Gastrointestinal Flashcards
(197 cards)
1
Q
What is inflammatory bowel disease?
A
A term that describes disorders involving chronic inflammation of the intestines causing malabsorption
2
Q
What are the types of inflammatory disease?
A
Chrohn’s disease
Ulcerative Colitis
3
Q
What is Ulcerative colitis?
A
Autoimmune inflammatory condition of the colon mucosa up to the ileocaecal valve. Ulcers form along the lumen of intestine.
4
Q
What are the risk factors of ulcerative colitis?
A
FHx, jewish, associated with HLAB27 gene,
smoking - PROTECTIVE
5
Q
What is macroscopic view of ulcerative colitis?
A
- starts at rectum can progress to ileocaecal valve
-circumferential and continuous inflammation
-no skipped lesions
-ulcers and pseudopolyps in severe disease
6
Q
What is the microscopic view of UC?
A
- mucosa only inflamed
-crypt abcesses
-depleted goblet cells
7
Q
What is the presentation of UC?
A
-Pain in LLQ + Tenesmus (rectal defamation pain)
-Bloody mucusy watery diarrhoea
-Extraintestinal:
-erythema nodosum
-uveitis
-PSC - primary sclerosis cholangitis
8
Q
What is the diagnosis for UC?
A
Test for pANCA
Fecal calprotectin - indicates IBD when raised
Biopsy - mucosal inflammation with crypt hyperplasia
colonoscopy/XR- continuous ‘lead pipe’ sign
Severity of flares. -truelove +witts scoring
9
Q
What does the biopsy show for UC?
A
mucosal inflammation with crypt hyperplasia
10
Q
What would the colonoscopy/XR for UC show?
A
continuous/ “Lead pipe sign”
11
Q
What scoring is used to test the severity of UC?
A
True love and Witts scoring
12
Q
What is the treatment for UC?
A
- Flares = Sulfasalazine and prednisolone
- For remission =Azathioprine
3.Biologics = Anti-TNF Infliximab -
Surgery - total/ partial colectomy - curative
13
Q
What is a complication of UC?
A
Toxic megacolon
14
Q
What is Crohn’s disease?
A
A transmural, granulomatous inflammation affecting any part of the gastrointestinal tract(usually rectum spared)
15
Q
what are the risk factors for crohn’s?
A
FHx, jewish, smoking, NOD2 gene
16
Q
What does chrohns look like macroscopically?
A
- any part from mouth to anus- most commonly terminal ileum and proximal colon
-skip lesions
-cobblestone appearance -ulcers and fissures in mucosa
17
Q
What does chrohns look like microscopically?
A
-transmural inflammation (all layers of bowel wall)
-granulomas - no caseating
-incraesed chronic inflammatory cells and lymphoid hyperplasia
18
Q
What is the presentation of crohn’s?
A
-Pain in RLQ
-Malabsorption - B12/folate/Fe deficiency
-Gall/kidney stones
-watery diarrhoea
-apthous mouth ulcers
-uveitis
-erythema nodosum
-spondylarthritis
19
Q
What is the diagnosis for Crohn’s?
A
pANCA negative
fecal calprotectin high - as IBD
Biopsy/endoscopy/XR
Endoscopy/XR= skip lesions, cobblestones, string sign
Biopsy= transmural inflammation with non caseating granulomas
20
Q
What is shown on the endoscopy/XR for crohns?
A
skip lesions, cobblestoning/String sign
21
Q
What does the biopsy show for crohn’s?
A
Transmural inflammation with non caseating granulomas
22
Q
What is the treatment for crohns?
A
- For flares: sulfasalazine and prednisolone
- For remission: Azathioprine
- Biologics: Anti TNF- infliximab
Surgery -not curative
23
Q
What are the complications of crohns?
A
fistula, strictures, accesses, small bowel obstruction
24
Q
What is Coeliac disease?
A
An autoimmune type 4 hypersensitivity reaction to gluten causing inflammation of the mucosa of the upper small bowel.
HLADQ2 +DQ8 susceptible
25
What is the pathology of coeliacs?
Prolamins in gluten (A-gliadin) is resistant to proteases in the small intestinal lumen.
