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GI Extra > 7.2 Distal GI tract pathology > Flashcards

7.2 Distal GI tract pathology Flashcards

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1
Q

classify diarrhoea

A

-loose,watery stool
->3 per day
-acute if <2weeks

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2
Q

pathophysiology of diarrhoea

A

-unwanted substance in gut stimulates secretion and increased motility (to get rid of it)
-colon overwhelmed and can’t absorb enough water

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3
Q

how is water normally moved across the gut?

A

paracellular/transcellular following osmotic forces generated by movement of electrolytes/nutrients

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4
Q

2 categories of diarrhoea

A

secretory:
-water actively secreted into gut lumen by epithelial cells trying to flush out toxin
-continues in fasting

osmotic:
-water follows molecules of high osmotic pressure
-stops in fasting

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5
Q

other causes of diarrhoea

A

-reduced SA for absorption (bowel removed`)
-IBD, coeliac
-reduced contact time (IBS, diabetes)

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6
Q

define constipation

A

-strain, lumpy, hard stools, incomplete evacuation, feeling obstruction in >25% defections
-<3 unassisted bowel movements per weeks

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7
Q

risk factors for constipation

A

female:male 3:1
opioids, anti diarrhetics
low physical activity
age

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8
Q

pathophysiology pf constipation

A

-normal transit: psychological
-slow transit: megacolon, fewer intestinal pacemaker cells so slower peristalsis, hypothyroidism, MS
-defeacation problems: lack of pelvic floor/anorectal muscle coordination

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9
Q

what are the intestinal pacemaker cells

A

interstitial cells of cajal

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10
Q

treatments for constipation

A

-psychological support
-increased fluid
-icnreased fibre (for mild cases)
-increased acitvity
-laxatives

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11
Q

types of laxatives

A

-stimulatory: CFTR activators
-osmotic
-stool softeners

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12
Q

what is the appendix?

A

diverticulum off caecum

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13
Q

longitudinal muscle layer of appendix

A

complete

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14
Q

blood supply to appendix

A

mesoappendix from ileocolic branch of SMA

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15
Q

possible appendix locations

A

-retro caecal
-pelvic
-sub-caecal
-pre/post ileal

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16
Q

how does appenditicits cause ‘classic’ pain?

A

contact of inflamed appendix with parietal peritoneum in RIF, which arises from somatic origin

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17
Q

broad categories of appendicitis

A

-acute: mucosal oedema
-gangrenous: transmural inflammation, necrosis
-perforated: peritonitis

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18
Q

classic explanation of appendicitis

A

blockage of lumen (faecolith, lymphoid hyperplasia, foreign body)

increased venous pressure= oedema in walls
=
ischaemia as harder to supply blood
=
bacterial invasion

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19
Q

alternative explanation of appendicitis

A

viral/bacterial infection causes mucosal changes allowing for bacterial invasion

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20
Q

classic presentation of appendicitis

A

-poorly localised peri umbilical pain
-anorexia
-nausea/vomiting
-low fever
-12-24 hours pain in RIF

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21
Q

in what situations might you not get the classic RIF pain for appendicitis? why?

A

-retro caecal or pelvic position of appendix

parietal peritoneum in RIF doesn’t come into contact with inflamed appendix

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22
Q

location of pain in retro caecal or pelvic position of appendix in appendicitis

A

could be
-supra pubic
-R rectal
-vaginal

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23
Q

why does the well localised pain take 12-24 hours in classic appendicitis?

A

appendix enlarges more and then comes into contact with parietal peritoneum

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24
Q

why is initial appendicitis pain vague?

