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Y3 MedEd > Lower GI > Flashcards

Lower GI Flashcards

(52 cards)

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1
Q

Anal fissure acute vs chronic length

A

Acute < 6 weeks < Chronic

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2
Q

Causes of secondary anal fissures (3)

A

Constipation
Crohn’s disease
Pregnancy

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3
Q

Mx of acute anal fissure (pain 3, constipation 2)

A

Paracetamol/ibuprofen
Topical lidocaine

Topical GTN/diltiazem if >1 week

↑ Fibre/fluid intake
Laxative

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4
Q

What is the difference between internal and external haemorrhoids

A

Internal: above dentate line, not painful
External: below dentate line, painful if thromboses

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5
Q

What are the 4 grades of haemorrhoids

A 
Grade 1
Project in lumen, not palpable
Grade 2
Prolapse w/straining, spontaneously reduce
Grade 3
Prolapse w/straining, manually reducible
Grade 4
Irreducible
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6
Q

Haemorrhoids presentation

A

Usually painless rectal bleeding:

Small amounts of bright red blood on wiping/in bowl

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7
Q

Ix for haemorrhoids (3)

A

Proctoscopy

Anaemia Hb/MCV

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8
Q

Complication of each type of haemorrhoids

A

Thrombosis of external haemorrhoids
Severe pain + purplish oedematous perianal mass
If <72 hours, surgical incision

Strangulation of internal haemorrhoids
Severe pain
Urgent haemorrhoidectomy

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9
Q

Mx of haemorrhoids (3)

A

Stool softening: fibre/fluid/laxative
Rubber band ligation/injection sclerotherapy
Large grade ¾ may require haemorrhoidectomy

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10
Q

Colorectal cancer is usually what type of cancer

A

Adenocarcinoma

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11
Q

How does each form of IBD affect your chances of getting colorectal cancer

A

IBD (UC > Chron’s)

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12
Q

Which tumour marker suggests colorectal cancer

A

CEA

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13
Q

Ix for colorectal cancer (4)

A 
Bloods: 
FBC (iron-deficiency anaemia)
LFTs (mets)
CEA (tumour marker, NOT used for diagnosis)
Colonoscopy (gold standard)
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14
Q

What is seen on a barium enema that suggests colorectal carcinoma

A

Barium enema, apple core stricture

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15
Q

Where does colorectal cancer often metastasise

A

Liver

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16
Q

Which IBD can be anywhere in the GI tract

A

Crohns

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17
Q

RF UC (2)

A

HLA-B27

NOT smoking

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18
Q

RF Crohn’s

A

Smoking

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19
Q

Which IBD is transmural vs mucosa only

A

UC mucosa only

CD transmural

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20
Q

Which IBD causes bloody diarrhoea

A

UC

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21
Q

Which IBD causes malabsorption

22
Q

Complications of UC (2)

Study These Flashcards
A

Toxic megacolon

Colorectal cancer

23
Q

Complications of CD (2)

Study These Flashcards
A

Fistulae

Abscesses

24
Q

What are EI manifestations related to disease activity you see in both IBD’s (3 both, CD)

Study These Flashcards
A

Erythema nodosum
Asymmetric oligoarthritis
Osteoporosis

CD
Episcleritis

25
What are EI manifestations unrelated to disease activity in IBD's (3 both, 3UC, 1 CD)
Clubbing Symmetrical, polyarticular arthritis Pyoderma gangrenosum UC PSC/cholangiocarcinoma Uveitis CD Gallstones (+ kidney stones)
26
IBD Ix in bloods (5)
FBC: anaemia of chronic disease, ↑ platelets, ↑ WCC LFT: low albumin ESR/CRP
27
IBD Ix apart from bloods (6)
``` U&E Stool culture Faecal calprotectin C diff toxin Colonoscopy Barium enema ```
28
Mx of UC induction and maintenance (normal and severe)
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
29
Mx of CD induction and maintenance (first and second line)
Induction Steroids (topical, oral, IV) Elemental, enteral feeding 2nd line: Mesalazine, azathioprine/mercaptopurine, infliximab Maintenance Azathioprine/mercaptopurine 2nd line: Methotrexate
30
IBS diagnostic criteria (3)
>6 months of either: (ABC) Abdominal pain/discomfort, relieved by defecation, brought on by eating Bloating Change in bowel habit, stool form (incl. mucus)
31
IBS normal population
Young women
32
Mx IBS (4 symptoms)
Diet: low caffeine/alcohol/fizzy drinks, lots of water Pain: antispasmodics (mebeverine [anticholinergic]), low dose TCA Diarrhoea: loperamide Constipation: laxative (NOT lactulose) Psychological therapy after 12 months
33
Ix for IBS
FBC/CRP | Coeliac antibodies
34
Define coeliac disease
T-cell mediated autoimmune reaction to dietary gluten leads to small bowel + systemic disease
35
Which part of the GI system does coeliac affect
Small bowel
36
Which gene is involved in Coeliac
HLA DQ2/8 alleles
37
RF of coeliac (2)
Hx/FHx autoimmune disease  women
38
Presentation of coeliac disease (3 ways)
``` Chronic GI symptoms: N&V, diarrhoea, bloating Malabsorption Calories: weight loss/failure to thrive Vitamins & minerals: osteoporosis, anaemia, neuropathy Fats: steatorrhoea 3. Dermatitis herpetiformis ```
39
Coeliac Ix (4)
Microcytic/macrocytic anaemia (increased RCDW) Haematinics: low b12 and ferritin Low calcium/vit D LFT  non specific transaminitis Confirm with endoscopy and duodenal biopsy
40
AUTO-ANTIBODIES to test in coeliac (2)
IgA anti-tissue transglutaminase (TTG) | IgA anti-endomysial antibodies
41
What is seen in the biopsy of coeliac (3)
Villous atrophy Crypt hyperplasia Intraepithelial WBC
42
Mx of coeliac (2)
Gluten free diet | + pneumococcal vaccine (every 5 years) due to hyposplenism
45
What is coeliac associated with that we should always look out for (4)
Enteropathy associated T-cell lymphoma (EATL) NHL and HL Other small bowel adenocarcinomas
46
What are EI manifestations unrelated to disease activity you only see in UC (3)
PSC/cholangiocarcinoma | Uveitis
47
What are EI manifestations unrelated to disease activity you only see in CD
Gallstones (+ kidney stones)
48
What are EI manifestations related to disease activity you only see in CD
Episcleritis
49
What are EI manifestations related to disease activity you see in both IBD's (3)
Erythema nodosum Asymmetric oligoarthritis Osteoporosis
50
What are EI manifestations unrelated to disease activity you see in both IBD's (3)
Clubbing Symmetrical, polyarticular arthritis Pyoderma gangrenosum
51
Mx of UC induction (normal and severe)
Mesalazine (5-ASA) (topical if L-sided, topical +oral if whole colon) If severe: IV steroids
52
Mx of CD induction (first and second line)
Steroids (topical, oral, IV) Elemental, enteral feeding 2nd line: Mesalazine, azathioprine/mercaptopurine, infliximab
53
Mx of UC maintenance (normal and severe)
Mesalazine (topical/oral) If severe: Azathioprine/mercaptopurine
54
Mx of CD maintenance (first and second line)
Azathioprine/mercaptopurine 2nd line: Methotrexate

Y3 MedEd (34 decks)

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