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CP3 SURGERY > UGI/CR - Colon part 2 > Flashcards

UGI/CR - Colon part 2 Flashcards

1
Q

Def Diverticulosis

A

Presence of diverticula

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2
Q

Def Diverticulitis

A

Inflammation of the diverticula

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3
Q

Def Diverticular disease

A

Symptomatic diverticula

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4
Q

What % people over 50 have diverticula

A

50%

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5
Q

Which part of the bowel are 95% diverticula

A

sigmoid

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6
Q

Most common cause diverticula

A

low fibre diet

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7
Q

3 rarer conditions diverticula are associated with

A

Marfans
PKD
Ehlers Danlos

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8
Q

Pathogenesis diverticula

A

hypertrophy of mm propria

Diverticula occur at sites of potential weakness in bowel wall

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9
Q

What is a ‘true’ diverticulum

A

Just mucosa

No muscle covering

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10
Q

Def diverticula

A

Outpouching of mucosa and submucosa that herniate through to colonic mm layers

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11
Q

What % of diverticulae are asymp

A

95%

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12
Q

If diverticulae are symptomatic, what do they mimic

A

Colon cancer

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13
Q

Complications of diverticulae (6)

A 
Bleeding 
Perforation 
Ulceration 
Abscess 
Fistulae
Strictures
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14
Q

Sx of diverticular disease (5)

A 
Sudden painelss bleeding 
Nausea
Flatulence 
Changes in bowel habit 
Left sided colic relieved by defacation
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15
Q

Sx diverticulitis (6)

A 
LIF pain 
Localised peritonism 
Fever 
TachyC
Nausea + vomiting 
Sometimes palpable mass
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16
Q

RF Diverticular disease (4)

A

Low fibre diet
High fat diet
Age
Constipation

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17
Q

Ix diverticular disease (4)

A

PR
Sigmoidoscopy/colonoscopy
Barium enema
CT

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18
Q

When should you be wary of doing a sigmoidoscopy diverticular disease

A

If bowel is inflamed

Due to risk of perforation

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19
Q

Mx diverticular disease

A

Mebeverine

+ laxatives + lifestyle advice

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20
Q

Why does diverticulitis occur?

A

Because of stagnation of contents of diverticula

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21
Q

Mx of mild diverticulitis (3)

A

Bowel rest @ home

PO Co-amoxiclav +/- metronidazole

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22
Q

Mx of severe attack diverticulitis (4)

A 
Admit if pain not controlled 
Analgesia 
IV fl 
IV cefuroxine + metronidazole 
Keep NBM
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23
Q

Ix severe attack diverticulitis (3)

A

CXR
AXR
+ CT contrast
(to assess for complications)