Binds to IgA and interacts with
tissue transglutaminase.
Interacts with antigen presenting cells via HLA-DQ2 or 8, causing an immune response.
Results in high IgA, IgA anti-ttg and endomysial antibodies
26
What is the presentation of coeliac disease?
-Malabsorption - Fe/B12/Folate feficiency causing anaemia - anaemia Sx (fatigue, angular stomatitis)
-Diarrhoea
-steatorrhoea
-weight loss and failure to thrive
-osteopenia - low calcium absorption
-Dermatitis herpetiformis - rash on knees due to IgA skin deposition
27
What is the diagnosis of coeliac disease?
1st line screening -Serology - anti -ttG, total IgA high
2nd. - EMA high
Gold - diagnostic - Duodenal biopsy; crypt hyperplasia and villous atrophy + epithelial lymphocyte infiltration
28
What is the treatment for coeliac?
- stop eating gluten (replace vitamins/ mineral deficiency)
-monitor osteoporosis with deja scans
29
What is tropical sprue?
enteropathy associated with tropical travel, produces similar sprue to coeliac biopsy - crypt hyperplasia and villous atrophy
Treat - Abx
30
What is irritable bowel syndrome?
Functional chronic bowel disorder related to psychology (stress/anxiety); 3 months of GI Sx with no underlying cause. Everything rules out (IBD, coeliac)
31
What are the 3 types of IBD?
IBS - C - constipation
IBS - D - Diarrhoea
IBS - M - mixed of C/D
32
What is the presentation of IBS?
Abdo pain + bloating - relieved from defeacation
Altered stool form/frequency
urgency
33
What is the diagnosis of IBS?
Exclusions:
- exclude coeliac(serology), IBD(fecal calprotectin) and infection (ESR,CRP, blood cultures)
34
What is the treatment for IBS?
1 - conservative =patient education and reassurance
2- moderate IBS-C= laxatives, more fibre
IBS-D=antimotilitydrug - loperamide
3.Severe - TCA- amitriptyline /consider CBT/referal
35
What is GORD - Gastro - oesophageal reflux disease?
Gastric reflux into oesophagus due to low pressure across lower oesophageal sphincter causing oesophagitis.
36
What are the causes of GORD?
- increase intra-abdominal pressure - obesity/pregnant
-hiatal hernia (mostly with sliding; LOS slides up through diaphragm
-Drugs e.g antimuscarinic
-Scleroderma (LOS-scarred)
37
What is the pathology of GORD?
Low, lower oesophageal sphincter pressure so more potential for free up passage of acid.
38
What is the presentation of GORD?
Heartburn - retrosternal burning chest pain + chronic cough and nocturnal asthma + dysphagia
Worse lying down
39
What is the diagnosis for GORD?
-No red flags - Go straight to treatment - diagnosis is clinical
-Red flags (Dysphagia, heamatemesis, weight loss)
Endoscopy - oesophagitis or barrets oesophagus
Oesophageal manometry - measure LOS pressure and measure gastric acid pH
40
What is the treatment for GORD?
1. conservative - lifestyle changes (smaller meds, >3hr eating before bed)
2. PPI - lansoprazole
Antacids
Alginates - Gaviscon (symptomatic)
Surgery- tightening of LOS- Nissan fundoplication
41
What are the complications of GORD?
-Oesophageal strictures: usually 60+ patients, progressively worsening dysphagia
Treat: PPI and oesophageal dilation
-Barrets oesophagus
42
What is Barrets oesophagus?
-10% GORd patients develop barrets, always involves hiatal hernia
-Metaplasia(stratified squamous to simple columnar)-->dysplasia -Adenocarcinoma
-Usually middle aged caucasian male with history of GORD
-Dx- biopsy
43
What is a Mallory Weiss Tear?
Linear Lowe oesophageal mucosal tear due to sudden increase in intraabdominal pressure.
44
What are the risk factors of Mallory Weiss tear?
Alcohol, chronic cough, bulimia, hyperemesis gravidarum (severe N+V in pregnancy)
45
What would you suggest if the patient had no history of liver disease and pulmonary hypertension and are presenting with haemetemesis?
