Session 7- Distal GI pathology

Question 1

pathophysiology of diarrhoea

Answer 1

unwanted substance in gut stimulates secretion and motility

colon is overwhelmed and cannot absorb the quantity of water it recieves from ileum

Question 2

secretetory diarrhoea

Answer 2

toxin in gut lumen therefore water is secreted inside. Too much secretion of ions

persists despite fasting

increased stool osmolality

Question 3

osmotic diarrhoea

Answer 3

water moves into gut becaue there are molecules present that have a high osmotic pressure.
stops when fasting

Question 4

why do you get diarrhoea if you have lactose intolerance

Answer 4

as the lactose isnt broken don it acts as a osmotic pressure drawing water in and the gets fermented in Large intestine

Question 5

constipation

Answer 5

hard stools
difficulty passing stools
inability to pass stools

Question 6

risk factors of constipation

Answer 6

female
certain meds
low levels of activity
age

Question 7

treatments of constipation

Answer 7

psychological support
increased fluid intake
increased activity and fibre
laxatives

Question 8

what is the appendix

Answer 8

diverrticulum off the caecum

Question 9

how does the appendix differ from the colon structuly

Answer 9

has a complete longitudinal layer of muscle whereas colon has incomplete bands called teniae coli

Question 10

blood supply to appendix

Answer 10

comes up through mesentery- mesoappendix- from the ileocolic branch of SMA

Question 11

why is the location of the appendix important

Answer 11

changes the presentation of acute appendicitis

Question 12

cause if appendicitis

Answer 12

blockage of appendicel lumen creates a higher pressure in the appendix
-this causes venous pressure to rise which blocks arterial supply -> ischeamia

a viral or bacteral infection causes the lymphoid tissue to hypertrophy to the point that they obstruct the lumen

Question 13

presentation of appendicitis

Answer 13

poorly localised per-umbilical pain
anorexia
nausea/ vomiting
low grade fever

Question 14

where is pain felt normally in appendicitis

Answer 14

right iliac fossa

Question 15

where is mcburneys point

Answer 15

2/3 of the way from umbilicus to ASIS

Question 16

what is rebound tenderness

Answer 16

push into right iliac fossa let go and it should hurt more when let go than when pressure is applied

Question 17

diagnosis of appendicitis

Answer 17

blood test- raised WBC
history and physical examination

pregnancy test- ectopic preg

Question 18

treatment if appendicitis

Answer 18

appendectomy - open or laproscopic

Question 19

what is diverticula

Answer 19

outpouchings of mucosa and submucosa herniate through muscularis layers where nutrient vessels penetrate bowel wall

Question 20

what causes diverticulitis

Answer 20

increased intra-luminal pressure

Question 21

what is diverticular disease

Answer 21

when the patientexeriences pain bt there s no inflammaion

Question 22

what is acute diverticulitis

Answer 22

when the diverticula become inflammed or perforate due t the entrance being blocked by faeces which allows bacterial invasion

Question 23

uncomplicated diverticulitis

Answer 23

inflammation and small abcesses confined to colonic wall

Question 24

complicated diverticulitis

Answer 24

larger abceses fistula perforation

Question 25

symptoms of acute diverticulitis

Answer 25

abdominal pain at site of inflammation -left lower quadrant fever bloating constipation haematochezia

Question 26

signs of acute diverticulitis

Answer 26

localosed abdominal tenderness distension reduced bowel sounds signs of peritonitis

Question 27

treatment of acute dverticultis

Answer 27

abitibiotcs fluid resusciation analgesia surgery if perforation or large abcesses need to be frained

Question 28

what is the superior rectal artery a continuation of

Answer 28

inferior mesenteric artery

Question 29

blood supply to rectum

Answer 29

superior rectal middle rectal inferior rectap

Question 30

where is the start of the anal canal

Answer 30

proximal border of the anal sphincter complex

Question 31

in what direction does the rectum point

Answer 31

anteriorly

Question 32

what changes the direction of te rectum

Answer 32

pubo-rectalis

Question 33

what way doe sthe anal canal point

Answer 33

posteriorly

Question 34

what are anal cushions

Answer 34

complex netwoek of blood vessels the anus contains a complex venous plexus which is divided into three areas of tissues and play a role in anal continence

Question 35

nerve supply to external anal sphincter

Answer 35

pudental nerve

Question 36

what is the dentate line

Answer 36

junction of hindgut and proctodaeum

Question 37

what lies above the dentate line

Answer 37

visceral pain receptors | columnar epithelium

Question 38

what is below the dentate line

Answer 38

somatic pain receptors | stratified squamous epithelia

Question 39

what are internal haemorrids

Answer 39

above dentate line caused by loss of connective tissue support painless bleed bright red blood

Question 40

treatment of internal haemorrhoids

Answer 40

hydration avoid straining surgery

Question 41

external haemorroids

Answer 41

below dentate line | swelling of anal cushions which may thrombose

Question 42

anal fissure

Answer 42

linear tear in the anoderm caused by passing of hard stool haematochezia

Question 43

cause of anal fissure

Answer 43

reduced blood flow to anal mucosa | high internal anal sphincter tone

Question 44

treatment of anal fissure

Answer 44

``` warm bath medication hydration fibre analgesia ```

Question 45

melaena

Answer 45

black tarry stools | offensive smelling - due to hb being altered by digestive enzymes and gut bacteria

Question 46

causes of maleana

Answer 46

``` upper GI bleed peptic ulcer disease varicel bleeds oesophageal cancer upper GI malignancy ```