Large Bowel

Front 1

2 most common western causes large bowel obstruction

Back 1

colorectal ca
inflammatory stricture (esp second to diverticular disease)
colonic volvulus
(also: faecal impaction in elderly)

Front 2

differentiate between diverticulosis, diverticular disease and diverticulitis

Back 2

diverticulOSIS- diverticular are present
divertivular DISEASE- symptomatic
diverticuLITIS- inflammation

Front 3

pathology of divertucular disease:
- loc
- cause
- process
- age

Back 3

SIGMOID, right
low fibre = mucosal herniation through wall
33% have by 60yrs

Front 4

clinical features S&Ss of diverticulITIS

Back 4

LIF pain/ tenderness (colicky- relieved by defaecation)

septic/ feverish (↑WCC, ↑ESR/CRP)

altered BOWEL habit (dia/const, BLOOD)

3 F's: Fever, Fast pulse, Flushed

Front 5

Dx by Ix's of diverticulitis/ diverticular disease (3)

Back 5

PR examination (abscess, colorectal ca)
SIGMOISOSCOPY
Ba ENEMA

Front 6

treatment/ management for diverticular disease (3)
- which abx's indivated in inflammation

Back 6

IV fluids & NBM (bowel rest)

IV abx's (-itis)....metranidazole
high FIBRE diet

Front 7

some complications of diverticular disease/ -itis that may require surgery

Back 7

abscess
perforation
haemorrhage
fistula
stricture

Front 8

2 surgical ops fro diverticular disease

Back 8

1) artmann's procedure- 2 step: resection & colostomy....later closure.

2) primary resection & anastomosis (elective)

Front 9

syptoms of acute & chronic colitis

Back 9

diarrhoea +/- BLOOD....dehydration
abdo cramps
sepsis (3F's: Fever, Fast pulse, Flushed)

wt loss, anaemia

Front 10

Dx by Ix's of acute/chronic colitis (inflammatory, ischaemia & infective)

Back 10

(basics: FBC, CRP, coeliac, coagulation, U&E's...)
STOOL.....?infection
★SigmoidoSCOPY + BIOPSY★
AXR..... (ischaemic- "thumb printing")
Ba enema

Front 11

3 types of acute and chronic colitis beginning with I

Back 11

Inflammatory (IBD: Crohn's & UC)
Ischaemic
Infective

Front 12

general treatment of inflammatory colitis (Crohn's & UC)

Back 12

IV fluids
steroids
NBM- bowel rest
?surgery

Front 13

AF/emboli/ vasculitis/ atherosclerosis with abdo pain suggests what
which area commonly affected & why

Back 13

ischaemic colitis....'mesenteric angina'
- splenic flexure & rectum (points of less blood supply)

Front 14

what classical AXR/ Ba enema sign found in ischaemic colitis due to submucosal swelling

Back 14

"thumb-printing"

Front 15

what's angiodysplasia:
- where in wall affected
- where in colon
- man sym
- age

Back 15

submucosal arteriovenous malformations
RIGHT colon (or anywhere)
fresh BLOOD PR
elderly
unknown aetiology

Front 16

Dx by Ix of colonic angiodysplasia

treatment

Back 16

★angiography★
colonoscopy

INJECTION- embolisation
Endoscopic ABLATION
SURGICAL resection

Front 17

S&Ss large bowel obstruction

Back 17

colicy abdo pain
distention
N&V
high-pitched tinkling or NO BS!
constipation

Front 18

how to differentiate between small and large bowel obstruction on AXR

Back 18

small- plicae circularis completely ENCIRCLE lumen

large- haustra DON't cover lumen width

Front 19

treatment of a sigmoid volvulus

Back 19

flatus tube (sigy)
resection

Front 20

what's the likely type of colinic obstruction;
- elderly, debilitated,
- malignancy, low electrolytes, recent surgery
- nausea, post-prandial abdo pain
- may have wt loss

Back 20

PSEUDO-obstruction (no cause found)

Front 21

2 types of microscopic colitis

Back 21

changes in walls --- cause diarrhoea

Front 22

pathology on appearance and histology of abx-induced colitis / "pseudomembranous" colitis

Back 22

psuedomembrane
extra FIBROPURULENT exudate surface layer....volcano lesions (fibrin, pus, neutrophils, debris)

Front 23

what's the cause of pseudomembranous colitis
- gram stain

Back 23

broad spectrum abx allow overgrowth of Cl.DIFF
toxin A & B = massive diarrhoea & BLOOD
- gram +ve aerobic bacilli

Front 24

treatment of pseudomembranous abx-induced colitis

Back 24

IV fluids
metranidazole/ vancomycin
(colectomy if fatal)

Front 25

biospy & pathology of microscopi collagenous colitis

Back 25

thickening of basement membrane with submucosal collagen
patchy
intra-epithelial inflammatory cells
no chronic architectural change

Front 26

what change does microscopic lymphocytic colitis show on histopathology

Back 26

increased INTRAEPITHELIAL lymphocytes
no thickening of basement membrane

Front 27

why is microscopic colitis (collagenous or lymphocytic) hard to dx without histopathology (biopsy)

Back 27

endoscopy looks normal

Front 28

which likely type of colitis?
- telangectasia (pic). hx of cervical/ rectal ca & radiotherapy
- diarrhoea
- acutely inflamed mucosa, cryptitis, but no architectural abnormality

