Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GI Extra > 7.2 Distal GI tract pathology > Flashcards

7.2 Distal GI tract pathology Flashcards

1
Q

classify diarrhoea

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

how is water normally moved across the gut?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

other causes of diarrhoea

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

define constipation

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

risk factors for constipation

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are the intestinal pacemaker cells

A

interstitial cells of cajal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

treatments for constipation

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

types of laxatives

A

-stimulatory: CFTR activators
-osmotic
-stool softeners

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is the appendix?

A

diverticulum off caecum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

longitudinal muscle layer of appendix

A

complete

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

blood supply to appendix

A

mesoappendix from ileocolic branch of SMA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

possible appendix locations

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how does appenditicits cause ‘classic’ pain?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

broad categories of appendicitis

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

alternative explanation of appendicitis

A

viral/bacterial infection causes mucosal changes allowing for bacterial invasion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

classic presentation of appendicitis

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

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

A

could be
-supra pubic
-R rectal
-vaginal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

why is initial appendicitis pain vague?

A

appendix stretches viscera peritoneum so referred pain at T9-10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

groups of people it’s harder to diagnose appendicitis in, why?

A

children
-history harder
-non specific sympmtoms

pregnant
-altered anatomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

signs of appendicitis

A

-slightly ill
-slight fever/tachy
-lie still
-localised RQ tenerdness
-rebound tenderness in RIF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

‘classic’ appendix location

A

McBurney’s point: 2/3 way from umbilicus to ASIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

diagnosis of appendicitis

A

-raised WBC on bloods
-history/examination
-pregnancy test/urine dip to rule out ectopic or UTI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

treatment of appendicitis

A

appendicectomy

30
Q

diverticulosis

A

presence of diverticula

31
Q

where’s most diverticulosis?

A

sigmoid colon

32
Q

diverticula

A

outpouchings of mucosa and submucosa herniate through muscular layers where vasa recta penetrate

33
Q

diverticulosis cause

A

low fibre diet so increased intra luminal pressure

34
Q

1.diverticular disease vs 2. diverticulitis

A
  1. pain
  2. pain, inflammation/perforation
35
Q

acute diverticulitis

A

diverticula become inflamed or perforate

36
Q

pathophysiology of diverticulitis

A

entrance to diverticula blocked by faeces, inflammation allows bacterial invasion of wall of diverticula
can perforate

37
Q
  1. uncomplicated vs 2. complicated diverticulitis
A
  1. inflammation and abscesses confined to colonic wall
  2. larger abscesses, fistula, perforation
38
Q

symptoms of diverticulitis

A

-abdo pain at site (LLQ)
-fever
-bloating
-constipation (if blocks colonic lumen)
-haematochezia

39
Q

signs of diverticulitis

A

-distension
-localised abdo tenderness
-reduced bowel sounds (blockage)
-peritonitis signs if perforated

40
Q

diagnosis of diverticulitis

A

-raised WBC on bloods
-USS
-CT to see fistuale
-colonoscopy if large haematochezia

41
Q

treatment of diverticulitis

A

-ABx, fluids, analgesia
-surgery if perforation or need abscess drainage
-maybe partial colectomy if other stuff fails

42
Q

longitudinal muscle of rectum

A

continuous

43
Q

venous drainage of rectum

A

portal drainage: superior rectal, inf mesenteric, splenic, portal

systemic drainage: int iliac, common iliac, IVC

44
Q

start of anal canal

A

proximal border of anal sphincter complex

45
Q

what changes the direction of the anal canal?

A

puborectalis sling

46
Q

factors required for anal continence

A

-distensible rectum
-normal anorectal triangle
-anal cushions
-anal sphincters

47
Q

why is a distensible rectum needed for continence?

A

so increased pressures won’t overcome the sphincter complex

48
Q

2 parts of anal sphincter complex

A

internal, involuntary
external, conscious

49
Q

internal anal sphincter

A

involuntary
thickened circular smooth muscle
autonomic control (80%)

50
Q

external anal sphincter

A

conscious
levator ani fibres + puborectalis
pudendal nerve supply
20% resting pressure

51
Q

external anal sphincter nerve supply

A

pudendal nerve

52
Q

what processes allow us to ‘delay’ increased rectum pressure

A

-external anal sphincter contracts
-puborectalis contracts
-reverse peristalsi to sigmoid+ discendi colon

53
Q

what processes allow us to ‘defecate’ during increased rectum pressure

A

-external anal sphincter relaxes
-pubotrectalis relaxes
-forward peristalsis in rectum
-valsalva manoeuvre (increased abdo pressure)

54
Q

dentate line

A

junction of handgun to proctadaeum

55
Q

epithelium above and below dentate line

A

above- cplumnar
-below- stratified squamous

56
Q

pain receptors above and below dentate line

A

above: visceral, vague pain
below: somatic

57
Q

stratified squamous epic above and below white line

A

above: non keratinised
below: keratinised

58
Q

what’s malaena?

A

black tarry stool, with lots of Hb being digested

59
Q

common causes of malaena

A

upper GI bleed
-peptic ulcer disease
-variceal bleed
-oeseophagela/gastric cancer

60
Q

uncommon causes of malaena

A

-gatsritis
-meckels diverticulum
-iron supplements

61
Q

how can iron supplements cause malaena?

A

not all iron absorbed so some digested

62
Q

common causes of haematochezia in order of frequency

A

diverticulitis
angiodysplasia
colititis (IBD, infective)
colorectal cancer (erodes through blood vessels)
anorectal disease (haemorrhoids)
upper GI bleeds

63
Q

what’d angiodysplasia?

A

small vascular formation in bowel wall

64
Q

anal cushions

A

3 areas, help continence by distending, connections to veins and arteries

65
Q

how do we know arteries must be part of ‘venous’ plexus of anal cushions

A

bright red blood shows O2

66
Q

internal haemorrhoids
-cause
-where
-result

A

-loss of connective tissue support
-above dentate line
-prolapse through anal canal, bright red bleeds

67
Q

treatment of internal haemorrhoids

A

-increased hydration and fibre
-avoid straining
-rubber band ligation = necrosis
-surgery (if prolapsed and cant manually reduce)

68
Q

external haemorrhoids
-cause
-where
-treatment

A

-swelling of anal cushions which may thrombose
-below dentate line
-surgery

69
Q

external haemorrhoids
-cause
-where
-treatment

A

-swelling of anal cushions which may thrombose
-below dentate line
-surgery

70
Q

what’s the anoderm?

A

ectodermally derived stratified squamous part of anal canal below pectinate line

71
Q

anal fissure
-what is it
-cause
-result

A

-linear tear in anoderm
-high anal sphincter tone, reduced blood flow to anal mucosa,(passing of hard stool, diarrhoea)
-pain on defaeacation, haematochezia

72
Q

2treatment of anal fissure

A

hydration, fibre, analgesia
warm. baths
meds to relax internal anal sphincter

GI Extra (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions