Lower GI Conditions

Question 1

What is Diverticulosis?

Answer 1

Diverticulosis is when pockets called diverticula form in the walls of your digestive tract.
Outpouching of gut wall, usually at sites of entry of perforating arteries

Question 2

What is Meckel’s Diverticulum?

Answer 2

Congenital bulge/outpouching in lower part of small intestine (leftover of umbilical cord)

Contains gastric + pancreatic tissue (may be gastric acid secretion)

Question 3

Where is meckel’s diverticulum found?

Answer 3

2 inches long and more than 2 feet from ileocaecal valve

Question 4

What is the presentation of Meckel’s Diverticulum?

Answer 4

Mostly asymptomatic

May present like appendicitis with GI pain + bleeding

Question 5

What is Diverticulitis?

Answer 5

Inflammation of diverticulum

Question 6

Presentation of Diverticulitis?

Answer 6

Altered bowel habit, nausea, flatulence

+/- left sided colic relived by defecation, pyrexia, raised WCC, raised CRP, tender colon

Question 7

Investigations for Diverticulitis?

Answer 7

Barium enema or sigmoidoscopy

Question 8

What are the possible complications of Diverticulitis and the appropriate treatments?

Answer 8

Perforation (cause peritonitis) –> Hartmann’s Procedure

Haemorrhage (sudden + painless) –> usually stops with bed rest (transfusion)

Fistulae –> surgery

Abscesses (swinging fever, leucocytosis) –> ABs + drainage

Question 9

Risk factors for Ischaemia of the bowel?

Answer 9

AF!!!!! (AF with abdo pain)
Heart failure
Chronic kidney failure 
Previous MI
Prone to blood clots

Question 10

Presentation of acute mesenteric ischaemia?

Answer 10

Acute, severe abdominal pain (no abdo signs)
Rapid hypovolaemia
Pain constant + central (around right iliac fossae)

Question 11

True or False - in young people venous thrombosis is the most common cause of acute mesenteric ischaemia

Answer 11

TRUE

Arterial thrombosis commonest cause (but venous thrombosis in the young)

Question 12

Presentation of Chronic small bowel ischaemia?

Answer 12

Severe, colicky post prandial abdo pain

with PR bleed, weight loss and malabsorption

Question 13

Investigations and treatment for acute mesenteric ischaemia?

Answer 13

Ix - raised HB due to plasma loss, persistent metabolic acidosis
AXR - gasless abdomen

Mx - resus with fluid ABs (gentamicin + metronidazole) and heparin

Question 14

Investigation and treatment for chronic small bowel ischaemia?

Answer 14

Ix - angiography

Mx - angioplasty

Question 15

Presentation of Chronic colonic ischaemia?

Answer 15

Lower left sided abdominal pain & blood diarrhoea

May be pyrexia, tachycardia, PR bleeding, leucocytosis

Question 16

Investigation findings of chronic colonic ischaemia?

Answer 16

Barium enema may show thumb printing due to submucosal swelling

Doppler US - detect stenoses

Question 17

Complications of chronic colonic ischaemia?

Answer 17

May progress to gangrenous ischaemic colitis
With development of hypovolaemic shock and peritonitis
(Stricture are common)

Question 18

Treatment of chronic colonic ischaemia?

Answer 18

Fluid resuscitation +ABs

Angioplasty and stent insertion

Question 19

What is Hartmann’s Procedure?

Answer 19

Surgical resection of the rectosigmoid colon with closure of the anorectal stump and formation of an end colostomy

Question 20

Presentation of Acute Appendicitis?

Answer 20

Periumbilical pain that moves to the RIF

May also have vomiting, constipation or diarrhoea

Question 21

Investigations of acute appendicitis?

Answer 21

Raised WCC & CRP

Ultrasound

Question 22

Complications of acute appendicitis?

Answer 22

Peritonitis, rupture, abscess, fistula, sepsis, liver abscess

Question 23

Treatment of acute appendicitis?

Answer 23

Appendectomy

Metronidazole + cefuroxime

Question 24

What is Coeliac Disease?

Answer 24

Autoimmune inflammation of the small bowel mucosa in response to gluten
Villa become flattened and reduce capacity for absorption

Question 25

Presentation of Coeliac Disease?

