Gastrointestinal Flashcards
(202 cards)
1
Q
What is irritable bowel syndrome?
A
A functional bowel disorder. It affects the large intestine.
2
Q
What are the symptoms of IBS?
A
- Abdominal Pain
- Pain is relieved on defecation
- Bloating
- Change in bowel habit
- Mucus
- Fatigue
3
Q
What are the differential diagnoses for IBS?
A
- Coeliac disease
- Lactose intolerance
- Bile acid malabsorption
- IBD
- Colorectal cancer
4
Q
What investigations would be used in IBS?
A
- Bloods – FBC, U+E and LFT
- CRP
- Coeliac serology
5
Q
What is the multifactoral pathophysiology of IBS?
A
- Psychological morbidity e.g. trauma in early life
- Abnormal gut motility
- Genetics
- Altered gut signalling (visceral hypersensitivity)
6
Q
What is the treatment for mild IBS?
A
- Education –> dietary modification e.g. FODMAP
2. Reassurance
7
Q
What is the treatment for moderate IBS?
A
- Antispasmodics for pain, Laxatives for constipation
- Anti-motility agents for diarrhoea
- CBT and hypnotherapy
8
Q
What is the treatment for severe IBS?
A
- MDT approach –> referral to specialist pain treatment centres, Tri-cyclic anti-depressants
9
Q
What is coeliac’s disease?
A
An autoimmune disease affecting anywhere from the mouth to anus (digestive system) that makes the person have an adverse reaction to gluten.
10
Q
What is the pathophysiology of Coeliac’s disease?
A
- Gliadin (product of gluten digestion) = immunogenic
- It can have direct toxic effects by up regulating the innate immune system
- Or HLADQ2 can present it to T helper cells in the lamina propria
- This causes inflammation –> Villi atrophy and malabsorption
11
Q
What are patient’s with coeliac’s disease likely to have?
A
Iron deficiency as it mainly affects the duodenum
12
Q
How many people does coeliac’s disease affect?
A
1% of pop.
13
Q
What is the main breakdown product of Gluten?
A
Gliadin
14
Q
What histological features are needed to make a diagnosis of Coeliacs disease?
A
- Raised intraepithelial lymphocytes
- Crypt hyperplasia
- Villous atrophy
15
Q
What are the symptoms of coeliac’s disease?
A
- Diarrhoea
- Weight loss
- Irritable bowel
- Iron deficiency anaemia
- Abnormal liver function
16
Q
What investigations would you order in coeliac’s disease?
A
- Serology – look for Autoimmune antibodies – TTG and EMA
2. Gastroscopy – Duodenal biopsies
17
Q
What are some associated disorders with coeliac’s disease?
A
- T1
- Thyrotoxicosis
- Hypothyroidism
- Addison’s disease
Osteoporosis is also associated.
18
Q
What is the treatment of coeliac’s disease?
A
Exclusionary diet.
19
Q
What is C. difficile?
A
C.diff is a highly infective gram positive spore forming bacteria.
20
Q
What are the risk factors of c.diff?
A
- Increasing age
- Co-morbidities
- Antibiotic use
- PPI
- Long hospital stays
21
Q
What are the antibiotics which are likely to cause C.diff?
A
- Ciprofloxacin
- Co-amoxiclav
- Clindamycin
- Cephlasporins
- Carbapenems
22
Q
How would you manage C.diff?
A
- Control Antibiotic use
- Infection control measures
- Isolate the case
- Case finding
- Test stool samples for toxins
23
Q
What treatment would be given for c.diff?
A
Metronidazole and Vancomycin (PO)
24
Q
What is Pancreatitis?
A
Inflammation of the pancreas
25
What is the cause of acute pancreatitis
- AI disease
- Drugs/medications
- Surgery
- Trauma
- Metabolic disorders
26
What drugs cause acute pancreatitis
- NSAIDs
- Diuretics
- Steroids
27
What are the potential implications of acute pancreatitis?
systemic inflammatory response syndrome and multiple organ dysfunction
28
What are the symptoms of acute pancreatitis?
1. Severe abdo pain
2. Epigastric pain radiation to the back
3. Nausea and vomiting
4. Decreased appetite
5. Exocrine and endocrine dysfunction
29
What is the consequence of endocrine dysfunction in pancreatitis?
1. Malabsorption
2. Weight loss
3. Diarrhoea
4. Steatorrhoea
30
What is the investigations in pancreatitis?
Investigation
- Right epigastric pain radiating to the back
- FBC --> Pancreatic enzymes raised – amylase and lipase
- CRP --> Inflammatory markers up
31
What is the treatment of Pancreatitis?
1. Analgesia
2. Catheterise and ABC approach for shock patients
3. Antibiotics
4. Nutrition
5. Bowel rest
6. Drainage of oedmatous fluid collections
32
What is chronic pancreatitis?
Inflammation of the pancreas lasting over 6 months.
33
What is the pathogenesis of pancreatitis?
Not fully understood but believed that
1. Pancreatic duct obstruction causes activation of pancreatic enzymes
2. This causes necrosis then fibrosis
34
How does alcohol cause chronic pancreatitis?
Alcohol --> alcohol proteins precipitate in distal structure of pancreas --> obstruction --> pancreatic fibrosis
35
What would be raised in chronic autoimmune pancreatitis?
IgG4
36
What does AI pancreatitis respond well too?
Steroids.
37
What drug is contraindicated in pancreatitis?
Morphine is contraindicated as it increases the sphincter of oddi pressure and aggravates pancreatitis
38
What enzymes are raised in pancreatitis?
LDH and LST
39
What are the categories of Pancreatitis?
1. 70% are oedenamatous – acute fluid collection
2. 25% necrotising
3. 5% haemorrhagic
40
What are the causes of pancreatitis?
1. Gallstones
2. Alcohol
3. Hyperlipidaemia
4. Direct damage e.g. trauma
5. Idiopathic
6. Toxic e.g. drugs, infection and venom
41
How could you make a diagnosis of pancreatitis?
2 of the following
1. Characteristic sever epigastric pain radiating to the back
2. Raised serum amylase
3. Abdo CT scan pathology
42
What can be used as a prognostic tool in pancreatitis?
The Glasgow scoring system
43
What is the treatment for pancreatitis?
1. Analgesia
2. Catheterise and ABC approach for shock patients
3. Antibiotics
4. Nutrition
5. Bowel rest
6. Drainage of oedmatous fluid collections
44
What is Crohn's disease?
A Type of inflammatory bowel disease that inflames the lining of the digestive system.
45
What is the cause of Crohn's disease?
A non-functioning mutation in NOD2.
46
What are some risk factors of Crohn's disease?
Being young
Smoking
Long term NSAID usage
47
What is the histological features of Crohn's disease?
Patchy, granulomatous, transmural inflammation (can affect mucosa or go through bowel wall)
48
What are the symptoms of Crohn's disease?
- Diarrhoea
- Fever and fatigue
- Weight loss and reduced appetite
- Severe crohn’s may cause joint pain.
- Mouth sores
49
What are some complications of Crohn's disease?
1. Malabsorption
2. Fistula
3. Obstruction
4. Perforation
5. Anal fissures
6. Neoplasia
7. Amyloidosis
50
What are the investigations you would conduct in Crohn's disease?
- Blood – CRP - FBC
- Faecal occult blood test
- Colonoscopy and endoscopy
51
What is the appropriate treatment for Crohn's disease?
- Anti-inflammatories
- Corticosteroids e.g. prednisone
- Surgery to heal abscesses/remove fistulas.
52
What is gastritis?
Inflammation of the Gastric lining
53
What are 5 things which cause gastritis?
1. Not enough blood – mucosal ischaemia
2. H. pylori
3. Aspirin or NSAIDs
4. Increased stress
5. Bile reflux
6. Alcohol
54
What are the risk factors for gastritis?
1. Alcohol
2. Older age
3. Stress
4. Autoimmune
55
What are the symptoms of gastritis?
1. Abdo pain – gnawing and burning
2. Vomiting or nausea
3. A feeling of fullness in upper abdo after eating.
56
What investigations would you order in gastritis?
1. Faecal Occult blood test
2. CRP blood test
3. FBC
4. Endoscopy
5. H Pylori Test
57
What is the treatment for Gastritis?
1. Reduced mucosal ischaemia
2. PPI
3. H2RA
4. Enteric coated aspirin
58
How would you diagnose gastritis?
CRP Up
| Endoscopy to confirm as the gold standard.
59
What is GORD?
Gastro-oesophageal reflux disease
A condition where acid frequently flows back into the oesophagus from the stomach and irritates the oesophageal lining.
60
What are 3 indications of GORD?
1. Dyspepsia
2. Dysphagia
3. Anaemia
4. Suspected Coeliac disease
61
What are the symptoms of GORD?
1. Heart burn/chest pain
| 2. Acid Reflux
62
What are the causes of GORD?
1. Weakened muscular sphincter at the bottom of the oesophagus
63
What are the risk factors of GORD?
1. Obesity
2. Pregnancy
3. Smoking
4. Hiatus Hernia
5. Stress
6. Eating large amounts of fatty foods.
64
What are indications for a colonoscopy?
1. Altered bowel habit
2. Diarrhoea
3. Anaemia
65
What is the treatment for GORD?
1. PPI
2. Lifestyle modification
3. Anti-reflux surgery
66
What is dyspepsia?
Indigestion --> refers to a group of conditions causing discomfort, nausea, burping and bloating
67
What is the criteria for dyspepsia?
1. Postprandial fullness
2. Early satiation
3. Epigastric pain/burning
68
What is the cause of dyspepsia?
1. Excess acid
2. Prolonged NSAIDs
3. Large volume meals
4. Obesity
5. Smoking/alcohol
6. Pregnancy
69
What are red flag symptoms in patients with dyspepsia?
1. Unexplained weight loss
2. Anaemia
3. Dysphagia
4. Upper abdo Mass
5. Persistent vomiting
70
What investigations would you give to someone with dyspepsia?
1. Endoscopy
2. Gastroscopy
3. Barium swallow
4. Capsule endoscopy
71
How would you manage dyspepsia if red flag symptoms are present?
1. Suspend NSAID use and review medication
2. Refer malignancy to specialist
3. Endoscopy
72
How would you manage dyspepsia if red flag symptoms were not present?
1. Review medication
2. Lifestyle advice
3. Full dose PPI for 1 month
4. Test and treat H. Pylori infection
73
What lifestyle advice would you give to someone with dyspepsia?
1. Lose wight
2. Stop smoking
3. Cut down alcohol
4. Dietary modification
74
What is Helicobacter Pylori?
A Gram negative bacilli with a flagellum which causes gastritis and abdominal symptoms.
75
How does H Pylori break down the gastric mucosa?
Pylori procures urease --> ammonia --> damage to gastric mucosa
76
What can H Pylori cause?
Gastritis
Peptic ulcer
Gastric cancer
77
What are the risk factors of H Pylori?
Living without clean water, in crowded conditions, living with someone with H pylori infection.
78
What are the symptoms of H Pylori infection?
1. Ache or burning pain.
2. Abdo pain that’s worse when your stomach is empty
3. Bloating, weight loss and nausea
79
What investigations would you carry out with suspected H Pylori infection?
- Urea breath Test
- Blood test
- Stool test
- Endoscopy
80
What is the appropriate management for H Pylori?
Treatment – Triple therapy
2 Antibiotics and 1 PPI
- Omeprazole, Clarithromycin and amoxicillin.
81
What is the potential consequence of H pylori infection in a person with decreased gastric acid?
Gastric cancer
82
What is the potential consequence of H pylori infection in a person with increased gastric acid?
Duodenal ulcer
83
What are the 3 broad a categories of intestinal obstruction?
1. Blockage
2. Contraction
3. Pressure
84
What are the causes of intestinal blockages?
1. Tumour
2. Diaphragm disease – caused by NSAIDs
3. Gallstones in ileum (rare)
85
What are the causes of intestinal contraction?
1. Inflammation
2. Intramural tumours
3. Hirschsprung’s disease
86
What are the causes of intestinal pressure?
1. Adhesions – secondary to abdo surgery, loops of bowel stick together.
2. Volvulus – twist/rotation in the bowel --> risk of necrosis
3. Peritoneal tumour
87
What immediate surgical signs should you identify in intestinal obstruction?
1. Signs of perforation (peritonitis)
| 2. Signs of strangulation
88
Where does volvulus occur?
In free floating areas of the bowel, e.g. mesentery to sigmoid colon.
89
How can crohn's cause intestinal obstruction?
Causes fibrosis, leading to contraction then obstruction
90
How can diverticular disease cause intestinal obstruction?
Outpouching of mucosa --> Faeces trapped --> inflammation in wall --> contraction --> obstruction
91
What are the signs of small bowel obstruction?
1. Vital signs e.g. increased HR, hypotension and raised temperature
2. Tenderness and swelling
3. Resonance
4. Bowel sounds
92
What are the common causes of small bowel obstruction in adults?
1. Adhesions
2. Hernias
3. Crohn’s disease
4. Malignancy
93
Is large bowel or small bowel obstruction more common?
Small bowel is much more common --> 75%
94
What are common causes of small bowel obstruction in children?
1. Appendicitis
2. Volvulus
3. Intussusception – part of the intestine invaginates into another
95
What is Hirschsprungs disease?
Congenital condition where lack of nerves in bowel means motility is affected, gross dilation of bowel and obstruction occurs.
96
What are the symptoms of small bowel obstruction?
1. Vomiting
2. Pain
3. Constipation
4. Distension
5. Tenderness
97
What are the characteristics of proximal obstruction?
Dilation
Distension
Increased secretions
98
What investigations would you order in small bowel obstruction?
1. Good history – ask about previous surgery
2. FBC, U+E, Lactate
3. CT, Ultrasound, MRI
99
What is the management of small bowel obstruction?
1. Fluid resuscitation
2. Bowel decompression
3. Analgesia and anti-emetics
4. Antibiotics
5. Surgery e.g. laparotomy bypass segments.
100
What are the common causes of large bowel obstruction?
- Colorectal malignancy
| - Volvulus (especially in the developing world)
101
What are the symptoms of large bowel obstruction?
1. Tenesmus
2. Constipation
3. Abdo Discomfort
4. Bloating
5. Vomiting
6. Weight loss
102
What are the investigations in large bowel obstruction?
1. Digital rectal exam
2. Sigmoidoscopy
3. Plain X-ray
4. CT scan
103
What is the appropriate management of large bowel obstruction?
1. Fast the patient
2. Supplement O2
3. IV Fluids to replace losses and correct electrolyte balance
4. Urinary catherization to monitor urine output
104
What are the consequences of untreated intestinal obstructions
1. Ischaemia
2. Necrosis
3. Perforation
105
What is Ulcerative collitis?
Continuous inflammation affecting only the mucosa
106
What does Ulcerative collitis affect histologically?
Only affects mucosa.
107
What would you see Histologically in Ulcerative colitis
Crypt abscess and increase in plasma cells in the lamina propria.
108
What are the causes of UC?
- Not known but believed to be an auto immune disease
| - Heredity plays a role in it.
109
What are the symptoms of UC?
- Diarrhoea with blood or pus, abdo pain and cramping
- Rectal pain with or without bleeding
- Inability to defecate despite urgency
- Fatigue and fever
- Weight loss.
110
What investigations would you use for UC?
1. Bloods – FBC, ESR, CRP
2. Faecal calprotectin – shows inflammation but non specific
3. Flexible sigmoidoscopy
4. Colonoscopy
111
What is the treatment for UC?
- Anti-inflammatories e.g. mesalazine
| - Corticosteroids e.g. prednisone
112
What are the complications of UC?
