GI/Gen Surgery Flashcards
(316 cards)
1
Q
Broadly/anatomically, what causes colicky (visceral) pain?
A
Stretching or contracting of a hollow viscus
2
Q
Anatomically, what causes localised (somatic) pain?
A
Peritoneal irritation
3
Q
Back pain indicates the pathology is in which location?
A
Retroperitoneal
4
Q
Abdominal pain out of proportion to the physical signs is suggestive of what?
A
Bowel ischaemia
5
Q
What blood gas picture does bowel ischaemia give?
A
Metabolic acidosis
6
Q
‘Free air under the diaphragm seen on CXR’
A
Bowel perforation
7
Q
‘Dilated, thick oedematous loops of bowel seen on AXR’
A
Ischaemic bowel
8
Q
‘Sentinel dilated upper jejunum on AXR’
A
Pancreatitis
9
Q
‘Air in biliary tree on AXR’
A
Cholangitis
10
Q
‘Dilated, oedematous, featureless colon’
A
Acute colitis
11
Q
‘Dilated bowel loops, string of pearls sign on AXR’
A
Acute bowel obstruction
12
Q
‘Coffee bean sign’
A
Sigmoid volvulus
13
Q
What is Meckels diverticulum?
A
Congenital diverticulum seen in 2% of the population
14
Q
What symptoms may a Meckel’s diverticulum cause?
A
Abdominal pain (RIF), painless PR bleed, anaemia
15
Q
How is Meckels diverticulum diagnosed?
A
Radionucleotide scanning
16
Q
How is Meckels diverticulum managed?
A
Treat complications
Meckels diverticulotomy
17
Q
What is a sigmoid volvulus?
A
Large loop of bowel becomes distended and twists on mesenteric pedicle to create closed loop obstruction
18
Q
How does a sigmoid volvulus present?
A
Abdominal distension
Constipation
19
Q
Who is sigmoid volvulus common in?
A
Elderly people with constipation (have ‘floppy sigmoids’)
20
Q
How is a sigmoid volvulus treated?
A
Decompression with colonoscopy
21
Q
What may delay in treating a sigmoid volvulus result in?
A
Increased risk of bowel perforation and ischaemia
22
Q
What are the two broad causes of bowel obstruction?
A
Mechanical and Ileus
23
Q
What are mechanical causes of bowel obstruction?
A
Adhesions, hernias, tumours, intussusception, strictures, food bolus, volvulus, strangulation
24
Q
What are some causes of an aperastaltic bowel (ileus)?
A
Pancreatitis, spinal injury, post-operative, DKA, sepsis
25
How does small bowel obstruction present?
Vomiting, abdominal pain (colicky, peri-umbilical), distention, constipation
26
How does large bowel obstruction present?
Pain (constant, lower abdomen), distention, absolute constipation
27
What signs would be seen in bowel obstruction on examination?
Signs of shock (e.g. weak pulse, cyanosis), abdominal distention, resonant percussion, tinkling or absent bowel sounds
28
What investigations are important in bowel obstruction?
Bloods
| AXR
29
What does AXR show in small bowel obstruction?
Central dilated bowel with valvulae coniventes and no gas in large bowel
30
What does AXR show in large bowel obstruction?
Peripherally dilated bowel with haustra
31
What are the main complications of bowel obstruction?
Perforation, hypokalaemia, strangulation
32
How is bowel obstruction treated?
Drip & Suck
| Correct electrolyte imbalance
33
Where does the oesophagus run to and from?
From the cricopharyngeus to the lower oesophageal sphincter
34
What type of epithelium is the oesophagus lined by?
Stratified squamous
35
What is the key symptom in oesophageal pathologies?
Dysphagia
36
What is odynophagia?
Painful swallowing
37
What is gastro-oesophageal reflux disease?
Reflux of bile/stomach acid into the oesophagus
38
What are risk factors for GORD?
Hiatus hernia, obesity, gastric acid hypersecretion, LOS hypotonia, overeating, alcohol, smoking, pregnancy, drugs
39
What are symptoms of GORD?
Heartburn, belching, acid brash, excess saliva, painful swallowing, nocturnal asthma, chronic cough, laryngitis
40
What investigations are done for GORD?
Often none needed
| Can do upper GI endoscopy to rule out other pathologies/if ongoing/if patient elderly
41
What are some conservative management options for GORD?
Lose weight, smoking cessation, avoiding alcohol, spicy foods etc
42
What are some medical management options for GORD?
Antacids/alginates to relieve symptoms
| PPIs if evidence of oesophagitis
43
What are complications of GORD?
Oesophagitis, ulcers, anaemia, strictures, Barretts oesophagus, oesophageal cancer
44
What is Barrett's oesophagus?
Metaplasia of the lower oesophagus - stratified squamous epithelium replaced with columnar epithelium
45
What are risk factors for Barrett's oesophagus?
GORD, male sex, smoking, central obesity
46
What are some symptoms of Barrett's oesophagus?
Disease itself is asymptomatic but patients will often have GORD symptoms
47
What can be seen on endoscopy in Barrett's oesophagus?
Red velvety mucosa
48
Is there a risk of malignancy with Barrett's oesophagus?
YES
49
How is Barrett's oesophagus monitored?
Patients have an endoscopy every 3-5 years with biopsies
50
How is dysplasia found on endoscopy in Barrett's oesophagus managed?
Endoscopic mucosal resection or radiofrequency ablation
51
How is Barrett's oesophagus managed medically?
High dose PPI
52
What type of oesophageal cancer is related to Barrett's oesophagus?
Adenocarcinoma
53
What type of oesophageal cancer is related to smoking and alcohol?
Squamous cell
54
What are risk factors for oesophageal cancer?
Smoking, alcohol, GORD, Barratt's achalasia, Plummer-Vinson syndrome
55
What are symptoms of oesophageal cancer?
Dysphagia, anorexia, weight loss
56
How is oesophageal cancer diagnosed?
Upper GI endoscopy with biopsies
57
How is oesophageal cancer managed?
Surgically - Ivor Lewis Oesophagectomy
| Chemotherapy
58
What is achalasia?
Failure of oesophageal peristalsis and failure of lower oesophageal sphincter to relax
59
At what age does achalasia usually present?
Middle age
60
What are symptoms of achalasia?
Dysphagia of liquids (+/- solids), heartburn, regurgitation
61
What investigations would you do for achalasia and what would they show?
Oesophageal monometry - excessive LOS tone
| Barium swallow - birds beak appearance
62
How is achalasia treated?
Balloon dilatation
Heller cardiomyotomy
Botox injections
63
What is diffuse oesophageal spasm?
Uncoordinated contractions of the oesophagus
64
What are the symptoms of diffuse oesophageal spasm?
Intermittant dysphagia, chest pain
65
What investigation would you carry out for diffuse oesophageal spasm and what would it show?
Barium swallow - corkscrew appearance
66
How is diffuse oesophageal spasm treated?
CCBs, PPIs, hyoscine
67
What can cause a benign oesophageal stricture?
GORD, surgery, radiotherapy
68
How is a benign oesophageal stricture treated?
Endoscopic balloon dilatation
69
What is Plummer-Vinson syndrome also known as?
Paterson-Brown-Kelly syndrome
70
What is the key triad of symptoms in Plummer-Vinson syndrome?
Dysphagia (secondary to oesophageal webs)
Glossitis
Iron deficient anaemia
71
How is Plummer-Vinson syndrome treated?
Oesophageal web dilatation
| Iron supplements
72
What is a Mallory-Weiss tear?
Mucosal laceration occurring at the gastro-oesophageal junction
73
What is the common cause of a mallory-weiss tear?
Vomiting in alcoholics
74
What are oesophageal varices?
Dilated collateral veins in the lower oesophageal sphincter due to portal hypertension
75
What symptoms do oesophageal varices cause?
Large volume of fresh blood, potential haemodynamic compromise
76
What prophylactic treatment can be given for oesophageal varices?
Betablockers
| Endoscopic band ligation
77
What treatment is used acutely in oesophageal varices bleeds?
Vitamin K, FFP
Terlipressin
Endoscopic banding
Balloon tamponade
78
What is Boorhaeve syndrome?
Severe vomiting leading to oesophageal rupture
79
What are some symptoms of dyspepsia?
Epigastric pain, bloating, fullness, heartburn
80
What are the ALARM Symptoms of dyspepsia?
```
Anaemia
Loss of weight
Anorexia
Recent onset progressive symptoms
Malaena/haematemesis
Swallowing difficulties
```
81
Are gastric or duodenal ulcers commoner?
Duodenal (4x more common)
82
Which ulcers are relieved by eating?
Duodenal
83
Which ulcers are worsened by eating?
Gastric
84
Where do the majority of gastric ulcers occur?
Lesser curvature of the stomach
85
What are risk factors for gastric ulcers?
H Pylori infection, smoking, NSAIDs, duodenal reflux, delayed gastric emptying
86
What are the symptoms of a gastric ulcer?
Asymptomatic or epigastric pain made worse by eating
87
What are risk factors for duodenal ulcers?
H Pylori infection, NSAIDs, increased gastric acid secretion, increased gastric emptying, blood type O, smoking
88
What are the symptoms of a duodenal ulcer?
Asymptomatic or epigastric pain relieved by eating
89
What classification of organism is Helicobacter Pylori?
Gram negative flagellated bacillus
90
How is H Pylori acquired?
In infancy via faecal-oral or oral-oral spread
91
What are the consequences of H Pylori infection?
Peptic ulcer disease
| Gastric cancer
92
What is the investigation for H Pylori?
Urea breath test
93
What treatment is used to eradicate H Pylori?
PPI + amoxicillin + metronidazole (7 days)
94
How do you test for cure after H Pylori eradication therapy?
Repeat urea breath test after 4 weeks
95
If a patient with dyspepsia is over 55 or has ALARMSymptoms, what should you do?
Upper GI endoscopy
96
What is the first line management for a patient with dyspepsia (under 55 and no ALARMSymptoms)?
Stop drugs that may be causing dyspepsia (e.g. NSAIDs)
Lifestyle changes - stop smoking, avoid food triggers
Try OTC antacids
Review in 4 weeks
97
If after 4 weeks of conservative management a patient with dyspepsia is no better, what should you do?
Investigate for H Pylori
98
If a patient with dyspepsia is negative for H Pylori, how should you manage them?
PPI or H2 blocker for 4 weeks
99
Who is gastric cancer more common in?
Elderly males
| Japanese
100
What is seen on histology of gastric cancer?
Signet ring cells (filled with mucus)
101
What are risk factors for gastric cancer?
H Pylori infection, blood group A, gastric polyps, penicious anaemia, smoking, salty, spicy diet
102
What are symptoms of gastric cancer?
Often non specific - dyspepsia, weight loss, vomiting, dysphagia, anaemia
103
What are signs of gastric cancer?
Epigastric mass, hepatosplenomegaly, jaundice, ascites
104
What is Troisiers sign?
Enlarged left sided Virchows Node
105
What investigations should be done for gastric cancer?
Gastroscopy and biopsies
| Endoscopic ultrasound and CT/MRI for staging
106
How is gastric cancer managed?
Surgery
| Chemotherapy
107
What is Zollinger-Ellison syndrome?
Disease with peptic ulcers caused by a gastrinoma tumour
108
Where is the gastrinoma usually in Zollinger-Ellison syndrome?
Pancreas or duodenum
109
What may Zollinger-Ellison syndrome be associated with?
MEN1
110
Are the tumours in Zollinger-Ellison syndrome malignant?
60% are
111
What are the symptoms of Zollinger-Ellison syndrome?
