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Alimentary > Lower GI Disease > Flashcards

Lower GI Disease Flashcards

1
Q

Define IBD

A

A chronic, relapsing, remitting inflammatory condition of the GI tract.

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2
Q

What are the common types of IBD seen ?

A

Crohn’s disease and Ulcerative Colitis are the two main types of IBD.

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3
Q

What extra-intestinal manifestations are seen in those individuals with IBD ?

A

Uveitis/scleritis
Erythema nodosum
Ulcers in the mouth

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4
Q

What is the typical presentation of UC ?

A 
Bloody diarrhoea
Abdominal pain
Anaemia 
Weight loss 
Fatigue
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5
Q

How would you investigate UC ? (4)

A

Bloods - CRP, albumin and ferritin
FIT testing
Stool culture to rule out infection
Colonoscopy and biopsy

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6
Q

How is UC graded ?

A

Mild <4 stools/day
Moderate 4-6 stools/day
Severe >6 stools/day
Fulminant >10 stools/day

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7
Q

What is proctitis ?

A

Inflammation of the rectum

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8
Q

How does proctitis present ?

A 
Incontinence
Tenesmus 
Increased frequency 
Soreness around anus 
Pus and discharge 
Diarrhoea
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9
Q

How is proctitis treated ?

A

Topical therapies, suppositories

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10
Q

What is acute severe colitis ?

A

> 10 stools per day for more than 10 days and symptoms of regular colitis.

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11
Q

How do you treat acute severe colitis ?

A 
IV Corticosteroids 
IV hydration 
Enteral feeding 
Immunotherapy 
Urgent surgical review and psychological support
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12
Q

How is acute severe colitis diagnosed ?

A

Bloods - CRP, Ferritin
Colonoscopy with biopsy
Stool sample for culture

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13
Q

What may be seen on an AXR in colitis ?

A

Toxic dilation
Lead pipe sign
Oedema

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14
Q

How can you distinguish between Crohn’s and UC ?

A

Crohn’s can affect the entire GI tract whereas UC only the large intestine, Crohn’s may therefore cause vomiting if near the stomach.

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15
Q

What stool test can be done to differentiate between IBD and IBS ?

A

Faecal calprotectin

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16
Q

Out of CD and UC which ones has …
Granulomas
Transmural infarction
Abscesses ?

A

CD
CD
Both

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17
Q

How is perianal Crohn’s disease investigated ?

A

MRI or pelvis and an examination

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18
Q

How is perianal Crohn’s disease treated ?

A

Drainage of pus
Antibiotics
Biologic therapy

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19
Q

What is the treatment for UC ?

A

Flare ups :

  • Steroids with Vit D and calcium
  • 5ASA’s

Maintenance :

  • 5ASA’S
  • Thiopurines

Biologics help keep patient in remission

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20
Q

What is the treatment for CD ?

A

Flare ups :

  • Steroids with Vit D and calcium
  • Methotraxate

Maintenance :

  • Thiopurines
  • Methotrexate

Biologics help keep patient in remission

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21
Q

What are the side effects of thiopurines ? (4)

A

Pancreatitis
Hepatotoxicity
Leukopenia
Increased lymphoma risk

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22
Q

What are biologics ?

A

Monoclonal antibodies

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23
Q

What causes therapy to fail in UC/CD ?

A

Relapses or recurrent courses of steroids

Unacceptable side effects

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24
Q

If treatment of UC/CD fails what is the other option ?

A

Surgery

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25
Q

What might form in CD that needs fixing via surgery ?

A

Fistulas

Obstruction

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26
Q

What is a pouch procedure ?

A

Small bowel or part of GI that was preserve is reattached to rectal stump so no need for stoma after.

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27
Q

What is refractory colitis ?

A

UC main remain active though patient is receiving appropriate treatment.

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28
Q

Which parts of the duodenum are intraperitoneal and which bits retroperitoneal ?

A

The first part is intraperitoneal and the rest retroperitoneal

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29
Q

What cells are found in the crypts of the small intestine ? (4)

A

Endocrine cells
Paneth cells
Goblet cells
Stem cells

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30
Q

What is the intrinsic plexus of the intestine ?

A

Myenteric plexus

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31
Q

What is the extrinsic plexus of the intestine ?