Haematemesis + pul HTN= oesophageal varices rupture
Haematemesis + no HX of liver disease= MWT
46
What is the presentation of Mallory Weiss tear?
Haematemesis (after retching/vomiting HX)
+hypotensive if severe
47
What is the diagnosis for mallory Weiss tear?
Oesophago -gastro duodenooscopy to confirm (Rockall score= for severity of upper GI bleeds)
48
What is the treatment for Mallory Weiss tear?
Most spontaneously heal within 24hr
49
What is peptic ulcer disease?
Punched out round holes from either the stomach or the duodenum.
50
What's the most common PUD?
Duodenal ulcer
51
Where is a gastric ulcer?
most commonly in the lesser curve
52
What are the causes of a gastric ulcer?
Helicobacter pylori
NSAIDs
Zollinger Ellison syndrome
Gastrin secreting tumour triad:
-pancreatic tumour
-gastric acid hypersecretion
-widespread peptic ulcers
53
what is the presentation of a gastric ulcer?
Epigastric pain
-worse on eating
-better between meals and with antiacids
-typically weight loss
54
What is the diagnosis of gastric ulcers?
If no red flags (55+, haematemesis, anaemia, dysphagia)
- non invasive tests - stool antigen test - for H.pylori/ Urea breath test
If red flags:
-urgent endoscopy + biopsy
55
What is the treatment for gastric ulcers ?
- stop NSAIDs and if H.pylori positive = triple therapy CAP
CAP= clarythromycin, Amoxicillin +PPI
If PUD found - rescope around 6-8weeks later
56
What are the complications of gastric ulcers ?
Bleeding- left gastric artery ruptured
57
Where is a duodenal ulcer?
mostly at D1 and D2 posterior wall
58
What are the causes of a duodenal ulcer?
H.pylori
NSAIDs
ZE syndrome
59
What is the most common cause of duodenal ulcers?
H.pylori
NSAIDs and ZE more applicable to gastric ulcers
60
What is the presentation of duodenal ulcers?
Epigastric pain
-worse between meals
-better with food
-typically weight gain
61
What is the diagnosis of duodenal ulcers?
-If no red flags:
Non invasive testing
-urea breath test
-stool antigen test
-If red flags:
-urgent endoscopy and biopsy (will see brunners gland hypertrophy -more mucus production)
62
What are the red flags for PUD?
Haematemesis
Dysphagia
anaemia
55+
63
What is the treatment for duodenal ulcers?
Stop NSAIDs and if H.pylori - triple therapy CAP
CAP= clarythromycin, amoxicillin , PPI
If PUD found - rescope in 6-8weeks
64
What is the complication of duodenal ulcers?
Bleeding - ruptured gastroduodenal artery
65
What is gastritis?
Mucosal inflammation and injury of stomach
66
What are the causes of gastritis?
Autoimmune (related to pernicious anaemia + anti- IF antibody), H.pylori, NSAIDs, mucosal ischemia + campylobacter + viral
67
What is the pathology of autoimmune gastritis?
Affects fundus part of stomach, causes atrophy of parietal cells
68
What is the pathology of H.pylori causing gastritis?
H.pylori lives in gastric mucus = secrets urease which spilts urea into ammonia and CO2. Ammonia and H+ = ammonium. Ammonium damages gastric epithelium - causing an inflammatory response. Causes increase in gastrin release and decrease in somatostatin.
69
What is the presentation of gastritis?
Epigastric pain with diarrhoea, N+V, indigestion
70
What is the diagnosis of gastritis?
If H.pylori suspected : stool antigen test, urea breath test
Gold standard - endoscopy and biopsy
71
What is the treatment for gastritis?
H.pylori - triple therapy
CAP = clarythromycin, amoxicillin, PPI
72
What is Appendicitis?
Inflamed appendix, usually due to lumen obstruction. Surgical emergency -peak age 10-20
73
What are the causes of appendicitis?
Faecolith (hard solidified faeces), lymphoid hyperplasia, intestinal worms
74
What is the pathology of appendix?
