Lower GI Tract Disorders

Question 1

what are the most common causes of acute abdomen presentation?

Answer 1

non-specific pain

acute appendicitis

Question 2

what are the possible types of pain experienced in acute abdomen?

Answer 2

colic pain
peritoneal pain
body wall pain

Question 3

which types of abdominal pain are associated with systemic upset?

Answer 3

colic pain and peritoneal pain

Question 4

what type of pain is colic and peritoneal?

Answer 4

visceral pain

poorly localised

Question 5

what type of pain is body wall pain?

Answer 5

somatic pain

well localised

Question 6

what type of pain can be mistaken for somatic pain?

Answer 6

referred pain

Question 7

why is visceral pain non-specific in the abdomen?

Answer 7

because the fibres run with autonomic fibres along the main arteries supplying the gut

Question 8

why is somatic pain easily localised in the abdomen?

Answer 8

because its fibres are skeletal nerves running along the body wall

Question 9

what can be routes of infection for peritonitis?

Answer 9

perforated body wall
perforated GI/biliary tree
gynaecological route
haematological spread

Question 10

what are the possible three aetiologies of intestinal obstruction?

Answer 10

obstruction within gut lumen
obstruction from gut wall
compression from outside gut tube

Question 11

what are the main steps to be taken for resuscitation in cases of acute abdomen?

Answer 11

fluids
oxygenation
perfusion
treat sepsis
decompress gut if obstructed
pain relief

Question 12

what investigations should be done for acute abdomen?

Answer 12

urine analysis
bloods - FBC, U&E, LFT, glucose, calcium
imaging - AXR, CT, USS
laparoscopy

Question 13

what treatment should be adopted for acute abdomen?

Answer 13

pain relief
antibiotics
surgery for underlying problem

Question 14

why is acute abdomen an emergency?

Answer 14

because it can cause sepsis, systemic upset and may lead to death if not investigated and treated quickly

Question 15

what is the main histological and distributional difference between ulcerative colitis and Crohn’s disease?

Answer 15

UC - only affects mucosa and only found in colon (continuous distribution). no granulomas
CD - affects whole gut lining and can be found anywhere from mouth to anus (skip lesions). often has granulomas

Question 16

what are the commonest ages for UC and CD to appear?

Answer 16

UC - 20-40

CD - 20-40 and over 60

Question 17

list some common symptoms of ulcerative colitis and crohn’s disease

Answer 17

abdominal pain
bloody diarrhoea
weight loss
systemically unwell (malaise, fever)
anaemia
malabsorption
nausea and vomiting

Question 18

which IBD disease presents more insidiously?

Answer 18

crohn’s disease

Question 19

list some signs of ulcerative colitis

Answer 19

anorexia
anaemia
dehydration
tachycardia
pyrexia

Question 20

list some signs of crohn’s disease

Answer 20

anorexia
anaemia
dehydration
angular stomatitis
aphtous ulcers
perianal fissures

Question 21

name some common complications of crohn’s disease

Answer 21

stricturing
obstruction
perforation
fistulae

Question 22

name some common complications of ulcerative colitis

Answer 22

toxic dilatation
venous thromboembolism
colorectal cancer

Question 23

what are the step-up treatment options for ulcerative colitis and crohn’s disease?

Answer 23

• 5ASA (UC only)
• steroids
• immunosuppression
• biologics
• surgery
  nutrition throughout (eg elemental feeding)

Question 24

in which type of IBD is surgery more likely to be elective/emergency?

Answer 24

UC - emergency

CD - elective

Question 25

what are the main options for UC surgery?

Answer 25

- ileostomy and proctectomy (stoma bag) | - pouch procedure (no stoma bag)

Question 26

name some exampled of when surgery is indicated in IBD

Answer 26

unresponsive to medication unable to maintain remission side effects of medication outweigh benefit relieving obstructions

Question 27

which type of IBD is more likely to require further operations in the future?

Answer 27

crohn's disease

Question 28

what classification is used to distinguish between mild, moderate and severe UC?

Answer 28

montreal classification

Question 29

presence of which antibodies can be used to confirm a diagnosis of IBD?

Answer 29

p-ANCA

Question 30

how can ulcerative colitis result in colorectal cancer down the line?

