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GI System > Diarrhoea, Constipation, Appendicitis and Diverticulitis > Flashcards

Diarrhoea, Constipation, Appendicitis and Diverticulitis Flashcards

1
Q

Compare the 2 broad causes of Diarrhoea in;

  • Stool volume
  • Response to fasting
  • Stool osmolality
  • Ion gap
A

Osmotic;

  • Moderately increased
  • Diarrhoea stops
  • Normal to increased
  • > 100mOsm/kg

Secretory;

  • Very large
  • Continues
  • Normal
  • <100mOsm/kg
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2
Q

Briefly outline the Secretory cause of Diarrhoea

A
  • Electrolyte transport abnormal
  • Secretion of Cl/ HCO3 into Lumen of gut
  • Na follows and so does H2O
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3
Q

Suggest 3 non-osmotic, non-secretory causes of Diarrhoea

A

Insufficient Na absorption from gut lumen;

  • Reduced SA for absorption
  • Mucosal disease/ bowel resection (Coeliac, IBD)
  • Reduced contact time (Intestinal rush)
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4
Q

What are 4 risk factors for Constipation

A
  • Female (3:1)
  • Certain medications
  • Low levels of physical activity
  • Increasing age (also common <4)
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5
Q

What are 3 types of causes of Constipation

A
  • Normal Transit Constipation
  • Slow Colonic Transport
  • Defecation problems
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6
Q

What causes Normal Transit Constipation?

List 2 causes of Defecation problems

A
  • Psychological stress
  • Cannot coordinate muscles of defecation
  • Disorders of Pelvic Floor/ Anorectum
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7
Q

List 5 cause of Slow Colonic Transport

A
  • Large colon (Megacolon)
  • Fewer an shorter peristaltic movements
  • Nervous system diseases (MS, Parkinson’s)
  • Systemic disorders (diabetes, hypothyroidism)
  • Fewer Interstitial cells of Cajal (intestinal pacemaker cells)
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8
Q

List 5 treatments of Constipation

A
  • Psychological support (If Normal Transit Constipation)
  • Increased fluid intake
  • Increased activity
  • Increases fibre intake (Only useful if mild)
  • Laxatives (Osmotic, Stimulatory, Stool softeners)
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9
Q

Describe the Appendix (including itself, its muscle, blood supply)

A
  • A diverticulum of the caecum
  • Has a complete longitudinal layer of muscle (colon has incomplete bands called Teniae Coli)
  • Blood Supply: Branch of Ileocolic branch of SMA, that comes up through a mesentery (mesoappendix)
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10
Q

Why is the location of the appendix important?

A

This changes the presentation of acute appendicitis

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11
Q

What are the 3 broad categories of Appendicitis?

A
  • Acute (Mucosal oedema)
  • Gangrenous (Transmural inflammation and necrosis)
  • Perforated (Can-> Peritonitis)
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12
Q

Describe the classic explanation for Appendicitis

A
  • Blockage of Appendiceal Lumen creates a raised pressure in the appendix

Causes venous pressure to rise (causing oedema in walls)->;

  • Harder for arterial blood to supply appendix
  • Ischaemia, then bacterial invasion follows
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13
Q

What is the alternative explanation for Appendicitis?

A

Viral or bacterial infection causes mucosal changes that allows bacterial invasion of Appendix walls

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14
Q

How does Appendicitis present classically? (<60% of cases)

A
  • Poorly localised peri-umbilical pain
  • Anorexia
  • Nausea and vomiting
  • Fever
  • After 12 to 24 hrs, pain is felt more intensely in Right Iliac Fossa
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15
Q

Describe the pain changes in Appendicitis, considering that the appendix is intra-peritoneal

A

Initially;

  • Appendix swells, stretching Visceral Peritoneum’s afferents
  • Pain referred to T9/ T10 Dermatome

After 12-24hrs;

  • Enlarges to touch wall of abdomen and irritate Parietal Peritoneum
  • Pain localised to Right Iliac Fossa
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16
Q

Why may you not get Right Iliac Fossa pain if the Appendix is Retro-Caecal or Pelvic in position?

Where else may you get pain?

A
  • RIF parietal peritoneum does not come into contact with inflamed appendix
  • Supra pubic
  • Right sided rectal
  • Vaginal
17
Q

Suggest 2 patient groups in which it may be harder to diagnose Appendicitis

A

Children;

  • Difficult to get full accurate history
  • Symptoms are more non-specific

Pregnancy;
- Altered anatomy

18
Q

What are 5 signs of Appendicitis?

A
  • Appear SLIGHTLY ill
  • Slight fever/ tachycardia
  • Lie quite still (to avoid irritation to peritoneum)
  • Localised Right Quadrant tenderness
  • Rebound tenderness in right iliac fossa (Pain felt on rebound_
19
Q

Where is McBurney’s Point?

What is significant about it?

A
  • 1/3 of way from ASIS to Umbilicus

- Generally this is where the Appendix lies

20
Q

What are 2 treatments of Appendicitis?

A
  • Open appendicectomy

- Laparoscopic appendicectomy

21
Q

What is Diverticulosis?

Is it symptomatic?
Where do most occur?

A

The presence of Diverticula- Outpouchings of Mucosa and Submucosa herniation through Muscularis layers

  • Asymptomatic
  • Sigmoid colon, along where nutrient vessels penetrate bowel wall
22
Q

State the suspected cause of Diverticula forming

A

Increased intra-luminal pressure (low fibre diet)

23
Q

Compare Diverticulosis, Acute Diverticulitis and Diverticular Disease

A

Diverticulosis;
- Presence of Diverticula

Acute Diverticulitis;
- Inflammation/ perforation of Diverticula (+/- bleeding and abscess formation)

Diverticular Disease;
- Pain due to Diverticula, WITHOUT inflammation/ infection

24
Q

What percentage of people with Diverticulosis develop Acute Diverticulitis?

A

Up to 25%

25
Q

Describe the pathophysiology of Acute Diverticulitis

Similar to Classic Appendicitis

A
  • Entrance to Diverticular blocked (E.g by faeces)
  • Inflammation eventually allows bacterial invasion of Diverticula wall
  • Can lead to perforation
26
Q

Compare Uncomplicated and Complicated Diverticulitis

A

Uncomplicated;
- Inflammation + small abscesses confined to colonic wall

Complicated;
- Larger abscesses, Fistula, Perforation

27
Q

List 5 symptoms of Acute Diverticulitis

A
  • Ab pain (usually left lower quadrant as sigmoid colon is here)
  • Fever
  • Bloating
  • Constipation (Inflammation can block colonic lumen)
  • Haematochezia (Large amounts of blood loss)
28
Q

List 4 signs of Acute Diverticulitis

A
  • Localised abdominal tenderness
  • Distension
  • Reduced bowel sounds
  • Signs of peritonitis (due to perforation)
29
Q

What are 5 investigations for Acute Diverticulitis

A
  • Blood tests (Raised WBCs, pregnancy test)
  • Ultrasound
  • CT
  • Colonoscopy if large haematochezia
  • Elective colonoscopy (after symptoms settled) to determine cause of symptoms if unclear
30
Q

How do you treat Acute Diverticulitis non-surgically?

A
  • Antibiotics
  • Analgesia
  • Fluid resuscitations

(In uncomplicated diverticulitis, may only need analgesia and antibiotics)

31
Q

When do you treat Acute Diverticulitis surgically?

A

If perforation or large abscesses need to be drained

Partial colectomy may be needed

GI System (26 decks)

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