A

Autonomic plexus

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32
Q

What diseases other than UC and CD does IBD include ?

A

Appendicitis
Ischaemic colitis
Radiation colitis

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33
Q

What is NOD2 associated with ?

A

CD

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34
Q

What is HLA and pANCA associated with ?

A

UC

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35
Q

Pseudopolyps and ulceration are commonly seen in which IBD disease ?

A

UC

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36
Q

Which IBD disease presents with a thickened, oedematous mesentery ?

A

CD

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37
Q

Which drugs increase risk of ischaemia ?

A

OCP
Atherosclerotic drugs
Vasoconstrictive drugs (propranolol)

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38
Q

Which part of the GI tract has a high risk of ischaemia ?

A

The splenic flexure

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39
Q

How does ischaemia affect gut wall ?

A 
Haemorrhages 
Oedema
Necrosis
Perforation 
Ulceration 
Inflammation
Fibrosis
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40
Q

How does ischaemia present ? (4)

A

Pain, cramping
Nausea
Blood
Diarrhoea

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41
Q

How does radiation colitis present ? (4)

A

Weight loss
Malabroption
Diarrhoea
Abdominal pain

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42
Q

How does appendicitis present ?

A

Pain
Nausea
Lack of appetite
Fever

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43
Q

How is appendicitis diagnosed ?

A

History and examination
USS
CT

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44
Q

Which 3 shapes can polys be ?

A

Villous
Tubular
Tubulovillous

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45
Q

What are the risk factors for adenocarcinoma of the colon ?

A

Family/genetics
Alcohol/red meat
Low fibre diet
IBD

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46
Q

How does right sided adenocarcinoma of the colon present ?

A

Anemia
Vague pain
Obstructions
Polypoid

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47
Q

How does left sided adenocarcinoma of the colon present ?

A

Annular
Obstruction
Fresh blood
Altered bowel habit

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48
Q

How do you stage bowel cancer ? (2)

A

TNM staging and Duke’s

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49
Q 
Duke stages ?
A
B
C
D
A

A - The cancer is in the inner lining of the bowel. Or it is slightly growing into the muscle layer.
B - The cancer has grown through the muscle layer of the bowel.
C - The cancer has spread to at least 1 lymph node close to the bowel.
D - The cancer has spread to another part of the body, such as the liver, lungs or bones.

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50
Q

Which polyps are most likely to turn malignant ?

A

Villous

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51
Q

Name an oncogene

A

k-ras

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52
Q

Name a tumour suppressor gene

A

APC, p53

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53
Q

How does colorectal cancer usually present ?

A 
Diarrhoea/constipation 
Blood in stool
Weight loss 
Anaemia 
Palpable mass
54
Q

How is colon cancer investigated ?

A

Colonoscopy with biopsy

Blood tests

55
Q

How is colon cancer staged using imaging ?

A

CT of the abdomen/pelvis
PET scans
MRI rectal

56
Q

What is used to mop up lymph node metastases ?

A

Chemotherapy

57
Q

What is radiotherapy used for ?

A

Rectal cancer only

58
Q

What is used for palliation in colon cancer ?

A

Chemotherapy and stenting

59
Q

What does FIT stand for ?

A

Faecal immunochemical testing

60
Q

What does FOBT stand for ?

A

Faecal occult blood test

61
Q

When is FIT testing started and how often is it done ?

A

When you reach 50 every 2 years till 74 years.

62
Q

Which groups of patient are seen at high risk for the development of colon cancer ?

A 
Previous colon cancer
IBD
FAP
HNPCC
Family member had it
63
Q

What gene is defected in FAP ?

A

APC gene

64
Q

How are people with FAP screened ?

A

Yearly

65
Q

When do people with FAP usually have a proctocolectomy ?

A

16-25 years old

66
Q

What genes are abnormal in HNPCC ?

A

Mismatch repair genes

67
Q

How is HNPCC diagnosed ?

A

Amsterdam criteria and genetic testing

68
Q

How often are those with HNPCC screened ?

A

Every 2 years

69
Q

How often are those with a family history of colorectal cancers screened and what age does screening begin ?

A

Every 5 years from 50

70
Q

People with IBD when does screening begin and how often between colonoscopies ?

A

10 years after diagnosis and every 5 years

71
Q

What are haemorrhoids ?

A

Swellings containing enlarged blood vessels that are found inside or around the bottom

72
Q

What are the symptoms of haemorrhoids ?

A
  • Bright red blood after you poo
  • An itchy anus
  • Mucus
  • Lumps around your anus
  • Pain around your anus
73
Q

Why do haemorrhoids occur ?

A

They occur due to chronic constipation, chronic diarrhoea, lifting heavy weights, pregnancy, or straining when passing a stool.

74
Q

How are haemorrhoids diagnosed ?

A
  • Visual examination
  • Rectal examination
  • Colonoscopy
75
Q

How are haemorrhoids treated ?

A
  • Topical steroids
  • High fibre foods
  • Laxative if constipated and FODMAP if diarrhoea
  • Analgesics
76
Q

What are anal fissures ?

A

An anal fissure is a small tear in the thin, moist tissue (mucosa) that lines the anus.

77
Q

How do anal fissures occur ?

A

An anal fissure may occur when you pass hard or large stools during a bowel movement. Diarrhoea and other conditions such as CD, UC can cause them too.

78
Q

How do anal fissures present ?

A
  • Painful bowel movements

- Rectal bleeding

79
Q

How are anal fissures investigated ?

A

Digital rectal examination

Examination with anaesthesia

80
Q

How can anal fissures be prevented and treated ?

A
  • Give laxative
  • GTN or botox to relax muscle
  • Most will heel of there own but surgery may be needed if they persist

To prevent increase fibre intake, exercise, defecate when need arises and stay well hydrated.

81
Q

How do perianal abscesses present ?

A
  • Pain
  • Palpable mass
  • Fever and chills
82
Q

What are the risk factors for a perianal abscess ?

A

DM and obesity

83
Q

How do you treat a perianal abscess ?

A

Antibiotics and drainage

84
Q

What is a fistula in ano ?

A

An anal fistula can be described as a narrow tunnel with its internal opening in the anal canal and its external opening in the skin near the anus.

85
Q

How do you manage/treat anal fistulas ?

A

The most common type of surgery for anal fistulas is a fistulotomy. This involves cutting along the whole length of the fistula to open it up so it heals as a flat scar.

If your fistula passes through a significant portion of anal sphincter muscle, the surgeon may initially recommend inserting a seton.A seton is a piece of surgical thread that’s left in the fistula for several weeks to keep it open. This allows it to drain and helps it heal, while avoiding the need to cut the sphincter muscles. Loose setons allow fistulas to drain, but do not cure them. To cure a fistula, tighter setons may be used to cut through the fistula slowly.

86
Q

How does anorectal cancer present ?

A
  • Bleeding from the anus or rectum
  • Pain in the area of the anus
  • A mass or growth in the anal canal
  • Anal itching
87
Q

How would anal cancer be investigated ?

A

Examination
USS
Biopsy and microscopy

88
Q

What are the risk factors for anal cancer ?

A
  • HIV
  • Other cancers
  • Anal sex
  • Smoking
89
Q

How is anal cancer treated ?

A 
Chemotherapy 
Radiotherapy 
Surgery 
Immunotherapy 
Analgesics
90
Q

How is faecal incontinence investigated ?

A 
USS
Clinical examination 
Anal manometry 
Defaecating proctogram 
EMG
91
Q

How is faecal incontinence managed ?

A
  • Diet
  • Bowel habits
  • Antidiarrhoeals
  • Anal plugs
  • Pelvic floor strengthening
92
Q

What is rectal prolapse ?

A

Rectal prolapse is when part of the rectum protrudes from the anus.

93
Q

What are the symptoms of rectal prolapse ?

A
  • Feeling a bulge outside your anus.
  • Seeing a red mass outside your anal opening.
  • Pain in the anus or rectum.
  • Bleeding from the rectum.
  • Leaking blood, poop, or mucus from the anus.
94
Q

How is rectal prolapse treated ?

A

Surgery is the only way to effectively treat rectal prolapse and relieve symptoms. The surgeon can do the surgery through the abdomen or through the area around the anus. Surgery through the abdomen is performed to pull the rectum back up and into its proper position.

95
Q

What is pruritus ani ?

