Lower GI Flashcards
(123 cards)
1
Q
abdo pain mimicking appendicitis in kids + rectal bleeding
A
meckels diverticulum
2
Q
dx meckels diverticulum
A
radio nucleotide scan - t99
3
Q
tx meckels diverticulum
A
surgical excision - wedge or small bowel resection with anastomosis
4
Q
3 main causes of malabsorption
A
bowel disease
pancreatic - CF or cancer
infection - giardiasis
5
Q
ix for malabsorption
A
- Stool sample microscopy.
- Bloods: FBC, B12, folate, iron, calcium, anti TTG.
- Hydrogen breath test. (bacterial overgrowth, intolerances)
- OGD + biopsy.
6
Q
skin condition associated with coeliac
A
dermatitis herpetiformis
7
Q
1st line ix coeliac
A
serum anti TTG (IgA) after eating gluten for 6 weeks
8
Q
gold standard ix for coeliac
A
OGD + duodenal/jujenal biopsy - villous atrophy, crypt hyperplasia, lymphocytes
9
Q
deficiencies in coeliac
A
iron deficiency anaemia
B12 and folate
osteoporosis
osteomalacia
10
Q
cancer linked to coeliac
A
T cell lymphoma
small bowel cancer
11
Q
if patient with ? coeliac has low total IgA what can you measure
A
IgG TTG
assocaited with HLA DQ2 and 8
12
Q
vaccines in coealic
A
pneumococcal with 5 yearly booster
due to hyposplenism
13
Q
ix for lactose intolerance
A
hydrogen breath test
14
Q
ix for bacterial overgrowth
A
hydrogen breath test
15
Q
who is at risk of bacterial overgrowth
A
elderly
post gastric surgery
16
Q
tx bacterial overgrowth
A
abx e.g. trimethoprim
17
Q
tx tropical sprue
A
tetracycline + folic acid
18
Q
ix tropical sprue
A
OGD + biopsy
19
Q
what is whipples disease
A
infection with tropheryma whipplei
associated with HLA B27
20
Q
ix of whipples disease
A
OGD + jejunal biopsy –> PAS (periodic acid-schiff) positive macrophages and saggy mucosa
21
Q
tx whipples disease
A
LT antibiotics - oral co trim 1 year
22
Q
2 main RF for diverticular disease
A
low fibre
age
23
Q
tx diverticulosis
A
high fibre diet
24
Q
ix diverticular disease
A
colonoscopy
25
ix diverticulitis
erect CXR - rule out perforation
AXR - assess for obstruction
abdo CT with contrast to identify cause/local comps e.g. abscess
NOT colonoscopy due to risk of perforation in acute disease
26
mild diverticulitis tx
oral abx
27
severe diverticulitis tx
IV abx and IV fluids - cephalosporin and metronidazole
28
tx diverticular abscess
USS guided percutaneous drainage
29
diverticulitis + perforation/obstruction
probably hartmanns
30
AF predisposes to what bowel problem
acute mesenteric ischaemia
31
ischaemic colitis in young person
cocaine possibly
32
ischaemic colitis ix of choice
CT
33
where is ischaemic colitis most likely to occur
splenic flexure
34
AXR of ischaemic colitis
mucosal thumb printing
35
diagnostic ix of ischaemic colitis
sigmoidoscopy + biopsy - withering crypts
36
screening for ischaemic colitis
AXR
37
presentation of large bowel ischaemia / ischaemic colitis
intermittent LLQ pain
rectal bleeding
diarrhoea
hx of CVD/risk factors
38
tx ischaemic colitis
conservative
39
fresh intermittent PR bleeding in elderly
IDA on FBC
no mass
angiodysplasia
40
ix for angiodysplasia
rule out cancer - FIT, colonscopy
| diagnostic - mesenteric angiography is acutely bleeding
41
tx angiodysplasia
embolisation, endoscopic lazer cautery
| 2nd line - resection
42
dx and tx of colorectal polyp
colonscopy + polypectomy
43
how often are people with FAP screened
sigmoidoscopy annually from 15
44
inheritance of FAP
AD
45
what cancer does HNPCC predispose to
colorectal
ovarian
endometrial
46
screening in HNPCC
colonoscopy every 1-2 years from age 25
47
inheritance of HNPCC
AD
48
inheritance of gardners
AD
49
describe DUKES staging of colorectal cancer
A Tumour confined to mucosa.
B Tumour invaded through bowel wall.
C Involvement of local lymph nodes.
D Distant metastasis.
