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Defecation Flashcards

(89 cards)

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1
Q

Which part of the yolk sac is the primitive gut tube derived from

A

Dorsal

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2
Q

3 parts of the gut

A

Foregut
Midgut
Hindgut

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3
Q

Oesophageal atresia

A

Part of oesophagus closed or absent

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4
Q

Trachea oesophageal fistula

A

I abnormal connection between oesophagus and trachea

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5
Q

Duodenal atresia

A

Part of duodenum closed or absent

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6
Q

Meckels diverticulum

A

Vitelline duct persists

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7
Q

Vitelline duct

A

embryonic structure providing communication from the yolk sac to the midgut during fetal development

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8
Q

What causes malrotation

A

Midgut does not complete rotation before returning to abdomen

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9
Q

Mid gut volvulus

A

Volvulus around base of midgut causes bowel obstruction and mesenteric ischaemia

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10
Q

What defect predisposes a foetus to mid gut Volvos

A

Malrotation

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11
Q

What causes imperforate anus

A

Failure of rupture of anal membrane

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12
Q

What causes Hirschsprung’s disease

A

Lack of enteric neurones in distal portion of the gut

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13
Q

What organ is enlarged in Hirschsprung’s disease

A

Colon - megacolon

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14
Q

Hirschsprung’s disease symptoms

A

Failure to pass meconium within 48 hrs
Swollen belly
Vomiting bile

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15
Q

What part of the gut is abnormal in Hirschsprung’s disease

A

Distal part

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16
Q

Why does a lack of enteric neurones cause symptoms in Hirschsprung’s disease

A

Can’t relax gut muscles

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17
Q

How long does microbial colonisation of the infant gut take

A

1 year

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18
Q

What is examined in a stool sample

A

Metabolites
Microbes

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19
Q

Causes of incontinence

A

Sphincter is dysfunctiom
Impaired rectal sensorimotor function
Colonic sensorimotor dysfunction
Supra sphincteric Anatomical factors

