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CP3 SURGERY > UGI/CR - The Colon > Flashcards

UGI/CR - The Colon Flashcards

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1
Q

CAuse of Meckels diverticulum

A

Remnant of embryological vitellointestinal duct

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2
Q

RUle of 2’s Meckel’s

A

2% pop
2% develop Sx
2cm long
20 inches from ileocecal valve

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3
Q

PS Meckels diverticulum

A

Usually asymp or can mimic other conditions

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4
Q

What other conditions can Meckels mimic? (4)

A

Caecal volvulus
Intussusception
Appendicits
Peptic ulceration

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5
Q

Why can Meckels mimic a caecal volvulus

A

Because if tethered to umbilicus, diverticulum may act as apex of volvulus

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6
Q

Why can Meckels mimic peptic ulceration

A

Ulceration of gastric acid secreting epithelium

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7
Q

Ix Meckels

A

Technetium scan

CT

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8
Q

Def of IBS

A

12 months previously, at least 12 consecutive weeks of abdo pain/discomfort w/ 2-3 of:
Relieved by defacation
Onset assoc w/ change freq stool
Assoc w/ change form of stool

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9
Q

Other Sx IBS

A 
Bloating 
Passage mucus 
Stool passage Sx
Gynae Sx
Urinary Sx
back pain
Headaches
Bad breath 
Poor sleep 
fatigue
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10
Q

Stool passage Sx assoc w/ IBS (2)

A

Tenesmus

Feeling of incomplete evacuation

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11
Q

Gynae Sx assoc w/ IBS (3)

A

Dysmenorrhoea
Dysparenuia
Premenstrual tension

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12
Q

Urinary Sx assoc w/ IBS (3)

A

Frequency
Urgency
Nocturia

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13
Q

Prevalnce IBS

A

10-20%

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14
Q

M:F IBS

A

1:2

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15
Q

Factors triggering onset IBS (7)

A 
Affecting disorders 
Psychological stress + trauma 
GI infection 
ABx 
Sexual/physical/verbal abuse 
Pelvic surgery 
Eating disorders
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16
Q

Ix IBS (3)

A

Hx - ensure no red flag Sx
O/E - anaemia/masses
Ix to rule out coeliac (CRP/ESR, foecal calprotectin) (TTG/anti-endomysial), (FBC)

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17
Q

Success rate IBS Mx

A

50%

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18
Q

Mx IBS

A 
Advice - exercise/relaxation/diet
Can try low FODMAP diet 
Antispasmodics 
Laxatives  avoid constipation 
Antimotility Dx
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19
Q