50
describe the bowel cancer screening
every 2 years to people aged 60-74 (england) and 50-74 (scotland) using FIT
51
gold standard ix for bowel cancer if FIT positive
colonoscopy + biopsy
52
what is used to detect lynch syndrome (HNPCC) if colonoscopy diagnoses bowel cancer
CT colonography
53
staging of rectal cancer
MRI
54
staging of colonic cancer
CTCAP
55
monitoring of bowel cancer
CEA
56
tx bowel cancer
surgical 1st line - most with curative intent
57
surgery for Ceacal, ascending, proximal transverse
right hemicolectomy
58
surgery for Distal transverse or descending
left hemicolectomy
59
surgery for sigmoid
high anterior resection
60
surgery for upper or lower rectum
anterior resection
61
surgery for anal verge
abdomino-perineal excision of rectum
62
who gets chemo for colorectal cancer
Dukes C and above
63
chemo used in colonic cancer
5FU and oxaliplatin
64
is radiotherapy used in rectal cancer
yes - post op reduces local recurrence
65
monoclonal AB used in stage 4 colonic or metastatic disease
cetuximab
66
diagnostic criteria for IBS
3 month history of abdo pain/discomfort for 3 days/week that is relieved by defacation, associated with change in stool frequency and consistency with 2 + additional symptoms
diagnosis of exclusion - suspect ovarian/bowel cancer
67
tx diarrhoea in IBS
loperamide
68
tx constipation in IBS
bulking agents - fybogel, hyocine, avoid lactulose
69
tx bloating in IBS
meveberine
70
tx IBS if failed symptomatic control
psychotherapy, amitriptyline
71
eye problems in
- UC
- crohns
UC - uveitis
crohns episcleritis
(both can occur in both)
72
PSC is associated more with which IBD
UC
73
describe distribution of UC
rectum to ileoceacal valve
continuous
superficial inflammation
74
histology of UC
o Goblet cell depletion.
o Acute cryptitis and crypt abscesses.
o Superficial inflammation involving only the mucosa and submucosa.
75
is UC associated with bloody stool
yes
76
where is pain in UC typically felt
Left
77
diagnosis of UC
colonoscopy + biopsy
78
XR appearance of UC
lead pipe colon - short and narrow
79
ix of UC with severe colitis
flexible sigmoidoscopy
80
assessing extent of UC
colonoscopy
81
risks of UC
colorectal cancer
| toxic megacolon
82
dx toxic megacolon
AXR - thumb printing and colon > 6cm in diameter
83
remission induction:
| Tx UC proctitis
topical ASA
84
remission induction:
| Tx UC proctitis if remission not achieved in 4 weeks with topical ASA
add oral ASA
85
remission induction:
| Tx UC if remission not achieved with topical and oral ASA
add topical or oral steroid
86
remission induction:
| Tx UC proctosigmoiditis/left sided UC
topical ASA
87
remission induction:
| Tx UC proctosigmoiditis/left sided UC if not resolved in 4 weeks on topical ASA
add high dose oral ASA or switch to high dose oral ASA and topical steroid
88
remission induction:
| Tx UC proctosigmoiditis/left sided UC if not resolved in 4 weeks on topical ASA/steroid and oral ASA
stop topical treatments
| offer oral ASA and oral corticosteroid
89
remission induction:
| Tx UC extensive disease
topical ASA and high dose oral ASA
90
remission induction:
| Tx UC extensive disease if remission not achieved in 4 weeks with topical ASA and oral ASA
stop topical treatments and offer high dose oral ASA and oral steroid
91
tx severe UC
IV steroids in hospital - IV methylprednisolone
92
tx severe UC if no improvement in 72 hours with IV steroids
add IV ciclosporin
93
tx UC maintaining remission mild/moderate flare up proctitis/proctosigmoiditis
topical ASA
oral and topical ASA
or low dose oral ASA alone
94
tx UC maintaining remission if left sided UC/ extensive disease
low dose oral ASA
95
Tx UC severe relapse or > 2 exacerbations in a year
oral azathioprine or mercaptopurine
96
first line treatment of UC and mainstay for remission
5 ASA (mesalazine)
97
what is a risk of using mesalazine
acute pancreatitis
98
describe the distribution of crohns
any part of alimentary canal from mouth to anus
transmural inflammation
skip lesions (cobblestone)
99
where is pain typically felt in crohns
right hand side - most commonly affects terminal ileum
100
histology of crohns
o Non caseating granuloma.
o Deep, transmural (extends from mucosa to serosa) inflammation that can cause fissures and gives the mucosa a cobblestone appearance.
o Goblet cells
101
deficiency common in crohns
B12 - macrocytic anaemia
102
is crohns associated with blood
not as much as UC
| yes if crohns colitis
103
does UC or crohns get perianal disease
crohns
104
anaemia seen in crohns
macrocytic
105
what inflammatory marker correlates with disease activity in crohns
CRP
106
ix of crohns
colonoscopy and biopsy
107
what feacal marker is rasied in crohns
faecal calprotectin
108
dx of crohns
flexible sigmoidoscopy
109
treatment crohns - remission induction
glucocorticoids - oral topical or IV
| enteral feeding with elemental diet
110
what can be used as an add on medication to induce remission in crohns but not as a monotherapy
azathioprine or mercaptopurine
methotrexate is alternative
111
drug used in treatment crohns in refractory disease and fistulating disease
infliximab
112
isolated perianal disease in treatment crohns
metronidazole
113
1st line treatment crohns maintaining remission
azathioprine or mercaptopurine
114
2nd line treatment crohns maintaining remission
methotrexate
115
what needs to be measured before starting azatioprine
TMPT activity
116
ix for suspected perianal fistula
MRI
117
tx complex fistula
draining seton
118
tx perianal abscess
incision and drainage and antibiotics
119
tx severe flares in crohns
IV steroids
| azathioprine and mercaptopurine can be added on
120
most important advice in crohns
STOP SMOKING
121
where are ileostomies found
RIF
122
where are colostomys found
LIF
123
5ASA side effect that patients need to be aware of
agranulocytosis - if get a cold sore throat etc need to check FBC