1. Colon – blood loss and colorectal cancer
2. Arthritis
3. Iritis and episcleritis
4. Fatty liver and primary sclerosing cholangitis
5. Erythema Nodosum
113
What are the 5 broad categories of malabsorption?
1. Defected intra-luminal digestion
2. Insufficient absorptive area
3. Lack of digestive enzymes
4. Defective epithelial transport
5. Lymphatic obstruction
114
How can pancreatitis cause malabsorption?
- Results In pancreatic insufficiency and lack of enzymes
| - This causes defective intra-luminal digestion.
115
What are the causes of insufficient absorptive area?
1. Coeliac
2. Crohn’s
3. Extensive parasitisation
4. Small Intestine resection
116
What can cause lymphatic obstruction?
Lymphoma and TB
117
What lack of enzymes can cause lactose intolerance?
Disaccharide enzyme deficiency.
118
What is responsible for the production of gastric acid?
Gastrin
119
Where is folate absorbed in?
Jejunum
120
Where is Vit B12 absorbed?
terminal ileum
121
Where is iron absorbed in?
Duodenum
122
What e.coli causes blood diarrhoea and has a shiga like toxin?
EHEC
123
What E.coli causes large volumes of watery diarrhoea?
EPEC
124
What is EAEC?
Enteroaggregative e.coli
125
What is DAEC?
Diffusely adherent E.Coli
126
What is EIEC?
Enteroinvasive E.coli.
127
What are the symptoms of helmith infection?
1. Fever
2. Eosinophilia
3. Diarrhoea
4. Cough
5. Wheeze
128
What is the reproduction of schistosomiasis?
1. Fluke matures in blood vessels and reproduces sexually in human host
2. Eggs expelled in faeces and enter water source
3. Asexual reproduction in an a intermediate host.
4. Larvae expelled and penetrate back into human host
129
What is the leading cause of diarrhoeal illness in children?
Rotavirus
130
What is schistosomiasis?
A helmith infection which causes diarrhoea.
131
What is the chain of infection?
Reservoir - agent - transmission - host - person to person spread
132
How can you transmit infection?
1. Direct e.g. faeco-oral
2. Indirect e.g. Vector borne (malaria)
3. Airborne e.g. resp route
133
How can you treat birio Cholerae infection?
Hydration
134
What is a peptic ulcer?
Sores that develop in the lining of the stomach, lower oesophagus and SI
135
What are the symptoms of peptic ulcers?
Pain
Weight loss
Bleeding
Perforation
136
What investigations would you do in peptic ulcers?
1. H. Pylori test e.g. urease breath test and faecal antigen test
2. Gastroscopy
3. Barium meal
137
What is the treatment for Peptic ulcers?
1. Stop NSAID’s
2. PPI’s e.g. Omeprazole
3. H. Pylori eradication
138
Why are Peptic ulcers re scoped 6-8 weeks
To ensure they have healed - if they haven't it could indicate malignancy.
139
What are consequences of anterior ulcer haemorrhage?
Acute peritonitis
140
What are the consequences of posterior ulcer haemorrhage?
Pancreatitis.
141
What are the causes of diarrhoeal infection?
1. Traveller’s diarrhoea
2. Viral e.g. rotavirus and norovirus
3. Bacterial e.g. E. coli
4. Parasites e.g. Helminths
5. Nosocomial e.g. C.diff
142
What are the causes on non-infective diarrhoeal infection?
1. Gastritis/peptic ulcer disease e.g. pylori
2. Acute cholecystitis
3. Peritonitis
4. Typhoid/paratyphoid
5. Amoebic liver disease
143
How can you prevent diarrhoea?
1. Access to clean water
2. Good sanitation
3. Hand hygiene
144
Which group is at risk of diarrhoeal infection?
1. Food handlers
2. Health care workers
3. Children who attend nursery
4. Persons of doubtful personal hygiene
145
What important questions should you ask when taking a history of diarrhoea?
1. Blood in mucus or stools
2. Family history of bowel problems
3. Abdo pain
4. Recent foreign travel history
5. Bloating
6. Weight loss
146
What blood tests can be used to differentiate the causes of diarrhoea?