Answer 25

``` Steatorrhoea, diarrhoea Abdo pain, bloating, N&V Apthous ulcers Angular stomatitis Weight loss, fatigue, weakness, iron deficiency anaemia ```

Question 26

Findings on investigation of Coeliac disease?

Answer 26

AB Tests - Alpha gliandin, Transglutaminase, Antiendomysial (most specific) ``` Duodenal biopsy - villous atrophy, increased intra epithelial WBCs) Crypt hyperplasia (reversing on gluten free diet) ```

Question 27

Treatment of Coeliac Disease?

Answer 27

Lifelong gluten free diet

Question 28

True of False - Chronic colonic ischaemia usually results from low flow in inferior mesenteric artery

Answer 28

TRUE

Question 29

What is the presentation of Acute and Chronic Colitis (infective + ischaemic)

Answer 29

Diarrhoea +/- blood | Abdo cramps, dehydration, sepsis, weight loss, anaemia

Question 30

What are possible causes of Large Bowel Obstruction?

Answer 30

Colorectal cancer Sigmoid or caecum volvulus Pseudoobstruction Faecal impaction

Question 31

Presentation of large bowel obstruction?

Answer 31

``` V&N Fermentation causes feculent vomiting (found with colonic fistulawith proximal gut) Colicky pain Constipation Abdo distension Tinkling bowel sounds ```

Question 32

Buzzword - Tinkling bowel sounds

Answer 32

Bowel obstruction

Question 33

What are the treatments for the following? Volvulus: Faecal Impaction:

Answer 33

Volvulus - flatus tube & surgical resection FI - enemas, laxatives, manual evacuation

Question 34

What is Irritable Bowel Syndrome?

Answer 34

A mixed group of abdominal symptoms for which no organic cause can be found. Disturbed GI motility, high amplitude propagating contractions (exaggerated gastro colic reflex)

Question 35

What is the classic presentation of IBS?

Answer 35

Abdo pain and bloating with a change in bowel habit | Aggravated by stress

Question 36

What are the symptoms of a colorectal cancer (left-sided)?

Answer 36

Bleeding mucus, altered bowel habit or obstruction, tenesmus, mass PR

Question 37

What are the symptoms of a colorectal cancer (right-sided)?

Answer 37

Weight loss, low haemoglobin, abdo pain (obstruction less likely)

Question 38

What are haemorrhoids?

Answer 38

Disrupted and dilated anal cushions | Swellings containing enlarged blood vessels found inside or around the anus + rectum

Question 39

Presentation of haemorrhoids?

Answer 39

Bright red bleeding coating stools, on tissue or dripping into toilet May be mucous discharge + pritus ani (itch)

Question 40

What investigation would be done to see internal haemorrhoids?

Answer 40

Proctoscopy

Question 41

Treatment of haemorrhoids?

Answer 41

Infra-red coagulation applied to localised area Sclerosants (shrink vessels) Rubber band ligation (haemorrhoid tied off at base with band)

Question 42

What is a Anal Fissure?

Answer 42

Tear in squamous lining of the lower anal canal (anal margin) Symptoms - painful defaecation, bleeding, perianal abscess

Question 43

What is Fistula in Ano?

Answer 43

Abnormal epithelium connection between anal canal and perianal skin

Question 44

Symptoms and treatment of fistula in ano?

Answer 44

Symp - abscess formation Mx - drainage, fistulotomy, seton stitch

Question 45

What is a Rectal Prolapse?

Answer 45

Protruding mucosal mass from anus, usually during/due to defaecation

Question 46

Symptoms of rectal prolapse?

Answer 46

Loss of anal tone | Bleeding, mucus stools

Question 47

What is a Perianal Haematoma?

Answer 47

Pool of blood that collects in the tissue surrounding the anus Also called thrombosed external pile

Question 48

What is a Sigmoid Volvulus?

Answer 48

Bowel twists on mesentery

Question 49

True or False - older people are at high risk of sigmoid volvulus?

Answer 49

TRUE

Question 50

What are the symptoms of a sigmoid and stomach volvulus?

Answer 50

Sigmoid - signs of obstruction Stomach - gastro-oesophageal obstruction (Retching, pain, vomiting, saliva regurg)