Multiple gastroduodenal ulcers, diarrhoea, malabsorption
112
How is Zollinger-Ellison syndrome investigated?
Fasting gastrin levels
113
How is Zollinger-Ellison syndrome treated?
PPIs + surgical removal of gastrinoma
114
What is jaundice?
Yellow pigmentation of the skin, sclera and mucosa
115
What is the cause of jaundice?
Increased plasma bilirubin
116
What is the normal bilirubin level?
Below 17
117
What level does bilirubin need to reach for symptoms to manifest?
Over 35
118
What is bilirubin?
Waste product from the breakdown of haemoglobin in the spleen
119
What organ conjugates bilirubin?
Liver
120
What are pre-hepatic causes of jaundice?
Haemolytic anaemias (Thalassaemia, Hereditary spherocytosis, sickle cell disease, autoimmune) Gilberts syndrome
121
What are hepatic causes of jaundice?
Viral hepatitis, alcoholic hepatitis, autoimmune hepatitis, paracetamol, poisons, decompensated cirrhosis
122
What are post-hepatic causes of jaundice?
PBC, PSC, strictures, stones, pancreatitis, pancreatic cancer
123
Which liver enzymes are raised the most in hepatic jaundice?
ALT/AST
124
Which liver enzymes are raised the most in post-hepatic jaundice?
Bilirubin and Alkaline phosphatase
125
What is the commonest cause of liver disease?
Non-alcoholic fatty liver disease
126
What is NAFLD associated with?
Metabolic syndrome - obesity, increased lipids, type 3 diabetes
127
What are some features of NAFLD?
Asymptomatic, hepatosplenomegaly, increased liver echogenicity on ultrasound
128
How is NAFLD managed?
Lifestyle modification and monitoring
129
What may NAFLD result in?
Liver fibrosis and cirrhosis
130
What is the extent of alcoholic fatty liver disease often dependent on?
Extent of drinking
| Varies between individuals
131
What are some signs of chronic liver disease?
Spider naevi, encephalopathy, prolonged PT, decreased albumin
132
What are some signs of portal hypertension?
Caput medusa, varices, hypersplenism, thrombocytopenia
133
How is alcoholic fatty liver disease managed?
Mainly abstinence
134
How do Hepatitis A and E spread?
Faeco-oral
135
Which Hepatitis is the only one which is a DNA virus?
Hepatitis B
136
Which hepatitis is commonest in the UK?
Hepatitis C
137
When is Hepatitis D found?
As a co-infection with Hepatitis B
138
What does HBsAg mean in hepatitis B?
Acute or chronic disease
139
What is HbeAg a marker of in hepatitis B?
Current infection
140
What does Anti-Hbs indicate in a patient?
Immunity to hepatitis B (either through infection or vaccination)
141
What antibody indicates an acute hepatitis B infection?
Hep B IgM
142
What antibody indicates a past hepatitis B infection?
Hep B IgG
143
How is hepatitis B treated?
Peginteferon
144
How is hepatitis C treated?
Protease inhibitors and ribavirin
145
Who does autoimmune hepatitis commonly affect?
Young females
146
What antibodies are associated with autoimmune hepatitis?
ANA and anti-SM
147
What are some features of autoimmune hepatitis?
Chronic liver disease
Acute hepatitis (jaundice, fever etc)
Amenorrhoea
148
What are the investigations for autoimmune hepatitis?
Antibodies
| Liver biopsy
149
What does liver biopsy show in autoimmune hepatitis?
Piecemeal necrosis and inflammation
150
How is autoimmune hepatitis treated?
Steroids, immunosuppressants, transplant
151
What is primary biliary cirrhosis?
Autoimmune damage of the bile duct due to chronic inflammation
152
What are the symptoms of PBC?
Fatigue, itch, xanthelasma, varices, hypersplenism, encephalopathy
153
What antibody is positive in PBC?
AMA (anti-mitochondrial)
154
What is the diagnostic criteria for PBC?