1. FBC
| 2. ESR/CRP
147
What stool tests can be used to differentiate the causes of diarrhoea?
1. Stool culture
| 2. Faecal Calprotectin
148
What is the diagnostic tool for travellers diarrhoea?
3 unformed stools per day and at least one of:
1. Abdo pain
2. Cramps
3. Nausea
4. Vomiting
149
What are the causes of travellers diarrhoea?
1. Enterotoxigenic e.coli (ETEC)
2. Campylobacter
3. Norovirus
150
What is the pathophysiology of travellers diarrhoea?
1. Heat labile ETEC modifies Gs to make it permanently locked on stage
2. Adenylate cyclase activated --> increased cAMP
3. Leads to an increased secretion of Cl- into intestinal lumen
4. H2O follows down as osmotic gradient causing diarrhoea
151
What are non infective causes of diarrhoea?
1. Neoplasm
2. Inflammatory
3. IBS
4. Anatomical
5. Chemical
6. Radiation
7. Hormonal
152
What are the infective causes of dysentery?
1. Shigella
2. Salmonella
3. Campylobacter
4. E.coli 0157
153
What are the infective causes of non-bloody diarrhoea?
1. Rota virus
| 2. Noravirus
154
What is barrett's oesophagus?
When squamous cells undergo metaplastic changes and become columnar cells.
155
What is the oesophagus normally lined by?
Stratified squamous non-keratinising cells?
156
What are the causes of Barrett's oesophagus?
GORDs
| Obesity
157
What is a potential consequences of Barrett's oesophagus?
Adenocarcinoma
158
What is the risk factors for barrett's oeosphagus?
```
Male
White
Obesity
Smoking history
Chronic GORDs
```
159
How does GORDs cause Barrett's oesophagus?
1. GORD damages normal oesophageal squamous cells
2. Glandular columnar epithelial cells replace squamous cells (metaplasia)
3. Continuing reflux leads to dysplastic oesophageal glandular epithelium
4. Continuing reflux leads to neoplastic oesophageal glandular epithelium – adenocarcinoma
160
What are 3 causes of squamous cell carcinoma?
Smoking
Alcohol
Poor diet
161
What is the cause of oesophageal adenocarcinoma?
Barrett's oesophagus.
162
What are the symptoms of barrett's oesophagus?
Heart burn
Difficuilty swallowing food
Rarely chest pain
163
What is the treatment for Barretts oesophagus?
Endoscopic Monitoring
GERD treatment
Cryotherapy
Surgery to remove the damaged section.
164
What are the causes of Gastric cancer?
1. Smoked foods
2. Pickles
3. H. Pylori
4. Pernicious anaemia
165
What is the cause of gastric cancer?
A mutation in CDH1 --> 80% of gastric cancer
166
What is done prophylacticly in a patient with CDH1
Gastrectomy.
167
Describe the development of gastric cancer
- Smoked/pickled food diet leads to intestinal metaplasia of normal gastric mucosa
- Several genetic changes lead to dysplasia
- They eventually become intramucosal and invasive carcinoma
168
What are the signs of Gastric cancer?
1. Weight loss
2. Anaemia
3. Vomiting blood
4. Melaena
5. Dyspepsia
169
What investigations would you perform in suspected gastric cancer?
1. Endoscopy
2. CT – staging
3. Laparoscopy – detects metastatic disease that may not be detected otherwise
170
What is the treatment of gastric cancer?
- Gastrectomy
| - Radiotherapy
171
What are the symptoms of Oesophageal carcinoma?
1. Dysphagia
2. Odynophagia (painful swallowing)
3. Vomiting
4. Weight loss
5. Anaemia
6. GI bleed
7. Reflux
172
What disease is associated with causing oesophageal carcinoma?
Barrett's oesoophagus
173
What are the causes of oesophageal carcinomas?
1. GORDS Barrett’s
2. Smoking
3. Alcohol
174
What is a danger in Oesophageal cancer?
Metastasis
Lymph nodes can commonly metastasise to para-oesophageal lymph nodes
175
What investigations would you perform in suspected oesophageal cancer?
1. Barium swallow
| 2. Endoscopy
176
What is the treatment for oesophageal cancer?
Medically fit and no metastasis = operate. Oesophagus replaced w/ stomach or colon, patient often has 2/3 rounds of chemo beforehand
Medically unfit and metastasis = Palliative care, stents help with dysphagia.
177
What are the symptoms of GI cancer?
- Weight loss
- Dysphagia
- Vomiting
- Anaemia
178
How would you treat a patient with GI cancer with no spread?
- 3 cycles of chem, full gastrectomy and lymph node removal.
179
How would you treat a patient with distal GI cancer with no spread?
- 3 cycles of chemo, partial gastrectomy if tumour caused stenosis or bleeding, lymph node removal too
180
What may a patient be lacking in after a gastrectomy?
Intrinsic factor --> could cause pernicious anaemia
GIVE B12.
181
What does a deficiency in intrinsic factor cause?
Pernicious anaemia
182
Where do majority of the colon cancers occur?
descending/sigmooid colon + rectum
183
What has a worse prognosis;
proximal or distal colon cancer?
Proximal --> presents later with fewer symptoms and is more likely to be advanced.
184
What investigations would you order in a patient with GI cancer?
Endoscopy
| CT staging and biopsy
185
What is the management for GI cancer?
- Surgery
- Perioperative chemo (adjuvant)
- Radiotherapy if necessary
186
Describe the progression from normal epithelium to colorectal cancer?
1. Normal epithelium
2. Adenoma
3. Colorectal adenocarcinoma
4. Metastatic colorectal adenocarcinoma
187
What is adenocarcinoma?
A malignant tumour of glandular epithelium
188
What is the pathophysiology of hepatic nonpolyposis colorectal cancer?
- No DNA repair proteins so there is a risk of colon and endometrial cancers
189
How can you prevent adenoma formation?
- NSAIDs are believed to prevent adenoma formation
190
Why has cancer survival rates increased over the years?
1. Introduction of bowel cancer screening programme
2. Colonoscopy techniques
3. Improvements in treatment options
191
What is the emergency presentation of L sided colon cancer?
LHS of colon is narrow so patient presents with obstruction
- e.g. constipation, colicky, abdo pain with abdo distension and vomiting.
192
What is the emergency presentation of R sided colon cancer?
- RHS of colon is wide so patient probably presents with signs of perforation
193
Describe 3 features of a malignant neoplasm.
1. High mitotic activity
2. Rapid growth
3. Border irregularity
4. Necrosis
5. Poor resemblance to normal tissues
194
What are 5 risk factors for colorectal cancer?
1. Low fibre diet
2. Diet high in red meat
3. Alcohol and smoking
4. A PMH Of adenoma or UC
5. A family history of colorectal cancer – FAP or HNPCC
195
What are the signs of rectal cancer?
1. PR Bleeding
2. Mucus
3. Thin stools
4. Tenesmus
Clinical presentation of colorectal cancer is dependent on how close to the rectum it is.
196
What are 2 signs of L sided cancer?
1. Change of bowel habit e.g. diarrhoea and constipation
| 2. PR bleeding
197
What are 3 signs of R sided cancer?
1. Anaemia
2. Mass
3. Diarrhoea that doesn’t settle
198
What is familial adenomatous polyposis?
A genetic condition where you develop thousands of polyps.
199
Describe the pathophysiology of FAP?
1. Mutation in APC protein so APC/GSK complex isn’t formed
2. Beta Catenin levels increased
3. Up-regulation of adenomatous gene transcription
200
What investigations would you order in suspected colon cancer?
- Permits biopsy and removal of small polyps
- Faecal occult blood is used in screening but not diagnosis
- Tumour markers are good for monitoring progress.
201
How would you treat adenoma and colorectal adenocarcinoma?
Endoscopic resection
202
How would you treat metastatic colorectal adenocarcinoma?
Chemo + palliative care.
