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MB1: Gastrointestinal > Large bowel disease > Flashcards

Large bowel disease Flashcards

(62 cards)

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1
Q

what exactly is a diverticulum

A

mucosal herniation through muscle coat

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2
Q

where is diverticular disease usually

A

sigmoid colon

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3
Q

how is diverticular disease classified

A

hinchey classification

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4
Q

what is colonic angiodysplasia

A

submucosal lakes of blood, usually on right side of colon

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5
Q

causes of large bowel obstruction

A

colorectal cancer
benign stricture
volvulus

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6
Q

what is a sigmoid volvulus and the complication

A

bowel twists on the mesentery

gangrene

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7
Q

what is a pseudo-obstruction and who is it more common in

A

no real large bowel obstruction

elderly and debilitated

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8
Q

what genes predispose to IBD

A

NOD2/CARD15

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9
Q

what T cell mediated response is chrons disease

A

TH1

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10
Q

what T cell mediated response is UC

A

TH1/TH2

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11
Q

when are antibiotics effective in chrons

A

peri-anal chrons disease

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12
Q

True/false - smoking aggravates UC and protects against chrons

A

false - it aggravates chrons and protects against UC

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13
Q

what is proctitis

A

UC only affecting rectum

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14
Q

what is left sided colitis

A

UC affecting descending and sigmoid colon and rectum

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15
Q

what is pancolitis

A

UC affecting entire colon

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16
Q

what is severe colitis classed as

A

> 6 bloody stools/24hrs and one of Fever, tachycardia, elevated ESR, anaemia

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17
Q

what does endoscopy look like with UC

A

inflammation extending from anal margin to transition zone
lost vessel pattern
contact bleeding
grainy mucosa

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18
Q

true/false - UC has increased risk of colorectal cancer

A

true

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19
Q

what is primary sclerosing cholangitis and who is it more common in

A

inflammatory disease of biliary tree

more common in IBD (80%)

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20
Q

what type of lesions and inflammation does chrons cause

A

skip lesions and transmural inflammation

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21
Q

complications of chrons

A

peri-anal disease, abscess, fistula

stricture

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22
Q

treatment options available for UC

A 
5ASA
Steroids 
Immunosuppression 
Anti-TNF therapy 
Surgery
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23
Q

Treatment options for chrons

A

Steriods
immunosuppression
anti-TNF
surgery

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24
Q

what types of 5ASA therapy are there

A

oral- pH or delayed release (asacol/pentasa)

suppository/enema (salazopyrin/balsalazide/mesalazine)

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25
side effects of 5-ASA therapy
diarrhoea and idiosyncratic nephritis
26
side effects of steroid therapy
``` osteoporosis acne skin thinning weight gain diabetes hypertension growth failure ```
27
what drugs may be used for immunosuppression and what are the side effects
methotrexate/azathroprine/mercaptopurine | pancreatitis/hepatitis/lymphoma
28
name the 2 anti TNF drugs and their administration
infliximab - IV | adalimumab - S/C
29
for what IBD is surgery curative
UC
30
too much surgery in chrons can cause...
SBS/SGS
31
risk factors of IBS
usually <45 2 times more likely women FHx Anxiety, depression
32
name 3 antispasmodics and effectiveness and indication
IBS-C and D peppermint oil mebeverine, alverine citrate mild short term relief of discomfort
33
indication of soluble fibre for IBS and name
mild diarrhoea | ispaghula
34
Polyethylene glycol use and downside
osmotic laxative to prevent H2O absorption | doesnt improve discomfort
35
name a guanate cyclase agonist, mechanism and effect
linaclotide increases GMP so increases motility and intestinal secretion reduces abdominal pain/constipation
36
name a C-2 chloride channel activator, mechanism and effect
lubiprostone increases chloride rich secretion so increased water secretion into bowel soften stool and improve motility
37
downside to loperamide
does not improve pain/bloating
38
what anti-diarrhoeal does improve bowel pain/bloating but what is the downside
codeine phosphate | dependence
39
when is surgery in UC indicated
medically unresponsive disease malignancy growth retardation in children
40
in a proctocolectomy what are the options
end ileostomy ileorectal anastomosis pouch
41
true/false - pouch is just like a rectum
false
42
complications of proctocolostomy with pouch
``` haemorrhage abscess infection anastomotic leak impotence pouchitis ```
43
when is a subtotal colectomy usually indicated in UC
severe colitis
44
true/false - surgery cures chrons
false- but it is the best chrons management
45
surgery for multisite chrons
stricturoplasty
46
causes of fistulas
Sepsis Nutrition Anatomy Prolonged stay
47
management of fistulas?
resect and close secondary organ | stoma if severe
48
mortality of colorectal cancer
50% in 5 years
49
what do most colorectal cancers originate from and in what timeframe
adenomatous polyps | 3-5 years
50
causes of colorectal cancer
``` genes - rare age smoking high sugar, fat, alcohol, red meat, processed foods IBD -UC low fibre lack of physical exercise ```
51
most colorectal cancers are not genetic, but for the ones that are name 2 common mutations
p53 | APC - 100% chance getting it
52
in what ways do bowel cancer patients present with bowel cancer
bowel screening urgent referral emergency
53
following initial diagnosis how would you investigate further
biopsy and confirm by histopathology | stage with CT chest/abdo/pelvis OR MRI if rectal
54
what is a right hemicolectomy
removal of caecum and ascending colon
55
what is a transverse colectomy
removal of transverse colon
56
what is an extended right hemicolectomy
removal of caecum, ascending colon and transverse colon
57
what is a sigmoid colectomy
removal of sigmoid colon
58
what is an anterior resection
resection of diseased part of colon and rectum
59
what is an APR
removal of anus and diseased rectum and colon to form colostomy
60
besides cancer what aggressive options may be used to treat colorectal cancer
chemotherapy/radiotherapy
61
how would you treat advanced colorectal cancer
cancer resection and chemo - colon, lung, liver | HIPEC
62
what palliative support may be offered to patients whos cancer cannot be treated
stenting palliative radiotherapy/chemo bypass

MB1: Gastrointestinal (19 decks)

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