2 from:
Positive AMA
Cholestatic LFTs
Positive liver biopsy
155
How is PBC treated?
Urseodoxycholic acid
156
What can PBC result in?
Cholestasis, cirrhosis, portal hypertension. Can need transplant
157
What is primary sclerosing cholangitis?
Autoimmune destruction of bile ducts leading to bile getting blocked intra and extra hepatically
158
What is PSC associated with?
Ulcerative colitis
159
What are symptoms of PSC?
Asymptomatic or itch, fatigue, jaundice, abdominal pain
160
How can PSC be diagnosed?
Imaging shows beaded appearance of biliary tree
| ANCA +ve
161
What does biopsy of liver show in PSC?
Onion skinning fibrosis
162
How is PSC treated?
Stents to maintain bile flow, transplant
163
What is haemochromatosis?
Inherited disorder of iron metabolism
164
How is haemochromatosis inherited?
Autosomal recessive
165
What are features of haemochromatosis?
Fatigue, ED, bronzed skin, diabetes, cardiomyopathy, chronic liver disease
166
How is haemochromatosis investigated?
Genetic testing
| Liver biopsy shows perl staining
167
How is haemochromatosis treated?
Venesection
168
What is Wilsons disease?
Condition characterised by excess copper deposition
169
What are features of Wilsons disease?
Kayser-Flesher rings
| Hepatitis, cirrhosis, neurological (basal ganglia deterioration)
170
How is Wilsons disease managed?
Penicillamine
171
How is Wilsons disease inherited?
Autosomal recessive
172
How is alpha-1-antitrypsin deficiency inherited?
Autosomal recessive
173
What organs does alpha-1-antitrypsin deficiency affect?
Lungs and liver (causing emphysema and cirrhosis)
174
How is alpha-1-antitrypsin deficiency managed?
Stop smoking, supportive care, alpha-1-antitrypsin concentrates IV
175
What is the function of the gallbladder?
Stores bile
176
What is bile composed of?
Cholesterol, phospholipids, bile salts and bilirubin
177
Why do gallstones occur?
An imbalance between the ratios of cholesterol and bile salts
178
What is biliary colic?
When the gallstone obstructs the cystic duct
179
How does biliary colic present?
Severe RUQ pain radiating around the right costal margin, usually lasting a few hours. Vomiting
180
Does biliary colic cause jaundice?
No
181
What is the underlying cause of acute cholecystitis?
Gallstone impacted in the neck of the gallbladder
182
How does acute cholecystitis present?
Continuous RUQ/epigastric pain, vomiting. Murphys sign positive
183
How does chronic cholecystitis present?
Vague intermittant RUQ pain, distension, fatty food intolerance
184
Does acute cholecystitis cause jaundice?
No
185
What is choledocholithiasis?
Presence of gallstone in the common bile duct
186
How does choldecholithiasis present?
Can be asymptomatic, or epigastric/RUQ pain and jaundice and pale stools
187
What may choledocholithiasis lead to?
Biliary colic
| Ascening cholangitis
188
Does choledocholithiasis cause jaundice?
Yes
189
What is ascending cholangitis?
Bacterial infection of the biliary tree secondary to biliary tree obstruction
190
How does ascending cholangitis present?
Charcots triad, maybe hypotension or confusion
191
What is Charcots triad?
Severe RUQ abdominal pain
Obstructive jaundice
High fever/rigors
192
What is a gallstone ileus?
When a gallstone erodes through the gallbladder into the duodenum. May obstruct terminal ileum
193
What is a mucocele in the gallbladder?
When gallbladder fills with mucus secondaru to biliary colic
194
What occurs if a mucocele in the gallbladder becomes infected?
Empyema
195
What are the investigations for gallstones?
Bloods - FBC, U&Es, LFTs
USS biliary tree
MRCP if USS is negative
196
How is biliary colic treated?
Elective laparoscpic cholescystectomy
197
How is cholecystitis treated?