Back 28

radiation colitis

Front 29

2nd most common cause cancer deaths UK ?
56% over what age

Back 29

colorectal cancer
>70yrs (screening >50yrs)

Front 30

aetiology/ predisposing factors to colorectal cancer
- lifestyle
- medical conditions (OMH/ FH)

Back 30

neoplastic polyps (benign)
UC/ Chron's
FAP & HNPCC
prev ca
low fibre, ↑red/processed meat, smoking, alcohol, obesity

Front 31

FAP has a mutation in which gene

Back 31

APC

Front 32

differentiate an adenoma from an adenocarcinoma

Back 32

ADENOMA (pic): glandular, tubular, villous, benign, well differentiated, DYSPLASTIC

ADENOCARCINOMA: variable differentiation, INVASIVE

Front 33

Duke's staging of colorectal carcinoma

Back 33

A- confined to bowel wall
B- through wall
C- regional lymph nodes
D- mets

Front 34

what are the different 'T' stages for histological TNM staging of cancer

Back 34

Tumour SIZE:
T1- submucosa
T2- muscle
T3- through muscle
T4- adjacent structures (adventita/ peritoneum)

Front 35

2 common sites for colorectal carcinoma spread

Back 35

liver
lungs

Front 36

clinical presentation, S&Ss of colorectal carcinoma
- LEFT
- RIGHT
- both

Back 36

LEFT: BLOOD pr, altered BOWEL habit, tenesmus, pr MASS

RIGHT: ↓wt, anaemia, abdo pain (lower)

- distention (obstruction), mass, hepatomegaly, lymphadenopathy,

Front 37

Dx by Ix of colorectal cancer

Back 37

FBC (↓Hb), LFTs (mets?) FOB (screening)
★★COLONOSCOPY + biopsy★★
ba enema
CT/ MRI/ liver USS - staging

Front 38

imaging to stage colorectal ca

Back 38

CT/ MRI
liver USS
CXR

Front 39

S&S of colorectal polyp (1)

Back 39

blood/ mucus PR
(maybe- diarrhoea/constipation, abdo pain)

Front 40

types of surgery of colorectal cancer (only curative option)

Back 40

colostomy
resection + colostomy
stenting

Front 41

how is treatment for colon and rectal cancer different

Back 41

COLON- (5-FU)Chemo adjuvant for advanced
- colectomy

RECTAL- radiotherapy adjuvant and palliative
- abdomino-pelvic perineal excision
- anterior resection

Front 42

compare FAP & HNPCC:
- onset
- inheritance pattern
- what's the defect
- which FAP gene

Back 42

FAP: early onset, autosomal DOMinant, defective tumour supression- APC gene.

HNPCC: late onset, autosomal DOMinant, defect in DNA mismatch repair

Front 43

how & where is entry into the large bowel

Back 43

ileocaecal valve via gastro-ileal reflex

Front 44

what are pugatives used for
how do they work

when are they indicated

Back 44

used for constipation:
- ↑peristalsis +/- soften stool

- when 'straining' dangerous (angina)
- painful defaecation (haemorrhoids)
- pre-op
- drug-induced/ bedridden constipation

Front 45

4 types of pugatives

Back 45

BULK/ OSMOTIC, STIMULANT, SOFTENERS

Front 46

SE's of diarrhoea (3)

Back 46

dehydration
metabolic acidosis (HCO3- loss)
hypokalaemia (K+ loss)

Front 47

3 treatments of severe acute diarrhoea

Back 47

maintain fluid & electrolytes
anti-infective (if applicable)
non-antimicrobial anti-diarrhoeal agents (symptomatic)

Front 48

4 types of diarrhoea

Back 48

OSMOTIC
HYPERMOTILITY (↓transit)
INFLAMMATORY (↑ permeability)
SECRETORY (CFTR stimulation)

Front 49

how does cholera cause diarrhoea

Back 49

produces toxins → stimulates Gs → ↑adenylyl cyclase → ↑cAMP → ↑CFTR stimulation → ↑Cl- + Na+ secretion

Front 50

how do oral rehydration salts reduce diarrhoea
- which transport protein is exploited

Back 50

Na+ allosterically increases affinity for GLUCOSE on SGLT1
↑Na+ absorbtion = ↑H2O absorption

Front 51

why do morphine-like/ opiates cause constipation

Back 51

have anti-diarrhoeal-like effects
- inhibit enteric nerones
- decrease peristalsis, ↑segmentation
- ↑fluid absorption
- sphincter constriction

Front 52

3 anti-motility / antidiarrhoeals

Back 52

coedine
loperamide (↑gastric motility)
diphenoxylate

Front 53

in a screening test what are these 4 main validity factors;
- sensitivity
- specificity
- positive predictive value
- negative predictive value

Back 53

SENSITIVITY: % with disease correctly identified +ve
SPECIFICITY: % w/o disease correctly identified -ve

+ve PREDICTIVE: % +ve who actually have the disease
-ve PREDICTIVE: % -ve who actually don't have disease

Front 54

7 key criterias for a screening prog

Back 54

common/serious condition
latent periods (w/o screening)
available
effective Rx available
early detection
minimal risk!!!!!!!
cost effective £££

Front 55

what test is used for colorectal ca screening
- what Ix's offered fro +ve result

Back 55

FOB
+ve = sigmoidoscopy/ colonoscopy +/- biopsy