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General - Lower GI Flashcards

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1
Q

Where does an epigastric hernia occur?

A

In the upper midline, through the fibres of the linea alba

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2
Q

Where does a paraumbilical hernia occur?

A

Through the linea alba, around the umbilical region

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3
Q

Where does an obturator hernia occur?

A

A hernia of the pelvic floor, through the obturator foramen into the obturator canal

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4
Q

What is the pathophysiology of Angiodysplasia?

A

The formation of ateriovenous malformations between previously healthy blood vessels.

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5
Q

In which areas of the GI tract is angiodysplasia most common?

A

Caecum & Ascending colon

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6
Q

Clinical features of angiodysplasia?

A

Painless PR bleed
Acute haemorrhage
Anaemia
Melena

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7
Q

How would you investigate angiodysplasia?

A

Blood tests (FBC, U&E, LFT, Clotting, G&S)
Upper GI endoscopy
Colonoscopy
Wireless capsule endoscopy

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8
Q

Management of angiodysplasia?

A

IV fluid support
Tranexamic acid
Endoscopy + argon plasma coagulation
Mesenteric angiography
Bowel resection

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9
Q

Indications for bowel resection in patients with angiodysplasia?

A

Continuation of severe bleeding despite angiographic & endoscopic management
Severe acute life-threatening GI bleeding
Multiple angiodysplastic lesions that cannot be treated medically

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10
Q

Risks of mesenteric angiography as a treatment for angiodysplasia?

A

Haematoma formation
Arterial dissection
Thrombosis
Bowel ischaemia

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11
Q

What is a femoral hernia?

A

The abdominal viscera/omentum passes through the femoral ring into the femoral canal

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12
Q

What are the borders of the femoral canal?

A

Anterior border - Inguinal ligament
Posterior border - Pectineus
Lateral border - Femoral vein
Medial border - Lacunar ligament

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13
Q

Risk factors for femoral hernia?

A

Female
Pregnancy
Raised intra-abdominal pressure
Increasing age

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14
Q

Features of femoral hernia?

A

Small lump in groin
Infero-lateral to the pubic tubercle
Unlikely to be reducible

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15
Q

Differential diagnoses of femoral hernia/

A

Inguinal hernia
Femoral canal lipoma
Lymph node
Saphena varix

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16
Q

Investigations for femoral hernia?

A

US abdo-pelvis

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17
Q

Management for femoral hernia?

A

Always surgical due to high strangulation risk

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18
Q

Emergency presentations of femoral hernias that require urgent intervention?

A

Irreducible
Bowel Obstruction
Strangulation

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19
Q

What is an inguinal hernia?

A

Abdominal cavity contents enter into the inguinal canal.

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20
Q

What is a direct inguinal hernia?

A

Bowel enters the inguinal canal through a weakness in the posterior wall of the canal.

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21
Q

What is an indirect inguinal hernia?

A

Bowel enters the inguinal canal via the deep inguinal ring

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22
Q

Which is the most common type of inguinal hernia?

A

Indirect inguinal hernia (80%)

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23
Q

Risk factors for inguinal hernia?

A

Male
Increasing age
Raised intra-abdominal pressure
Obesity

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24
Q

Management of symptomatic inguinal hernia?