Elective/emergency laparoscopic cholecystectomy
198
How is choledocholilithiasis treated?
ERCP/cholecystectomy
199
How is cholangitis treated?
IV antibiotics and ERCP
200
What are some complications of ERCP?
Pancreatitis, bleeding, cholangitis, duodenal perforation
201
What are the main exocrine functions of the pancreas?
Production of digestive enzymes (e.g. amylase/lipase)
202
What do beta cells of the pancreas secrete?
Insulin
203
What do alpha cells of the pancreas secrete?
Glucagon
204
What do delta cells of the pancreas secrete?
Somatostatin
205
What do PP cells of the pancreas secrete?
Pancreatitc phospholipid
206
What do enterochromaffin cells of the pancreas secrete?
Serotonin
207
What is acute pancreatitis?
Inflammation of the pancreas initiated by an acute injury
208
What are the causes of acute pancreatitis?
Idiopathic, Gallstones, Ethanol, Trauma, Steroids, Mumps, Malignancy, Autoimmune, Scorpion bites, Hypercalcaemia/lipidaemia/parathyroidism, ERCP, Drugs
209
What are the two commonest of these causes of pancreatitis?
Gallstones and alcohol
210
What is the pathogenesis of pancreatitis?
Pancreatic inflammation secondary to premature and exaggerated response of pancreatic enzymes - AUTOLYSIS
211
What are the symptoms of pancreatitis?
Epigastric pain radiating to the back relieved by sitting forward, nausea, vomiting, tachycardia, pyrexia, jaundice
212
What is Grey-Turners sign?
Flank bruising
213
What is Cullens sign?
Peri-umbilical brusing
214
What bloods is it important to request in pancreatitis?
FBC, U&Es, clotting, amylase, lipase, CRP, glucose, calcium, ABGs
215
What may be seen on a CXR in pancreatitis?
Pleural effusion
216
What may be seen on AXR in pancreatitis?
Sentinel loop
217
What other imaging investigations should you do in pancreatitis?
USS to check biliary system
| CT for severity
218
What is the Glasgow Score?
```
Used to assess severity of pancreatitis
PaO2 less than 8
Age >55
Neutrophils - WCC >15
Calcium <2
Renal function - urea >16
Enzymes - LDH >600
Albumin <32g/l
Sugar - glucose >10
```
219
What score indicates severe pancreatitis on the Glasgow Score?
More than or equal to 3
220
How is pancreatitis managed?
```
IV fluids
Pain relief (morphine/fentanyl PCA)
Oxygen
Antibiotics if cholangitis
ERCP if gallstones
Drainage of fluid/pseudocysts
Pancreatic necrostomy if necrosis
```
221
What is chronic pancreatitis?
Progressive and irreversible damage to the pancreas with permanent loss of function
222
What is the main cause of chronic pancreatitis?
Alcoholism
223
How does chronic pancreatitis present?
Epigastric pain radiating to the back, weight loss, malabsorption, weight loss
224
What may be seen on AXR and CT in chronic pancreatitis?
AXR - calcified pancreas
| CT - dilated pancreatic ducts
225
How is chronic pancreatitis managed?
Stop alcohol intake and smoking
Pancreatic enzyme replacment
Drainage of cysts
If autoimmune - steroids trial
226
What is the only way to treat chronic pain in pancreatitis?
Pancreatectomy
227
What is the main histological type of pancreatic cancer?
Adenocarcinomas
228
Where do the majority of pancreatic tumours arise in the pancreas?
Head
229
What are risk factors for pancreatic cancer?
Smoking, alcohol, carcinogens, diabetes, chronic pancreatitis
230
What are symptoms of head of pancreas tumours?
Painless jaundice, dark urine, pale stools
231
How does pancreatic body/tail cancer present?
Epigastric pain, radiating to the back
232
What signs may be present in pancreatic cancer?
Palpable gallbladder
Epigastric mass
Jaundice
Hepatosplenomegaly
233
How is pancreatic cancer investigated?