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24
Q

What must you NOT do in an acute diverticulitis attack

A

Scope

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25
Complications of diverticulae (6)
``` Perforation Bleeding Stricture Abscess Fistulae Intestinal obstruction ```
26
What can perforation lead to in acute diverticulitis (3)
Paracolic/pelvic abscess Fistulae Generalised peritonitis
27
PS perforation from diverticulitis (3)
Ileus Peritonitis Shock
28
Mortality rate perforation from diverticulitis
40%
29
Mx perforation from diverticulitis
Laparotomy +/- Hartmanns procedure
30
PS - abscess from diverticulitis (3)
Swinging fever Leucocytosis Localised booggy rectal mass
31
PS - bleed from diverticulitis
Sudden painless bleeding
32
Mx bleed from divertilculitis
Stop w/ bed rest If doesn't stop - locate w/ angiography + Tx w/ embolisation +/- adrenaline + diathermy
33
2 types of fistulae from diverticulitis
Colovesical | Colovaginal
34
PS colovesical fistula
UTI + pneumaturia
35
PS colovaginal fistulae
Foul discharge
36
Where can obstruction occur as a result of repeated eps of diverticulitis
Sigmoid colon
37
Signs + Sx of malabsorption (8)
``` Diarrhoea/steatorrhoea W loss Lethargy Anaemia Bleeding disorders Oedema Osteomalacia Neuropathy ```
38
3 most common causes of malabsorption (Cs)
Coeliac Crohn's Chronic pancreatitis
39
Rarer causes of malabsorption (3)
Reduced bile Pancreatic insufficiency Bacterial overgrowth
40
Ix Malabsoprtion - bloods (12)
``` FBC Fe studies B12/folate Ca Mg PO4 Lipid profile LFT TFT inflammatory markers Clotting Coeliac serology ```
41
Ix Malabsoprtion - stool studies (3)
MCS Faecal elastase Calprotectin
42
Pathology coeliac disease
inflammation of jejunum | Alpha gilandin = modified by TTG which activates autoimmune reaction against the mucosa
43
Biopsy findings coeliac (3)
Flattened mucosa b/c loss of villi Hyperplasia of crypts increased intraepithilial lymphocytes
44
PS coeiliac (10)
``` 1/3 = asymp Non specific IDA, W loss Fatigue Apthous ulcers Diarrhoea Abdopain/bloating N+V Dermatitis heraptiformis ```
45
Ix coeliac (7)
``` FBC Clotting Bone profile EMA TTG antibodies Duodenal biopsy Done densitometry ```
46
What is gold standard Ix coeliac
Duodenal biopsy
47
WHy do bone densitometry coeliac Ix
B/c of increased risk OP
48
Which cancers are people w/ coeliac at a small increased risk of ? (2)
Small bowel lymphoma | Adenocarcinoma
49
Most common cause Chronic pancreatitis
Increased alcohol intake
50
Pathology chronic pancreatitis
Plugging pancreatic ducts --> space for infection/calcification --> ductal HTN --> fibrosis parenchyma + disturbed endocrine fct
51
PS chronic pancreatitis (8)
``` Epigastric pain radiating to back Relieved by sitting forward/hot water bottle W loss Bloating Steatorrhoea Brittle DM Obstructive jaundice Sx = relapsing + progressively worse ```
52
Ix chronic pancreatitis (5)
``` Faecal elastase elevated Trypsinogen > 10 = diagnostic Signs alcohol abuse TA USS Contrast CT/MRCP = diagnostic ```
53
What is seen on CT/MRCP chronic pancreatitis
Calcification
54
Mx chronic pancreatitis (5)
``` Analgesia Creon (lipase) Mutlivite (fat soluble vitamins) Monitor glucose Tx alcohol abuse Low fat diet ```
55
What is melaena due to?
Break down of blood in small intestine for an UGI bleed
56
What % of pt w/ CRC PS w/ mets on diagnosis
20%
57
RF CRC (10)
``` FHx Age Western diet Obesity Physical inactivity UC DM Smoking Alcohol XS Personal Hx bowel cancer ```
58
Protective factors CRC (4)
Healthy diet Exercise HRT Aspirin/NSAIDs
59
What % of CRC is caused by FAP
Familial adenomatous polyposis | <1%
60
Genes assoc w/ CRC (3)
FAP HNPCC BRCA1
61
Histology CRC
Signet ring cells
62
What part of the colon has the highest prevalence for CRC
25% sigmoid
63
How many polyps in colon = likely to be malignant
>5
64
Appearance of CRC on colonoscopy
Polypoid mass w/ ulceration
65
Spread CRC
Direct infiltration through bowel wall | Lymphatics/BV
66
mets of CRC (6)
``` Liver ** Lung Bone Brain LN Ovaries ```
67
Staging for CRC
Dukes
68
Dukes A
Tumours invade submucosa +/- mm propria
69
Dukes B
Tumours invade past mm propria (no nodal involvement )
70
Dukes C
Regional LN involvement (C1 - local) | C2 = apical
71
Dukes D
Distant mets
72
What type of cancer are the majority of anal cancers
SCC
73
RF anal cancer (4)
Anoreceptive sex Syphillis Anal warts/HPV Immunosuppression
74
Which line is v important in anal cance r
Pectinate line
75
Pectinate line (dentate)
Embryological division between upper 2/3 and lower 1/3 of anal canal
76
Features of anal cancers above pectinate line
Columnar epithelium | Lymph drainage to int iliac nodes + portal venous drainage
77
Mets anal ca above pectinate line
Hepatic mets
78
Features of anal ca below pectinate line
Squamous epithelium Lymph drainage to superficial inguinal nodes + Caval vv drainage
79
Mets anal ca below pectinate line
Pulmonary mets
80
Who are anal ca above pectinate line more common in
F (+ worse prog)
81
Who are anal ca below pectinate line > common in
M ( + better prog)
82
Sx R sided CRC
Often asymp W loss Lethargy/malaise/non-specfiic
83
Why do R sided CRC PS late
Because of large width of R colon
84
Ix results R sided CRc (3)
IDA Low Hb + Low MCV
85
Sx L sided CRC (3)
Obstruction Sx Changed in bowel habit Blood streaked stools
86
Sx Caecal CRC (5)
``` Anaemia Obstruction --> faecalant vom Mass Dyspepsia Appendicitis ```
87
Sx Rectal CRC (5)
``` Bright red PR bleed Tenesmus Dull pain May be able to feel mass on PR Bladder Sx ```
88
Sx Anal cancer (5)
``` Bleeding Pain Changes to bowel habit Pruritis ani Mass Stricture ```
89
Indications for 2WW Rx pt >40 CRC (4)
Rectal bleed/change bowel habit for >6w Persisitet rectal bleed >45 w/ no obvious ev benign anal disease IDA w/o obvious cause Palpable abdo/PR mass
90
Ix CRC (6)
``` FBC/LFT Colonoscopy CT chest abdo pelvis (stage) EAU + pelvic MRI - rectal CA ONLY CEA - monitor disease FTT test ```
91
What FTT test result is normal
<10
92
indication - right hemicolectomy (3)
Caecal tumours Ascending colon tumours proximal transverse colon tumours
93
indication - left hemicolectomy
Distal transverse/descending colon tumours
94
indications - sigmoid colectomy
Sigmoid tumours
95
indications - anterior resection (2)
Low sigmoid tumours | High rectal tumours
96
indication - AP resection
Tumours low in rectum
97
Indication - Hartmanns procedure (2)
Bowel obstruction | Palliation
98
Use of radiotherapy in rectal cancer
Pre-op to shrink tumour
99
When to use radiotherapy post op (CRC)
If high risk local recurrence
100
When is chemotherapy used in CRC
To reduce mortality of high stage tumours/palliation
101
Tx of anal carcinoma (3)
Radiotherapy 5FU Cisplatin chemo
102
What % of pt post anal carcinoma Tx retain normal anal fct
75%

CP3 SURGERY (19 decks)

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