Lower GI Flashcards
(32 cards)
What is an anal fissure?
What is the timeline for acute vs chronic.
Where are primary and secondary anal fissures commonly located?
A tear in squamous epithelium of anal canal
Acute< 6 weeks< chronic
Primary in posterior midline. Secondary in varying locations.
Give 3 causes of secondary anal fissures.
- Constipation
- Crohn’s disease
- Pregnancy
Give 2 features of a common anal fissure presentation.
What is a sign of a chronic ulcer?
- Young person
- Painful rectal bleeding on defecation
- Sentinel pile/ skin tag
Anal fissure patients can enter a pain-constipation cycle.
What is the management for the pain?
What is the management for the constipation?
- Paracetamol/ ibuprofen
+ topical lidocaine.
Topical GTN/ diltiazem if > 1 week. - Increase fluid/ fibre intake
- Laxative.
What are the two management options for chronic anal fissure?
- Botulinum injection
- Internal sphincterotomy
What is the definition of a haemorrhoid?
Engorgement of vascular cushions in anal canal.
What are the two differences between internal and external haemorrhoids?
What are the 4 grades of internal haemorrhoid?
Internal: above dentate line, not painful.
External: below dentate line, painful
- project into lumen, not palpable
- Prolapse w/ straining, spontaneously reduce
- prolapse w/ straining, manually reducible
- Irreducible
Give two aetiologies of haemorrhoids.
- Constipation/ straining
- Raised intra-abdominal pressure: Pregnancy, lifting, chronic cough.
What is the common presentation of haemorrhoids?
Give an individual complication for both external and internal haemorrhoids.
- Painless rectal bleeding- small amounts of bright red blood on wiping/ in bowl.
- Strangulation of internal haemorrhoid- severe pain, urgent haemorrhoidectomy.
- Thrombosis of external haemorrhoids- sever pain, purple oedematous perianal mass. <72 hours surgical incision
Give two investigations for haemorrhoids.
Give 3 steps in management for haemorrhoids.
- Proctoscopy
- Anaemia
- Stool softening: fibre/ fluid laxative
- Rubber band ligation/ or injection sclerotherapy
- Large grade 3/4 may require haemorrhoidectomy.
What is the most common form of colorectal cancer? Describe it’s global epidemiology.
Usually adenocarcinoma.
3rd most common cancer in world.
Give 4 etiological factors for colorectal cancer
- Genetic: FAP (APC gene), HNPCC - autosomal dominant.
- Demographic: old male
- Environmental: smoking, diet, alcohol, obesity
4: other: adenomatous/ neoplastic polyps. IBD (UC > Crohn’s)
What screening tool is used for colorectal cancer for 60-74yrs and how often?
- Screening is Faecal immunochemical test (FIT). Test for trace amounts of blood.
Every 2 years
Give 3 general symptoms of colorectal cancer.
- abdominal pain, weight loss, fatigue.
Differentiate presentation of left (6 factors) and right (2 factors) sided colorectal cancer.
Left: more common, present earlier.
- PR bleeding
- Change in bowel habit
- Rectal tenesemus, mass on DRE
- Can present with obstruction.
Right: less common, present later,
- anaemia
Give 3 blood results and 2 other investigations for colorectal cancer.
What 4 sites are common metastasis locations?
- Blood:
- FBC- iron deficiency anaemia
- LFTs (mets)
- CEA (tumour marker, not used for diagnosis) - Colonoscopy- gold standard.
- Barium enema: apple core stricture.
TNM staging, used to be Duke’s
Common mets: liver, lungs, bone, brain
Give the 1s and 2nd line management options for colorectal cancer treatment.
1st: Surgery- L/R hemicolectomy, sigmoid colectomy, rectum anterior resection.
2nd: radiotherapy, chemotherapy.
When should you refer the following people to 2 week wait for colorectal cancer:
- age >40
- age >50
- age >60
40- unexplained weight loss, abdominal pain.
50- unexplained rectal bleeding
60- iron deficiency anaemia or change in bowel habit.
Differentiate UC and Crohn’s disease in the following areas:
- Risk factors
- Pathology
- Presentation
- Complications
UC: RF: HLA-B27, not smoking PA: Rectum- ileocaecal valve, continuous, mucosa Pres: Abdo pain (L), bloody diarrhoea Comp: Toxic megacolon, colorectal cancer
Crohn’s:
RF: smoking
Path: Anus- mouth, discontinuous, transmural
Pres: Abdo pain (R), diarrhoea, perianal lesions, mouth ulcers, malabsorption.
Comp: fistulae, abscesses.
Differentiate UC and Crohn’s by their extraintestinal manifestations in the following:
- Eyes,
- Hepatobiliary
IBD also affects Musculoskeletal and skin.
- IBD gets MESSY
UC:
- Uveitis
- PSC/ cholangiocarcinoma
Crohn’s:
- Episcleritis
- Gallstones (+ kidney stones)
Give 3 results from blood test of IBD (chronic inflammation).
Give 3 stool investigations:
What is gold standard investigation for IBD
- FBC: anaemia of chronic disease, high platelets, high white cell count
- LFT: low albumin
- ESR/ CRP raised.
- Stool culture
- Faecal calprotectin- marker of inflammation, distinguishes IBS and IBD.
- C. Difficile toxin
Gold standard is colonoscopy.
In the management of UC: what are the induction and maintenance medications.
in the management of Crohn’s: what are the induction and management medications.
UC:
Induction: Mesalazine (5-ASA). Topical if L-sided, Topical + oral if whole colon). If severe, IV steroids.
Maintenance: Mesalazine topical/ oral. If severe, Azathioprine. mercaptopurine.
Crohn’s:
Induction: steroids: topical/ oral/ IV. Elemental, enteral feeding. If isolated perianal disease- metronidazole. 2nd line is Mesalazine, azathioprine, mercaptopurine, infliximab.
Maintenance: Azathioprine/ mercaptopurine. 2nd line methotrexate.
NBM and fluids.
Surgery common for Crohn’s
IBS is more than 6 months of what 3 symptoms.
What criteria is used to diagnose IBS?
ABC:
- Abdominal discomfort/ pain on eating, relieved by defecation. Muscle contract causing cramps.
- Bloating- bacteria produce gas
- Change in bowel habit, stool form incl. mucus.
Pellet-like stool is buzzword. Epithelial lining produces mucus.
ROME criteria for diagnosis
Classically young women. Reconsider if >40 yrs.
What two investigations exclude other causes from a diagnosis of IBS?
- FBC/ CRP
2. Coeliac antibodies.