A

appendix stretches viscera peritoneum so referred pain at T9-10

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25
groups of people it's harder to diagnose appendicitis in, why?
children -history harder -non specific sympmtoms pregnant -altered anatomy
26
signs of appendicitis
-slightly ill -slight fever/tachy -lie still -localised RQ tenerdness -rebound tenderness in RIF
27
'classic' appendix location
McBurney's point: 2/3 way from umbilicus to ASIS
28
diagnosis of appendicitis
-raised WBC on bloods -history/examination -pregnancy test/urine dip to rule out ectopic or UTI
29
treatment of appendicitis
appendicectomy
30
diverticulosis
presence of diverticula
31
where's most diverticulosis?
sigmoid colon
32
diverticula
outpouchings of mucosa and submucosa herniate through muscular layers where vasa recta penetrate
33
diverticulosis cause
low fibre diet so increased intra luminal pressure
34
1.diverticular disease vs 2. diverticulitis
1. pain 2. pain, inflammation/perforation
35
acute diverticulitis
diverticula become inflamed or perforate
36
pathophysiology of diverticulitis
entrance to diverticula blocked by faeces, inflammation allows bacterial invasion of wall of diverticula can perforate
37
1. uncomplicated vs 2. complicated diverticulitis
1. inflammation and abscesses confined to colonic wall 2. larger abscesses, fistula, perforation
38
symptoms of diverticulitis
-abdo pain at site (LLQ) -fever -bloating -constipation (if blocks colonic lumen) -haematochezia
39
signs of diverticulitis
-distension -localised abdo tenderness -reduced bowel sounds (blockage) -peritonitis signs if perforated
40
diagnosis of diverticulitis
-raised WBC on bloods -USS -CT to see fistuale -colonoscopy if large haematochezia
41
treatment of diverticulitis
-ABx, fluids, analgesia -surgery if perforation or need abscess drainage -maybe partial colectomy if other stuff fails
42
longitudinal muscle of rectum
continuous
43
venous drainage of rectum
portal drainage: superior rectal, inf mesenteric, splenic, portal systemic drainage: int iliac, common iliac, IVC
44
start of anal canal
proximal border of anal sphincter complex
45
what changes the direction of the anal canal?
puborectalis sling
46
factors required for anal continence
-distensible rectum -normal anorectal triangle -anal cushions -anal sphincters
47
why is a distensible rectum needed for continence?
so increased pressures won't overcome the sphincter complex
48
2 parts of anal sphincter complex
internal, involuntary external, conscious
49
internal anal sphincter
involuntary thickened circular smooth muscle autonomic control (80%)
50
external anal sphincter
conscious levator ani fibres + puborectalis pudendal nerve supply 20% resting pressure
51
external anal sphincter nerve supply
pudendal nerve
52
what processes allow us to 'delay' increased rectum pressure
-external anal sphincter contracts -puborectalis contracts -reverse peristalsi to sigmoid+ discendi colon
53
what processes allow us to 'defecate' during increased rectum pressure
-external anal sphincter relaxes -pubotrectalis relaxes -forward peristalsis in rectum -valsalva manoeuvre (increased abdo pressure)
54
dentate line
junction of handgun to proctadaeum
55
epithelium above and below dentate line
above- cplumnar -below- stratified squamous
56
pain receptors above and below dentate line
above: visceral, vague pain below: somatic
57
stratified squamous epic above and below white line
above: non keratinised below: keratinised
58
what's malaena?
black tarry stool, with lots of Hb being digested
59
common causes of malaena
upper GI bleed -peptic ulcer disease -variceal bleed -oeseophagela/gastric cancer
60
uncommon causes of malaena
-gatsritis -meckels diverticulum -iron supplements
61
how can iron supplements cause malaena?
not all iron absorbed so some digested
62
common causes of haematochezia in order of frequency
diverticulitis angiodysplasia colititis (IBD, infective) colorectal cancer (erodes through blood vessels) anorectal disease (haemorrhoids) upper GI bleeds
63
what'd angiodysplasia?
small vascular formation in bowel wall
64
anal cushions
3 areas, help continence by distending, connections to veins and arteries
65
how do we know arteries must be part of 'venous' plexus of anal cushions
bright red blood shows O2
66
internal haemorrhoids -cause -where -result
-loss of connective tissue support -above dentate line -prolapse through anal canal, bright red bleeds
67
treatment of internal haemorrhoids
-increased hydration and fibre -avoid straining -rubber band ligation = necrosis -surgery (if prolapsed and cant manually reduce)
68
external haemorrhoids -cause -where -treatment
-swelling of anal cushions which may thrombose -below dentate line -surgery
69
external haemorrhoids -cause -where -treatment
-swelling of anal cushions which may thrombose -below dentate line -surgery
70
what's the anoderm?
ectodermally derived stratified squamous part of anal canal below pectinate line
71
anal fissure -what is it -cause -result
-linear tear in anoderm -high anal sphincter tone, reduced blood flow to anal mucosa,(passing of hard stool, diarrhoea) -pain on defaeacation, haematochezia
72
2treatment of anal fissure
hydration, fibre, analgesia warm. baths meds to relax internal anal sphincter

GI Extra (16 decks)

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