Most commonly appendix occurs because of an obstruction within the appendix. The obstruction results in the invasion of gut organisms (E.coli) and a pressure increases inside appendix, increase in rupture risk.
75
What is the presentation of appendicitis?
Umbilical pain which localises to mcburneys point + rebound tenderness and abdo guarding
-pyrexic
SIGNS
-Rovsing sign - press on RLQ causes Low pain
-Obturator pain -internal rotation of thigh pain
-Psoas - (lying on left side and extending right led = pain)
76
What are the complications of appendicitis?
Periappendiceal abscess
77
What is the diagnosis of appendicitis?
CT abdo and pelvis - gold ST
Preg test- rule out ectopic pregnancy (presents with RIF pain)
78
What is the treatment for appendicitis?
Abx then appendectomy - laparoscopic
-Must drain abscesses - resistant to Abx
79
What is Diverticular disease?
Symptomatic outpouching of colonic mucosa
80
What is diverticulum?
An out pouching at perforating artery sites
81
What is diverticulosis?
Asymptomatic out pouch
82
What is diverticulitis?
Inflammation of out pouch ; infection
83
What is meckel's diverticulum?
paediatric disorder ; failure of obliteration of vitelline duct. Rule of 2s:
-2year old
-2inches long
-2feet from ileoceacal valve
Technetium scan
84
What are the risk factors for diverticular disease?
- low fibre diet
-ageing
-obesity
-increase in colon pressure; copd; chronic cough
85
What is the presentation of diverticular disease?
Triad:
-LLQ pain
-constipation
-fresh rectal bleeding
86
what is the diagnosis of diverticular disease?
CT abdo/pelvis with contrast - GS
87
What is the treatment for diverticular disease?
D-Losis = watch and wait
D-lar disease =bulk forming laxative. surgery is GS
D-Litis = Abx (coamoxiclav) + paracetamol. IV fluid +liquid food. Rarely surgery
88
What are complications of diverticular disease?
Obstruction, fistulae, SBP
89
What is intestinal obstruction?
Mechanical bowel obstruction, an arrest of onward propulsion of intestinal contents
90
What are the classifications of bowel obstructions?
small bowel - most common (60-75% of all cases)
Large bowel -(25-40% of all cases)
91
What are the causes of small bowel obstruction?
Adhesions - often surgical - mc
crohns
Strangulating hernias
malignancy
92
What is the presentation of small bowel obstruction?
First vomiting then constipations
mild abdo distension +pain
Tinkling bowel sounds
(hyper resonant bowels on percussion)
93
What are the causes of large bowel disease?
Malignancy(90%)
Volvulvus - mostly sigmoid colon
Intussusception - bowel telescope in on itself- mc in children
94
what os the presentation of LBD?
First constipation , then vomiting
Gross distention and pain
Hyperactive, then normal, then absent bowel sounds
95
What is the diagnosis of bowel obstructions?
1st line - XR = dilated bowel loops + transluminal fluid-gas shadows ( fluid and air accumulates in bowels here- diagnostic sign)
LBO - coffee bean sign (if sigmoid volvulus)
GS- CT abdo
96
What is the treatment for bowel obstruction?
-Fluid resuscitation
-Nasogastric tube - food and medicine
-antiemetics + analgesia for symptoms
-Abx
-surgery to remove obstruction
97
What is pseudo bowel obstruction?
No mechanical obstruction, often a result of post operative state
(symptoms but can't find anything blocking it)
98
What is diarrhoea?
Abnormal passage of loose or liquid stool more than 3 times daily. A presenting symptom with many different diagnosis.
99
What are the types of diarrhoea?
-watery
-secretory
-osmotic
-functional
-steatorrhea
-inflammatory
100
What is dysentery diarrhoea?
an infection of the intestines that causes diarrhoea containing blood or mucus.E.coli, shigella, salmonella
101
What is acute diarrhoea?
<14 days
102
What is chronic diarrhoea?
>28 days
103
What are the causes of diarrhoea?
-IBD
-Coeliac
-Hyperthyroidism
-Inflammation and malignancy
-infective
-worms
-Abx
-parasite - giardiasis
104
What are the viral causes of bacteria?
rotavirus - mc- <3years old kids
norovirus - adults
105
What are the bacterial causes of diarrhoea?