What is 1st line antispasmodic for Mx IBS

A

Mebeverine

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20
Q

Which laxative should not be used in Mx of IBS and why

A

Lactulose

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21
Q

1st line antimotility Dx IBS

A

Loperamide

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22
Q

2nd line Mx IBS

A

TCA once nightly

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23
Q

3rd line Mx IBS

A

SSRIs

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24
Q

Def Refractory IBS + Mx

A

Sx persisting after 12 months of anti-depressant meds - Rx to CBT

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25
M:F Chrons
=
26
RF chrons (4)
Poor diet FHx Smoking Altered immune state
27
WHere in the GIT is Chron's most common (2)
Terminal ileum | Ascending colon
28
Chrons appearance XR
Rose thorn ulcers
29
Chrons appearance CT
Cobblestone appearance
30
Which layers of the bowel are affected in chrons
ALl layers
31
Clinical features Chrons (6)
``` Abdo pain Diarrhoea W loss Severe aphthous ulcers mouth Anal complications Extra GI manifestations ```
32
Peak ages UC
15-30 | 60
33
Which RF for Chrons is protective in UC?
Smoking
34
Pathology UC
Inflammation starts in rectum and ascends into colon
35
What is UC called if in rectum alone
Proctitis
36
What layers of the bowel does UC affect
Mucosa only
37
PS UC (3)
Crampy lower abdo discomfort Gradual onset diarrhoea (bloody) Extra GI Sx
38
XR appearance UC
``` Thumb indents along colon Mucosal islands (necrosis) ```
39
Specific Sx: Proctitis + proctosigmoiditis (4)
Fresh bleeding Mucus Urgency Tenesmus
40
Specific Sx - extensive pancolitis (2)
Abdo pain | Blood diarrhoea
41
Histology Chrons (3)
Transmural inflammation Lymphoid hyperplasia Granulomas
42
Histology UC (3)
Mucosal inflammation Crypt abscesses Goblet cell depletion
43
Chrons vs UC: Location
C: Mouth --> anus UC: Colon only
44
Chrons vs UC - anal involvement?
C: Often UC: Seldomn
45
Chrons vs UC - Continuity
C: Discontinuous 'skip lesions' | UC; Continuous from rectum
46
Chrons vs UC - Fistulae
C: Common UC: uncommon
47
Chrons vs UC - smoking
C: Increases risk UC: protective
48
Chrons vs UC - cure
C: surgery to help Sx UC: surgery is cure
49
Ix - Chrons/UC - bloods (5)
``` FBC U+E ESR CRP LFT ```
50
FBC findings Chrons
Hypoalbuminaemia - severe Chrons | Se Fe/B12/folate anaemia common
51
Stool studies - Chrons/UC (3)
Stool chart MCS x 3 Calprotectin
52
Use of endoscopy in UC/Chrons
Rigid/flexi sigmoidoscopy UC Colonoscopy Endoscopic rectal biopsy may be taken
53
mx acute chrons flare - Mild
PO prednisolone
54
mx acute chrons flare - severe (3)
IV HC 100mg//6h NBM + parental nutrition Once improved - PO pred
55
What warrants admission - acute chrons flare (4)
Raised temp Raised pulse CRP/ESR raised Low albumin
56
2nd line Mx Severe acute chrons flare
Thiopurines
57
What must be checked before prescribing thiopurines
TMPT
58
Refractory disease Chrons acute flare up Mx
Biologics
59
Chrons maintenance - 1st line
Thiopurines
60
Chrons maintenance - 2nd line
methotrexate
61
Which med is specifically useful for Chrons w/ anal disease
PO metronidazole
62
Mx - mild mod acute UC flare up - proctitis/proctosigmoiditis
TO aminosalicylate +/- PO mesalazine
63
Mx mild/mod acute UC flare up - paancolitis
PO mesalazine +/- PO beclomethasone | + TO mesalazine
64
2nd line mild/mod acute UC flare up
Add PO prednisolone | If not successful after 4 w
65
3rd line mild/mod acute UC flare up
After another 2-4w | Add tacrolimus
66
4th line mild/mod acute UC flare up
Biologics
67
Acute severe/fulminating UC flare up Mx (4)
MDT Start IV CCS SC heparin Avoid anti-motility Dx
68
2nd line x - acute severe UC flare up Mx
IV ciclosporin
69
3rd line Mx - acute severe UC flare up
biologics
70
UC maintenance Mx - 1st line
5ASA derivatives TO if proctosigmoiditis PO if L sided
71
E.g.s of 5ASA derivatives (2)
Sulfasalazine | Mesalazine
72
2nd line Mx UC maintenance
PO thiopurines
73
General IBD complications (4)
bowel perforation Lower GI haemorrhage Toxic dilatation Colonic carcinoma
74
20y risk of colon cancer - UC
115%
75
PS toxic dilation (3)
Persistent fever TachyC Loose blood-stained stool
76
Ix results toxic dilation (2)
Falling albumin + potassium | AXR - dilated >6cm colon w/ mucosal ilsands
77
Mx toxic dilation
ER SURGERY
78
Chrons specific complications (4)
SBO Fistulae Abscess formation B12/folate/Fe deficiencies
79
Extracolonic manifesations duing active phase IBD (6)
``` Conjunctivitis/episcleritis/iritis Arthralgia large joints Erythema nodosum Pyoderma gangrenosum Venous thrombosis Fatty liver ```
80
Extracolonic manifesations at any time IBD (6)
``` Autoimmune hepatitis Gallstones Renal calculi 1SC Cholangiocarcinoma AS ```

CP3 SURGERY (19 decks)

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