarrhoea be classified by time (3)?

A
  • Acute - less than 2 weeks
  • Persistent - 2 - 4 weeks
  • Chronic - more than 4 weeks
137
Q

What is important in the treatment of diarrhoea?

A

Rehydration

138
Q

What investigations can be done for diarrhoea (8)?

A
  • FBC
  • Blood culture
  • CRP
  • ESR
  • Faecal calprotectin
  • Stool occult blood
  • Stool culture
  • Endoscopy
139
Q

What are non-infectious causes of diarrhoea (9)?

A
  • IBD
  • IBS
  • Coeliac disease
  • Bowel cancer
  • Stress
  • Hyperthyroidism
  • Hyperkalaemia
  • Drug-induced e.g laxatives
  • Menustration
140
Q

What is dyspepsia?

A

Pain or discomfort in the upper abdomen that usually occurs after eating or drinking (indigestion)

141
Q

What is pseudomembranous colitis?

A

Inflammation of the colon due to overgrowth of clostridium difficile bacteria

142
Q

When does pseudomembranous colitis usually occur?

A

Following antibiotic use - antibiotics disrupt normal bacterial flora but clostridium difficile is resistant to many antibiotics so will thrive

143
Q

How can pseudomembranous colitis be treated (4)?

A
  • Discontinue antibiotics
  • Vancomycin
  • Rehydration
  • Probiotics
144
Q

Describe the presentation of pseudomembranous colitis (3).

A
  • Abdominal pain
  • Fever
  • Diarrhoea
145
Q

What is a complication of pseudomembranous colitis?

A

Toxic megacolon - colon gets dilated and may rupture which can cause death

146
Q

What is the 1st line investigation for pseudomembranous colitis?

A

Stool testing - presence of clostridium difficile

147
Q

What is the gold standard investigation for pseudomembranous colitis?

A

Sigmoidoscopy/colonoscopy

148
Q

What is achalsia?

A

An oesophageal motor disorder characterised by oesophageal aperistalsis and insufficient relaxation of the LOS in response to swallowing

149
Q

Describe the presentation of achalasia.

A
  • Sudden onset dysphagia to solids and liquids
  • Adopts certain positions to aid swallowing
  • Regurgitation
  • Retrosternal pain
  • Gradual weight loss
150
Q

How can achalasia be diagnosed?

A
  • Upper GI endoscopy - exclude malignancy
  • Barium swallow - bird beak appearance
  • Manometry
151
Q

How can achalasia be treated?

A
  • Drugs to relax LOS e.g isosorbide dinitrate, nifedipine, verapamil
  • Pneumatic dilation - uses a balloon to open LOS
  • Laparoscopic hellers myotomy
152
Q

What are the 3 types of bowel ischaemia?

A
  • Acute mesenteric ischaemia
  • Chronic mesenteric ischaemia
  • Ischaemic colitis
153
Q

Which area of the bowel is most prone to ischaemia? Why?

A

Splenic flexure - it is a watershed region

154
Q

What are risk factors for bowel ischaemia (9)?

A
  • Atherosclerosis
  • Older age
  • Smoking
  • Heavy exercise
  • Heart failure
  • Atrial fibrillation
  • Hypercoagulability
  • Hyperlipidaemia
  • Vasculitis
155
Q

What are the 2 types of oesophageal cancers?

A
  • Adenocarcinoma
  • Squamous cell carcinoma
156
Q

Where is an oesophageal adenocarcinoma found?

A

Lower 1/3 of the oesophagus

157
Q

Where is an oesophageal squamous cell carcinoma found?

A

Upper 2/3 of the oesophagus

158
Q

Which type of oesophageal cancer is most common in the UK?

A

Adenocarcinoma

159
Q

What are the risk factors for oesophageal cancer (10)?

A
  • Older age
  • Male
  • Smoking
  • Alcohol
  • Hot drinks
  • Achalasia
  • GORD
  • Oesophagitis
  • Barrets oesophagus
  • Hiatus hernia
160
Q

Describe the presentation of oesophageal cancer.

A

ALARMS VC:
- Anaemia
- Loss of weight
- Anorexia
- Recent onset, progressive symptoms
- Meleana
- Swallowing difficulties - progressive dysphagia
- Vomiting
- Chest pain

161
Q

What is the 1st line investigation for oesophageal cancer?

A

Upper GI endoscopy and biopsy

162
Q

What can be used for staging of cancers?

A

CT scan

163
Q

What are the risk factors for gastric cancer (6)?

A
  • Male
  • Older age
  • Family history
  • Smoking
  • H. pylori
  • Pernicious anaemia
164
Q

Describe the presentation of gastric cancer (3).

A
  • Epigastric pain
  • Weight loss
  • Lymphadenopathy:
    –> Virchow’s node - left supraclavicular node
    –> Sister Mary Joseph’s node - umbilical node
    –> Irish node - left axillary node
165
Q

What is the 1st line investigation for gastric cancer?

A

Upper GI endoscopy and biopsy

166
Q

What is the most common cancer of the GI tract?

A

Colorectal cancer

167
Q

Where are colon cancers usually found?

A

Left side:
- Rectum
- Sigmoid colon

168
Q

What are the risk factors for colon cancer (8)?

A
  • Older age
  • Family history
  • Obesity
  • Smoking
  • Red meat
  • IBD
  • Familial adenomatous polyposis (FAP)
  • Hereditary non-polyposis colorectal cancer (HNPCC)
169
Q

How is colon cancer diagnosed?

A

Colonoscopy and biopsy

170
Q

Name the staging system used for colon cancer.

A

Dukes staging system

171
Q

Name the tumour marker associated with colon cancer.

A

Carcinoembryonic antigen (CEA)

172
Q

Which gene is associated with HNPCC?

A

MSH2/MLH1

173
Q

What is used to screen for bowel cancer?

A

FIT test - detects small amount of blood in the stool
- Sent to those every 2 years between the ages of 60 - 74

174
Q

What are haemorrhoids?

A

Swollen veins found in the anus or rectum

175
Q

What are the 2 types of haemorrhoids?

A
  • Internal - painless, covered in mucus
  • External - painful, covered in skin
176
Q

Describe the presentation of haemorrhoids (4).

A
  • Perianal pain
  • Constipation
  • Itchy anus
  • Fresh, bright, red blood on paper and outside of stools
177
Q

How are haemorrhoids diagnosed?

A

Anoscopy

178
Q

How are haemorrhoids treated (4)?

A
  • Lifestyle changes e.g increased fluid and fibre intake
  • Stool softeners
  • Analgesia - topical anusol
  • Haemorrhoidectomy
179
Q

What is an anal fistula?

A

An abnormal connection between the anal canal and perianal skin

180
Q

Which condition is associated with anal fistulas?

A

Crohns disease

181
Q

What is an anal fissure?

A

A tear in the sensitive skin-lined lower anal canal, distal to the dentate line

182
Q

What is the main cause of anal fissures?

A

Hard faeces

183
Q

Describe the presentation of anal fissures (3).

A
  • Intense pain on defaecation
  • Tearing sensation of defaecation
  • No fresh blood on stool or paper

Conditions (10 decks)

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