-c.diff
-campylobacter- mc
-e.coli
-salmonella
-cholera
106
How can antibiotics cause diarrhoea?
Antibiotics can give rise to antibiotic induced clostridium .difficile diarrhoea
Rule of C's:
-Clindamycin
-ciprofloxacin
-co-amoxiclav
-cephalosporins
107
What is the diagnosis of diarrhoea?
Think Hx, onset, travel, medications
acute, travel - infective
Under 3 = rotavirus
Abx = c.diff
ricewater= cholera
Non infective, longer Hx :
-IBD,coeliac,malignancy, will have signs
108
What is the treatment for diarrhoea?
Depends on underlying cause:
viral: self limiting
complication =Dehydration and electrolyte loss = fluids, diuralite
bacteria - metronidazole
anti-motility - loperamide
109
What are the two types of oesophageal cancer?
Adenocarcinoma and squamous cell carcinoma
110
What is oesophageal adenocarcinoma?
-lower third of oesophagus
-associated with barrets oesophagus
111
What is oesophageal squamous cell carcinoma?
-upper 2/3rd of oesophagus
-smoking and alcohol
112
What is the presentation of oesophageal cancer?
presents when advanced;ALARMS
113
What does ALARMS stand for?
Anaemia
loss of wt
anorexic
recent sudden Sx worsening
Melena/haematemesis
Swallowing- PROGRESSIVE difficulty
114
What would be non progressive difficulty swallowing?
Achalasia - DDx
oesophagus has reduced/ no ability to do peristalsis and transport food down
115
What is the diagnosis of oesophageal cancer?
GS- OGD + biopsy with barium swallow
CT/PET for staging
116
What is the treatment for oesophageal cancer?
medically fit = chemo/ radio +surgery
Unfit = palliative
117
What are the two types of gastric carcinomas?
Mostly adenocarcinomas
Type 1: The intestinal type/well differentiated, better prognosis , mc
Type 2: Diffuseundifferentiated , signet ring carcinomas
118
What are the causes of gastric carcinomas?
H.pylori
Smoking
CDH-1 mutation (mutated cadherin gene) ;80% risk - type 2
Pernicious anaemia (autoimmune chronic gastritis)
FHX
119
What is the presentation of gastric carcinomas?
severe epigastric pain
Anaemia, wt loss, progressive dysphagia
Mets signs:
Jaundice - liver
Krukenberg tumour -ovarian
Lymphatic spread
120
What is the diagnosis for gastric carcinomas?
Gastroscopy + biopsy
CT/MRI for staging
PET for mets
Staging=TNM
121
What is the treatment for gastric carcinomas?
Surgery
ECF chemo - E – epirubicin. C – cisplatin. F – fluorouracil
122
What are small intestine carcinomas?
SI = pretty tumour resistant -1% of all GI tumours
Most are adenocarcinomas
Same Dx and Tx as gastric
123
What is colorectal polyps and cancer?
precursor = adenoma or polyp.
Mostly spontaneous and benign
Common with age but can progress to cancers
124
What are two autosomal dominant inherited conditions that can increase the risk of polyps?
1. Familial adenomatous polyposis
2. Hereditry non polyposis colon cancer
125
What is FAP?
Autosomal dominant APC gene mutation: 1000s of duodenal polyps
- inevitably will get colorectal cancer
126
What is HNPC?
Autosomal dominat MSH-1 mutation (or MSH-2)- a DNA mismatch repair gene
-rapidly increases progression adenoma--> adenocarcinoma
127
What are the risk factors of colorectal polyps and cancer?
Familial inherited genetic predisposition
Adenomas/polyps
Alcohol,smoking,UC
128
What is the pathology of colorectal polyps and cancer?
progression:
Norm epithelium - adenomas- colorectal adenocarcinomas- metastatic colorectal adenocarcinoma
Can mets to liver and lung
129
What is the presentation of colorectal polyps and cancer?
mostly in distal colon(sigmoid) therefore LLQ pain, bloody mucusy stools(fresh blood; closer to anus)
Tenesmus - if rectal involvement
130
What is the diagnosis of colorectal polyps and cancer?