A

Pruritus ani is the irritation of the skin at the exit of the rectum, known as the anus, causing the desire to scratch.

96
Q

What is the main cause of pruritus ani in children ?

A

Threadworms

97
Q

How is pruritus ani treated ?

A
  • Steroids ointments
  • Antihistamines
  • Mebendazole to treat threadworm
98
Q

What is the name of the artery at the point where the SMA and IMA anastomose ?

A

The marginal artery

99
Q

Which artery supplies the rectum from the IMA ?

A

Superior rectal artery

100
Q

Where does the middle rectal artery come from ?

A

The internal iliac artery

101
Q

Where does the inferior rectal artery come from ?

A

The internal pudendal artery

102
Q

What are the 4 groups of abdominal lymph nodes called ?

A

Epicolic
Paracolic
Central
Intermediate

103
Q

What are the indications of surgical resection of the bowel ?

A 
Ischemia 
Polpys 
Obstruction 
Perforations 
Tumours
104
Q

What does TME stand for ?

A

Total mesorectal excision

105
Q

What is TME used for ?

A

To remove the entire mesorectum with rectum and lymph nodes.

106
Q

Which vitamins are produced in the large intestine ?

A

B and K

107
Q

Define screening

A

Presumptive identification of unrecognised disease in an asymptomatic individual. Uses tests, examinations and other procedures that can be applied rapidly and easily.

108
Q

At what age is a flexible sigmoidoscopy done in England ?

A

55

109
Q

How are polyps usually removed ?

A

Polypectomy with a hot snare

110
Q

How do colonic polyps present ?

A 
Weight loss
Bleeding 
Change in bowel habits
Fatigue 
Abdominal pain
111
Q

How are polyps investigated ?

A

Colongraphy

CT Colonoscopy

112
Q

What does CRM stand for ?

A

Circumferential resection margin

113
Q

What investigate is done prior to colorectal surgery for cancer ?

A

MRI of rectum to look if TME is needed and if there’s a clear margin

114
Q

What are the 4 bowel anastomosis principles ?

A

No tension
Clear surgical site
Well perfused/oxygenation
Acceptable systemic state

115
Q

Is a colostomy or ileostomy spouted ?

A

An ileostomy

116
Q

What is the contents of the stoma like in an colostomy/ileostomy ?

A

Ileostomy - Liquid

Colostomy - Solid

117
Q

What are the complications associated with a stoma ?

A

Infection
Bleeding
Anastomotic leak

118
Q

Damage to which structures in a lower resection are at risk and what problems can this cause ?

A

Pelvis nerves - Incontinence and sexual dysfunction

119
Q

What are the signs of bowel obstruction ?

A

Abdominal pain
N/V
Abdominal distension
Constipation

120
Q

Define shock lung

A

Rapid onset and widespread inflammation of the lungs

121
Q

Define acute abdomen

A

Intense abdominal pain that presents <24 hours from onset, requires urgent surgical review

122
Q

Define tubal pregnancy

A

A pregnancy that occurs in the fallopian tube

123
Q

What should you consider when a patient presents with acute abdomen ? (4)

A

Ischaemia
Obstruction
Peritonitis
Appendicitis

124
Q

What are the 4 common routes of infection in peritonitis ?

A

Abdominal wall perforation
Female genital tract
GI wall perforation
Via bloodstream

125
Q

What is the common presentation of peritonitis ?

A 
N/V
Abdominal pain 
Fever
Fatigue 
Constipation
Distension
126
Q

What is borborygmi ?

A

Stomach rumbles

127
Q

How is ischemic bowel diagnosed ?

A

Endoscopy/colonoscopy
Bloods - ABG
CT/MRI scans
Angiogram

128
Q

Where are somatic pain receptors found ?

A

Parietal peritoneum

Abdominal wall

129
Q

Where are visceral pain receptors found ?

A

Walls of the organs

130
Q

How does peritonitis lead to death ?

A

Sepsis, circulatory collapse (shock) then death.

131
Q

How is peritonitis managed ?

A

Need to assess/resuscitate
Bloods - WBC/culture
Paracentesis
CT/X-Ray

132
Q

Define active observation

A

Used when diagnosis is uncertain and risk of alternative intervention is greater

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