Answer 30

because of mucosal dysplasia as result of inflammation

Question 31

what can radiation colitis be caused by, and what does is resemble in presentation?

Answer 31

caused by pelvic radiation (for cancer), resembles IBD

Question 32

if someone is going through bladder cancer radiotherapy and presents with abdominal symptoms, what could be the possible cause?

Answer 32

radiation colitis

Question 33

name two common causes of appendicitis

Answer 33

obstruction by fecal stone | infection by bacteria or parasites

Question 34

why is colorectal cancer more likely to present late if in ascending colon?

Answer 34

because it's wider and stools aren't solid yet, easier to get past tumour without being obstructed

Question 35

what is the appearance of blood likely to be in right and left colorectal cancer? explain why

Answer 35

right - altered blood, broken down by bacteria in gut | left - fresh blood, not travelled through whole colon so not broken down by bacteria

Question 36

how can a precursor of colorectal cancer present?

Answer 36

as adenomas/polyps

Question 37

name some risk factors for developing colorectal cancer

Answer 37

``` lifestyle obesity smoking diet genetics (FAP, HNPCC) ```

Question 38

what type of cancer is colorectal carcinoma?

Answer 38

adenocarcinoma

Question 39

define desmoplasia in the context of colorectal cancer

Answer 39

a reaction from immune cells, causing fibrosis around tumour in an attempt to stop its invasion of surrounding structures

Question 40

name some investigations done to diagnose ulcerative colitis and crohn's disease

Answer 40

``` U&E fecal calprotectin ESR CRP Hb/ferritin WCC albumin platelet count ```

Question 41

name an important differential for IBD in patients with atherosclerosis

Answer 41

ischaemic colitis

Question 42

what is the first line treatment for induction and maintenance of remission of UC?

Answer 42

5ASA (aminosalycilates) = mesalazine

Question 43

what can dermatitis herpetiformis be a sign of?

Answer 43

celiac disease

Question 44

list some investigations done to diagnose/rule out celiac disease

Answer 44

distal duodenal biopsy | serology: endomysial IgA and anti-tissue transglutaminase

Question 45

what causes celiac disease?

Answer 45

inflammatory reaction to gliadin in gluten molecules

Question 46

how is celiac disease managed?

Answer 46

removal of gluten | specialist dietitian help

Question 47

how is giardia infection treated?

Answer 47

with metronidazole

Question 48

name some diseases that can present with steatorrhea

Answer 48

pancreatic disease cystic fibrosis celiac disease

Question 49

what is the preferred method of investigating colorectal cancer? name a few other alternatives

Answer 49

main: colonoscopy barium enema CT colonography

Question 50

name some symptoms of colorectal cancer

Answer 50

``` blood in stool frequent bowel movement abdominal mass weight loss anaemia ```

Question 51

what is the staging classification used for colorectal cancer?

Answer 51

Duke's staging classification

Question 52

what is the main treatment for colorectal cancer?

Answer 52

surgical removal

Question 53

how are chemotherapy and radiotherapy used in colorectal cancer treatment?

Answer 53

chemotherapy used along with surgery to remove micrometastases radiotherapy used before surgery to reduce tumour size

Question 54

what is the palliative management of colorectal cancer?

Answer 54

chemotherapy | stenting to prevent obstruction

Question 55

what investigations are done to stage colorectal cancer?

Answer 55

CT/MRI | PET scan

Question 56

what test is used to screen for colorectal cancer?

Answer 56

FIT - fecal immunochemical test

Question 57

name a few patient groups who might be at risk of developing colorectal cancer

Answer 57

- pts with family history of CRC - pts with FAP or HNPCC - pts with IBD - pts with previous adenomas or CRC

Question 58

what is the aetiology of the majority of CRC cases?

Answer 58

sporadic - idiopathic

Question 59

list a few risk factors for sporadic CRC

Answer 59

``` male obesity diet smoking sedentary diabetes ```

Question 60

what can precede colorectal cancer?

Answer 60

benign adenomatous polyps

Question 61

list some complications of colorectal cancer surgery

Answer 61

``` bleeding infection anesthetic related complications sepsis venous thromboembolism ```