FIT test (feacal occlult)
- screening test for micro blood particles in stool. Done in all 60+ with Fe deficient anaemia and bowel habit change
- suspected cancer pathway is 2 weeks air, if positive fit test a colorectal cancer referral for colonoscopy + biopsy is within 2 week
- GS =colonoscopy + biopsy
Classification - TNM
131
What is the treatment for colorectal polyps and cancer?
Surgery - only curative option if no mets + chemo
132
What is dyspepsia?
-NOT a disease. A presenting Sx of indigestion
133
What is the presentation of dyspepsia?
early satiation
Epigastric pain and reflux
Extreme fullness
134
What are the causes of dyspepsia?
often unknown , 'functional disorder', maybe related to ulcers
135
What is the diagnosis and treatment of dyspepsia?
Endoscopy to find underlying cause
136
What is achalasia?
oesophageal dysmotility (impaired peristalsis), LOS fails to relax -rare +idiopathic
137
What is the presentation of achalasia ?
Non progressive dysphagia (struggle swallowing on anything) + chesty substernal pain.
Food regurgitation, aspiration pneumonia
138
What is the diagnosis of achalasia?
Bird beak on barium swallow
Manometry (measure pressure across LOS) = diagnostic
139
What is the treatment of achalasia?
Only surgery curative (balloon stenting)
Drugs that may help pre-surgery = nitrates, nifedipine
140
What is a complication of achalasia?
may increase risk of oesophageal squamous cell lung cancer
141
What is ischemic colitis? (Bowel ischaemia?
occlusion of a branch of the superior/ inferior mesenteric artery causing ischaemia to watershed areas of the colon. Colon inflamed due to hypoperfusion.
142
What are the causes of IC?
Affecting IMA: Thrombosis, Emboli, Low CO2 and arrhythmias
143
What are the most common sites affected by IC?
Watershed areas- splenic flexure (mc), sigmoid colon and cecum
144
What is the presentation of IC?
LLQ pain + bright bloody stool
+/- signs of hypovolemic shock
145
What is the diagnosis of IC?
colonoscopy and biopsy - GS (but only after presentation fully recovered; prevents strictures formation and normal healing)
Rule out other causes - stool sample
146
What is the treatment of IC?
Symptomatic - IV fluid + Abx (prophylactic)
Gangrenous (infarcted colon) - only surgery
147
What is a complication of IC?
strictures therefore obstruction
148
What is mesenteric ischaemia?
Ischaemia of small intestine
149
What is acute and chronic mesenteric ischemia?
acute attack -abdo MI
Chronic - longer lasting over months -abdo angiina
150
What are the causes of mesenteric ischameia?
Affecting SMA: Thrombosis - mc
Emboli - due to AF
151
What is the presentation of mesenteric ischeamia?
Triad:
- Central/RIF acute severe abdo pain
-no abdo signs on exam
-rapid hypovolemic shock
152
What is the diagnosis of Mesenteric ischameia ?
CT angiogram
FBC +ABG =persistent metabolic acidosis
153
What is the treatment of mesenteric ischameia?
Fluid resuscitation
Abx
IV heparin(thromboembolism)
Infarcted bowel--> surgery
154
What is a complication of Mesenteric ischameia ?
SBP - Spontaneous bacterial peritonitis
155
What are the types of GI bacteria?
H.pylori
E.coli
C.difficile
156
What is H.pylori?
low virulence commensal in GIT
Gram negative
157
What is the pathology of H.pylori?
1. lowers somatostatin
2. high luminal gastric acid as gastrin incraese
3.Urease; results in ammonium generation
4.lowers HCO3 secretion
158
What can H.pylori cause?
PUD
Gastritis
Gastric carcinomas
159
What is the diagnosis for presence of H.pylori?
Biopsy - stool antigen
C-urea breath test
160
What is the treatment for H.pylori?
CAP
clarythromycin, Amoxicillin, PPI
161
What is E.coli?
Gram negative
commensal of GIT
162
What are the different strains/serotypes of E.coli?