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20
Q

What are the 2 anal sphincters

A

Internal anal sphincter
External anal sphincter

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21
Q

Which anal sphincter is voluntary muscle

A

External

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22
Q

Which anal sphincter encircles the other

A

External

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23
Q

Which anal sphincter extends further downwards

A

External

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24
Q

Which muscle group makes up the pelvic floor

A

Levator ani

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25
Which muscles make up Levator ani
Puborectalis Pubococcygeus Iliococcygeus
26
What pelvic floor muscle is only present in males
Puboerythralis
27
What pelvic floor muscle is only present in females
Pubovaginalis
28
What structures does Puborectalis surround
Rectum Vagina Urethra
29
Which pelvic floor muscle forms a U shaped loop
Puborectalis
30
Function of Puborectalis
Supports EAS Assists in creating anorectal angle
31
Which nerve roots supply the rectum, anus, bladder, and urethra
S2, s3, s4 S2 s3 s4 keep the 3 Ps off the floor
32
What nerve is responsible for continence
Pudendal nerve
33
Is the pudendal nerve sympathetic or parasympathetic
Parasympathetic
34
Nerve roots of pudendal nerve
S2-s4
35
What nerve supplies the EAS
inferior rectal branch of the pudendal nerve
36
Terminal branches of the pudendal nerve
Perineal nerve Inferior rectal nerves Dorsal nerve of the penis/clitoris
37
Which nervous system innervates the IAS
Enteric nervous system
38
Which nerves innervate the IAS
Hypogastric nerves - sympathetic + excitatory Pelvic nerve - parasympathetic + inhibitory
39
Do the pelvic nerves give excitatory or inhibitory innervation to the IAS
Inhibitory
40
Do the hypogastric nerves supply excitatory or inhibitory innervation to the IAS
excitatory
41
What factors effect continence
Anorectal angle Stool consistency Colonic transit time Rectal filling sensation Rectoanal inhibitory reflex
42
What type of valve does the anorectal angle form
Flap valve
43
How is passage of faeces prevented when intra abdominal pressure rises
Anterior rectal wall pushed downwards onto anal canal
44
Reservoir continence
Ability of rectum to retain stool
45
What features of the sigmoid colon slow the progression of stool
Lateral angulations Valves of houston
46
Rectal compliance
Ability of rectum to adapt to imposed stretch
47
What type of receptors pick up sensation of urgency
Mechanoreceptors
48
Which sphincter is more important for continence at rest
Internal anal sphincter
49
What type of muscle fibre is predominant in the IAS
Slow twitch, fatigue resistant smooth muscle fibres
50
Which anal sphincter is more important for generating squeeze pressure
EAS
51
Rectoanal inhibitory reflex RAIR
anal reflex response characterized by a transient relaxation of the anal canal following distention of the rectum
52
What 2 reflexes are involved in defecation
Voiding reflex Closure reflex
53
Voiding reflex
Opening of anus
54
Closure reflex
Closing anus
55
How is the anorectal angle broadened during defecation
Relaxation of EAS Relaxation of puborectalis
56
What manoeuvre is used to empty the anal canal
Valsalva manoeuvre
57
What is the purpose of recto sigmoidal contractions
Push stool through relaxed anal canal during emptying
58
What causes contraction of IAS in the closure reflex
Receptor adaptation of ampulla rectus removes inhibitory drive to IAS
59
What causes contraction of EAS in the closure reflex
Voluntary contraction
60
2 main categories of clinical problems in defecation
Constipation Faecal incontinence
61
What is the Bristol scale used for
Describing stool consistency
62
Is constipation a symptom or a diagnosis
Symptom
63
Constipation definition
<3 stools/wk or passage of hard stools or sensation of complete evacuation
64
What groups is constipation more common in
Elderly Children Females more than males
65
What does the Rome IV diagnostic criteria assess
IBS, constipation, functional defecation disorders functional abdominal bloating
66
Primary constipation
Constipation with no identifiable cause
67
Types of primary constipation
Normal transit constipation Slow transit constipation Pelvic floor dyssynergia
68
Pelvic floor dyssynergia
Inability to coordinate sphincters, abdominal, and pelvic floor muscles
69
What structural abnormalities can cause constipation
Rectal intussesception Rectal prolapse
70
Rectal intussesception
invagination of the rectal wall into the lumen of the rectum
71
Secondary constipation
Constipation caused by neuromuscular disorders of the colom
72
Faecal incontinence
Involuntary passage of rectal content
73
External signs of faecal incontinence
Visible soiling Excoriation Scars
74
2 types of faecal incontinence
Passive incontinence Urge incontinence
75
Which type of incontinence is caused by a lesion of the IAS
Passive
76
What type of incontinence is caused by lesion of EAS
Urge incontinence
77
Which type of incontinence is defecation not noticed
Passive
78
Tests for colonic transit
Radio opaque markers Colonic scintigraphy
79
Evacuation tests
MRI proctogram Evacuation proctogram Balloon expulsion test
80
Sphincter evaluation tests
Endoanal ultrasound Endoanal MRI Anorectal manometry
81
What structural damage can cause incontinence
Obstetric sphincter tear Latrogenic sphincter tear Radiation damage Congenital malformation
82
What functional damage can cause incontinence
Pudendal neuropathy
83
What does high resolution anorectal manometry assess
Resting pressure Squeeze pressure Endurance squeeze RAIR hyper/osensitivity
84
Rectal hypersensitivity
Reduced sensory threshold to volumetric rectal distension
85
Rectal hyposensitivity
Increased sensory threshold to volumetric rectal distension
86
Is rectal hypersensitivity associated with incontinence or constipation
Incontinence
87
Is rectal hyposensitivity associated with incontinence or constipation
Constipation
88
presentation of constipation
Abdominal pain Infrequent pass of bowel motion Nausea Vomiting Bloating Faecaloma
89
How is constipation manages
Diet and lifestyle changes Laxatives Biofeedback Intersphincteric Botox Anal irrigation Neuro modulation ACE/DACE stoma Psychological therapy

MET2 (25 decks)

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