A

Laparoscopic repair
Open mesh repair

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25
Where are the majority of gastroenteropancreatic neuroendocrine tumours located?
Small intestine
26
Risk factors for neuroendocrine tumours?
MEN1/2 Neurofibromatosis type 1 von Hippel-Lindau Female Family history
27
Clinical features of GEP-NETs?
Vague abdominal pain Nausea & vomiting Abdominal distension Carcinoid syndrome
28
What is carcinoid syndrome?
Metastatic carcinoid tumour cells oversecrete serotonin, prostaglandin and gastrin into the circulation. Presents with flushing, palpitations, intermittent abdominal pain, diarrhoea.
29
Which markers are useful for identifying GEP-NETs?
Chromogranin A Pancreatic polypeptide 5-HIAA
30
What imaging tests should be used in a patient with suspected GEP-NET?
Endoscopy CT CAP
31
What is the management of a Gastric NET?
Endoscopic resection of tumour Gastrectomy with regional lymph node clearance
32
What is the management of Small intestinal NETs?
Tumour resection with mesenteric lymph node clearance
33
What is the management of Appendiceal NETs?
Appendicectomy Right hemicolectomy
34
What is the management of Colonic NETs?
Segmental colectomy with regional lymph node clearance
35
Where do most small bowel tumours arise?
Duodenum
36
Risk factors for small bowel adenocarcinoma/
Increasing age Crohn's disease FAP Smoking Obesity High dietary red meat Alcohol excess
37
Clinical features of small bowel tumour?
Small bowel obstruction Fresh PR bleed / melena Hepatomegaly Ascites
38
What tumour marker for small bowel adenocarcinoma?
CEA (Carcinoembryonic Antigen)
39
What is the surgical management of small bowel cancer?
Segmental resection Whipple's procedure (pancreaticduodenectomy) Adjuvant chemotherapy
40
What age group is most commonly affected with appendicitis?
20-30yrs
41
Clinical features of acute appendicitis?
Peri-umbilical pain, migrating to RIF Nausea & vomiting Rebound tenderness Percussion pain over McBurney's point
42
Investigations for acute appendicitis?
Routine bloods Urinalysis Pregnancy test USS abdomen
43
Management of acute appendicitis?
Laparoscopic appendectomy
44
Potential complications of acute appendicitis?
Perforation Surgical site infection Pelvic abscess
45
What is the most common type of Colorectal cancer?
Adenocarcinoma
46
Which genetic mutations predispose an individual to colorectal cancer?
APC HNPCC
47
Risk factors for colorectal cancer?
Increasing age Family history Inflammatory bowel disease Low fibre diet High processed meat intake Smoking Excess alcohol intake
48
Clinical features of bowel cancer?
Change in bowel habit Rectal bleeding Weight loss Abdominal pain Anaemia
49
Referral criteria for investigation of suspected bowel cancer?
>40 with unexplained weight loss & abdominal pain >50 with unexplained rectal bleeding >60 with iron-deficiency anaemia or change in bowel habit
50
When is colorectal cancer screening offered?
Every 2 years in those aged 60-75
51
What is the gold standard diagnostic investigation for colorectal cancer?
Colonoscopy with biopsy
52
What staging system is used for colorectal cancer?
Duke's Staging
53
What is Duke's stage A of colorectal cancer?
Confined beneath the muscularis propria
54
What is Duke's stage B of colorectal cancer?
Extension through the muscularis propria
55
What is Duke's stage C of colorectal cancer?
Involvement of regional lymph nodes
56
What is Duke's stage D of colorectal cancer?
Distant metastasis
57
What is the surgical management for a caecal or ascending colon tumour?
Right hemicolectomy
58
What is the surgical management for descending colon tumours?
Left hemicolectomy
59
What is the surgical management of sigmoid colon tumours?
Sigmoidcolectomy
60
What is the surgical management of high rectal tumours?
Anterior resection
61
What is the surgical management of low rectal tumours?
Abdominoperineal resection
62
What area of the GI tract does Crohn's disease affect?
Any part of the GI tract
63
What are the macroscopic changes in Crohn's disease?
Skip lesions (discontinuous inflammation) Cobblestone appearance Fistula formation
64
What are the microscopic changes in Crohn's disease?
Non-caseating granulomas
65
What type of inflammation is present in Crohn's disease?
Transmural inflammation
66
Risk factors for Crohn's disease?
Family history Smoking
67
Clinical features of Crohn's disease?
Episodic abdominal pain Diarrhoea (blood/mucus) Oral aphthous ulcers Perianal abscess Nail clubbing Erythema nodosum Weight loss Malaise
68
Gold standard investigation for Crohn's disease?
Colonoscsopy
69
Long term management of Crohn's disease?
Smoking cessation Azathioprine Enteral nutrition support
70
How to induce remission in an acute attack of Crohn's disease?
Fluid resuscitation Prophylactic heparin Corticosteroid therapy
71
Potential complications of Crohn's disease?
Fistula Stricture formation GI malignancy Osteoporosis Gallstones Renal stones Malabsorption
72
Risk factors for formation of a diverticulum?
Increasing age Low dietary fibre intake Obesity Smoking Family history NSAID use
73
Clinical features of diverticular disease?
Intermittent lower abdominal pain Pain relieved on defecation Altered bowel habit Nausea Flatulence
74
Clinical features of acute diverticulitis?
Acute abdominal pain (LIF) Pain worse on movement Localised tenderness Decreased appetite Pyrexia Nausea
75
Investigations for suspected diverticulosis?
Routine bloods G&S VBG CT AP
76
Management of uncomplicated diverticular disease?
Simple analgesia Encourage oral fluid intake
77
Management of acute diverticulitis?
Antibiotics IV fluids Analgesia
78
Complications of diverticulitis?
Recurrence Diverticular stricture Fistula
79
What is Pseudo-obstruction?
Dilatation of the colon due to adynamic bowel, in the absence of mechanical obstruction.
80
Causes of pseudo-obstruction?
Hypercalcaemia Hypothyroidism Opioids CCBs Anti-depressants Cardiac ischaemia Parkinson's disease MS
81
Clinical features of pseudo-obstruction?
Abdominal pain Abdominal distension Constipation Vomiting
82
Differential diagnoses of suspected pseudo-obstruction?
Mechanical obstruction Paralytic ileus Toxic megacolon
83
Investigations for suspected pseudo-obstruction?
CT AP with IV contrast Blood tests (U&E, bone profile, TFTs) AXR
84
Management of pseudo-obstruction/
Treat underlying cause NBM IV fluids Endoscopic decompression (if no resolution within 24-48hrs)

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