CT scan + endoscopic US guided biopsy
234
How is pancreatic cancer managed broadly?
Palliative - radiotherapy, chemotherapy and surgery
235
What procedure can be performed for head of pancreas tumours?
Whipples Procedure - removal of head of pancreas, gallbladder, bile duct and 1st part of duodenum
236
What is the mean survival time of pancreatic cancer?
6 months
237
What is Crohns disease?
Inflammatory and ulcerating condition affecting from mouth to anus
238
What are risk factors for Crohns disease?
Positive family history, genetics, smoking
239
What are symptoms of Crohns disease?
Abdominal pain, diarrhoea, weight loss, malaise
240
What are signs of Crohns disease?
Apthous ulcers, abdominal tenderness, RIF mass, perianal abscesses/fistulas, clubbing, erythema nodosum, pyoderma gangrenosum, arthritis, anaemia
241
How is Crohns disease investigated?
Bloods (increased CRP, possible anaemia)
| Colonscopy
242
What is seen on pathology of Crohns disease?
```
Transmural inflammation
Segmented disease with skip lesions
Non-caseating granulomas
Cobblestone mucosa
Stricutres
Fissuring ulcers
```
243
What is the first line drug used in Crohns to induce remission (acute)?
Glucocorticoids (prednisolone)
244
What can be used in addition to steroids to induce remission in Crohns?
Azaithioprine/Methotrexate/Mercatopurine
| Infliximab in refractory disease
245
What are the first line drugs for maintaining remission of Crohns disease?
Azaithioprine or mercatopurine
246
What surgery is commonly done for patients with Crohns disease?
Ileocaecal resection due to a stricture in the terminal ileum
247
What are complications of Crohns disease?
Short bowel syndrome, malabsorption, obstruction, perforation, fistulae, cancer
248
What is ulcerative colitis?
Chronic inflammatory condition confined to colon and rectum
249
What is protective against UC?
Smoking
250
What are symptoms of UC?
Diarrhoea (+/- blood, mucus), abdominal pain in LIF, tenesmus, PR bleeding
251
What are signs of UC?
Clubbing, erythema nodosum, pyoderma gangrenosum, episcleritis, ankylosing spondyltitis, PSC, arthritis
252
What investigations should you do in UC?
Bloods - raised CRP
Stool microscopy to rule out infection
AXR
Colonoscopy
253
What may be seen on AXR in UC?
Mucosal thickening
| Drainpipe colon
254
What is the pathology seen in UC?
Superficial inflammation, crypt abscesses, inflammatory cell infiltrate
255
What is first line for inducing remission in UC (acute)?
Mesalazine
| Rectal steroids if solely rectal disease
256
What drugs are used for maintaining remission in UC?
Mesalazine
| Azaithioprine/Mercaptopurine
257
What are complications of UC?
Toxic megacolon, perforation, colorectal cancer
258
What is toxic megacolon?
Dilation of colon to diameter >6cm
259
Which IBD has granulomas?
Crohns
260
Which IBD has superficial inflammation?
UC
261
Which IBD has a high cancer risk?
UC
262
Which IBD are fistula common?
Crohns
263
What are risk factors for bowel cancer?
Increased age, male sex, obesity, smoking, alcohol, red meat, low fibre diet, IBD, genetic conditions
264
What is the usualy pathogenesis of bowel cancer?
Start from a polyp and progress to a pre-malignant adenoma before becoming an adenocarcinoma
265
Which side are the majority of bowel cancers found?
Left side
266
What are some general symptoms of bowel cancer?
Abdominal mass, tiredness, weight loss
267
What are some left sided symptoms of bowel cancer?
Altered bowel habit, bleeding PR, mucus PR, tenesmus, mass PR, bowel obstruction
268
What are some right sided symptoms of bowel cancer?
Iron deficient anaemia, abdominal pain
269
How is colorectal cancer investigated?