ETEC,EAEC,EPEC --> watery diarrhoea
EHEC--> Bloody diarrhoea
Serotype 0157:H7 --> haemolytic uremic syndrome (haemorrhage diarrhoea + nephrite syndrome)
163
What is the treatment for E.Coli?
Amoxicillin
164
What is C.difficile?
Gram positive spore forming bacteria
165
What can C.difficile cause?
-Mainly induced with Abx -C's!
Normal GIT flora killed by the C's Abx and C.dificil replaces these. Results in dangerous severe watery diarrhoea + dehydration and is highly infectous
- causes pseudomembranous colitis
166
What is the treatment for C.dificil?
Stop using C's Abx
Vancomycin
167
What is haemorrhoids (piles)?
Swollen veins around anus disrupt anal cushions - part of anal cushions prolapse through tight anal passage
168
What is the most common cause of haemorrhoids?
Constipation with straining - anal sex
169
What are the two types of haemorrhoids?
Internal and external
170
What are internal haemorrhoids?
Originate above internal rectal plexus (dentate line)
Less painful as has much less sensory supply. May feel incomplete emptying
171
What are external haemorrhoids?
Originate below dentate line, so painful patients can't sit down
172
What is the presentation of haemorrhoids?
Bright red fresh bleeding and mucusy stool + bulging pain + itchy bum
173
What is the diagnosis of haemorrhoids?
DRE for external
Proctoscopy - for internal
174
What is the treatment for haemorrhoids?
Stool softener
Definitive : Rubber band ligation
175
What is a perianal abscess?
Walled off collections of stool+bacteria around anus
176
What is the mc cause of perianal abscess?
Anal sex, causing anal gland infection
177
What is the presentation of perianal abscess?
pus in stool +constant pain/tender
178
What is the treatment for a perianal abscess?
Surgical removal + drainage - walled off so resistant to oral Abx therapy
179
What is an anal fistula?
Abnormal tracks between inside of anus to elsewhere (subcut skin mostly)
180
What are the causes of anal fistulas?
typically progress from perianal abscesses - abscess discharges (toxic substances ) aid fistula formation
181
What is the presentation of anal fistula?
Bloody/ mucusy discharge - often very visible and painful
182
What is the treatment for anal fistula?
Surgical removal and drainage + Abx if infected
183
What is an anal fissure?
Tear in anal skin lining below dentate line therefore very painful as strong sensory supply
184
What are the causes of anal fissures?
Hard faces
Trauma - childbirth
Crohns/UC
185
What is the presentation of an anal fissure?
Extreme defecation pain and very itchy bum (pruritus ANI) and anal bleeding
186
What is the treatment for anal fissures?
stool softening ; more fibre; more fluids
Topical creams
Definitive - surgery - but not rlly done
187
What is pilondial sinus/ abscess?
Hair follicles get stuck in natal cleft which form small tracts (sinuses)and can get infected (abscesses) - seen in very hairy people
188
What is the presentation of pilondial sinus/abscess?
swollen pus filled smelly abscess on bumcrack - visible on exam
189
What is the treatment for pilondial sinus/abscess?
surgery and hygiene advice
190
What is Zenker's Diverticulum (pharyngeal pouch)?
some food goes down pouch instead of totally down oeosophagus
Sx:
smelly breath
Regurgitation + aspiration of food
191
What is CMV - cytomegalovirus?
causes owl eye colitis on histology - in immunocompromised patients (AIDS defining illness)
192
What is TNM staging?
Cancer staging system
T- primary tumour
N- regional lymph nodes
M- metastases
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What is TX?
main tumour cannot be measured
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What is T0?
Main tumour cannot be measured
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What is T1,2,3,4
Refers to the size and extent of tumour
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What is NX,N0,N1,2,3?
NX: cancer in nearby lymph nodes cannot be measured
N0: no cancer in nearby lymph nodes
N1,2,3: Refers to the number and location of nodes that contain cancer
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What is MX,M0,M1?
MX: metastasis cannot be measured
M0: not spread to other pars of the body
M1:Cancer has spread to other parts of the body