Bloods - FBC, U&Es, LFTs
| Colonoscopy and biopsy - diagnostic
270
How is colorectal cancer investigated for staging?
CT chest abdo pelvis
271
What tumour marker is monitored throughout treatment?
CEA
272
What staging system is used in colorectal cancer?
Dukes Staging
273
What is Dukes stages A-D?
```
A= confined to bowel wall
B= through bowel wall
C= local lymphatic spread
D= distant mets
```
274
What surgery is done for tumours in the caecum, ascending colon or proximal transverse colon?
Right hemi-colectomy
275
What surgery is done for tumours in the distal transverse or descending colon?
Left hemi-colectomy
276
What surgery is done for tumours in the sigmoid?
Sigmoid colectomy
277
What surgery is done for tumours in the low sigmoid/upper rectum?
Anterior resection
278
What surgery is done for tumours in the low rectum?
Anterior resection
279
What surgery is done for tumours at the anal verge?
Abdomino-perineal excision of rectum
280
When is radiotherapy used in bowel cancer?
Adjuvantly
281
When is chemotherapy used in bowel cancer?
For Dukes stages C+. Adjuvant or neoadjuvant
282
What is done for peritoneal disease in bowel cancer?
HIPEC
283
What is Lynch Syndrome?
Inherited mutation of DNA mismatch repair genes
284
How is Lynch syndrome inherited?
Autosomal dominant
285
What cancers does Lynch syndrome predispose to?
Colorectal, endometrial and gastric
286
How are patients with Lynch syndrome monitored?
Colonscopy every 2 years from age 25
287
What is Familial Adenomatous Polyposis?
Mutation of APC tumour suppresor gene
288
What is the cancer risk in FAP?
100%
289
Who gets bowel screening and how often?
People aged 50-74 every 2 years
290
What test is done in bowel screening?
Faecal immunoglobulin test
291
If a bowel screening test in positive, what investigation do patients get next?
Flexible sigmoidoscopy or colonscopy
292
What is a hernia?
Abnormal protrusion of a viscous outwith its normal body cavity
293
What is a hiatus hernia?
Herniation of the stomach above the diaphragm
294
How may a hiatus hernia present?
GORD symptoms
295
How is a hiatus hernia diagnosed?
Barium swallow
296
What predisposes to hernias?
Obesity, ascites, heavy lifting, coughing, constipation, surgical wounds, increased age
297
What signs are often found with hernias?
Palpable lump, cough impulse, pain
298
When does an incisional hernia occur?
Post-surgery
299
Where is a paraumbilical hernia found?
Above or below the umbilicus
300
Where is an umbilical hernia found?
Directly below the umbilicus (commoner in kids)
301
What does an epigastric hernia arise from?
Congenital weakness of the linea alba
302
Which hernia is below and lateral to the pubic tubercle?
Femoral hernia
303
Which hernia is above and medial to the pubic tubercle?
Inguinal hernia
304
What is an incarcerated hernia?
Unable to be reduced
305
What is an obstructed hernia?
Hernia containing bowel becomes compressed causing bowel obstruction
306
What is a strangulated hernia?
Compression around hernia prevents blood flow
307
Where does a direct inguinal hernia protrude through?
Hesselbachs triangle
308
Is a direct inguinal hernia medial or lateral to the inferior epigastric vessels?
Medial
309
What is a direct inguinal hernia caused by?
Defect or weakness in fascia
310
Who commonly gets direct inguinal hernias?
Older men
311
Where does an indirect inguinal hernia protrude through?
Inguinal ring
312
Is an indirect inguinal hernia medial or lateral to the inferior epigastric vessels?
Lateral
313
What is an indirect inguinal hernia caused by?
Failure of closure of processus vaginalis
314
Who commonly gets indirect inguinal hernias?
Infants
315
What is a herniotomy?
Excision of hernial sac but no wall repair (indirect inguinal hernia)
316
What is herniorraphy?
Repair of the defect in the wall by either stitching healthy sides together or mesh
