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Flashcards in Week 209 - IBS/Constipation Deck (175):
0

A patient arrives to A and E with a form of anal prolapse - how can you tell the difference between rectal prolapse and prolapsed Haemorrhoids?

The difference is in observation. There are longitudinal lines in prolapsed Haemorrhoids, and circumferential lines (circular rings) in prolapsed colon.

2

List four indications for per rectal examinations.

 

1.) Rectal bleeding

2.) Constipation

3.)Change of bowel habit

4.) Problems with urinary or faecal incompetence

 

3

Which finger do you use for a PR exam?

Index finger of the right hand.

4

Give two reasons why you would not perform a PR.

1.) Patient refusal - no consent obtained.

2.) Examination not indicated

5


—What  position  would  you  ask  a patient to get in, in order to perform a per rectal examination?
 


POSITION =Left  lateral  position, with knees pulled  up towards chest.
 

6

You conduct a PR examination, and upon inspection see the following. What do you see?

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Erythematous right buttock.

7


—You examine a patient per rectally and find that he has an increased anal tone and a palpable smooth surface mass on the right hand side of the rectum. This is tender to palpate. What other feature of this mass might you expect to be present on palpation?
 


—Other feature of the mass = Fluctuant (unstable/moveable/compressable).

8

Other than the rectum, which organ is palpable through a PR exam?

 

The prostate.

9


You examine a patient per rectally and find that he has an increased anal tone and a palpable smooth surface mass on the right hand side of the rectum. This is tender to palpate. —What two laboratory investigations you would like to perform to help with diagnosis and management? What is the most likely diagnosis?


—Investigations =   FBC, culture of exudate
—
—Likely diagnosis =   Peri anal abscess
 

10

What condition is this?

 

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The image shows full thickness rectal prolapse.

11

Define Rectal Prolapse.

 


—Rectal prolapse = is the protrusion of either the rectal mucosa or the entire wall of the rectum.
 

12

Define partial (rectal) prolapse.


—Partial prolapse = involves only the mucosa and usually only protrudes by a few centimetres.
 

13

Define complete (rectal) prolapse.

 


—Complete prolapse = involves all layers of the rectal wall.
 

14

In which two groups is rectal prolapse most common?


—1.) Elderly females

2.) Children < 3 years (especially in first year of life)
 

15

In children, rectal prolapse may be associated with which conditions?


—cystic fibrosis

Ehlers-Danlos syndrome

Hirschsprung's disease
—congenital megacolon

malnutrition and rectal polyps.
 

16

List four risk factors for rectal prolapse.

 

 

ANY 4 OF THE FOLLOWING:

1.) Increased intra-abdominal pressure

—eg constipation, diarrhoea, benign prostatic hypertrophy, pregnancy—Chronic cough (eg COPD/cystic fibrosis/whooping cough).

2.) —Previous surgery.

3.) —Pelvic floor dysfunction.—

4.) Parasitic infections, eg amoebiasis, schistosomiasis.—

5.) Neurological disease

—eg previous lower back or pelvic trauma, lumbar disc disease, cauda equina syndrome, spinal tumours, multiple sclerosis.

—6.) Psychiatric disease.
 

17

Name the symptoms of rectal prolapse.

 

  • —Mass protruding through the anus—
  • Pain
  • —Constipation
  • —Faecal incontinence
  • —Discharge of mucus—
  • Rectal bleeding
     

18

What are the signs of rectal prolapse?

 

  • —Protruding mass
  • —should show concentric rings of mucosa = classic signs of rectal prolapse
  • —Rectal ulcer
  • —Decreased anal sphincter tone.
     

19

What is this?

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Thrombosed external hemorrhoid

20

What is this?

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Thrombosed external hemorrhoid.

21

What is this?

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Thrombosed external hemorrhoid.

22

What is this?

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Anal warts.

23

What is this?

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Anal warts.

24

What is this?

 

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Anal warts.

25

What is this?

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Anal warts.

26

What is this?

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Squamous cell carcinoma of the anus.

27

28

What is this?

 

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Anal skin tags.

29

What is this?

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Anal skin tags.

30

What is this?

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Anal fissure.

31

What is this?

 

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A child with an anal skin tag and anal fissure.

32

Describe the abnormality with this radiograph.

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Anal insertion (gone very very wrong)!

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33

34

What are the functions of the Large Bowel?

 


1.) Modification, storage and evacuation of waste
products of digestion and metabolism (faeces).
2.) Extraction of water & electrolytes from the fluid
ileal contents.
3.) Maintenance of bacterial flora and absorption of
nutrients derived from bacterial degradation of
luminal contents.
 

35

What are the functions of the colon?

 


1.) Colon absorbs large quantities of fluid and electrolytes
and converts liquid to solid stool (2L to 200mL)
2.) Absorbs short- chain fatty acids formed by catabolism (or
fermentation) of dietary carbohydrates that are not
absorbed in small bowel
3.) Reservoir function for storage of content
4.) Elimination of contents in controlled and regulated
fashion.
 

36

The colon is described as functioning like two organs. What is meant by this statement?


1.) Proximal colon i.e. ascending and transverse –fluids/electrolytes and bacterial fermentation.
2.) Distal i.e. distal and recto-sigmoid reservoir function.
 

37

What is the normal colonic transit time?

 

25-40 hours.

38

Both non propulsive segmentation and mass peristalsis occurs in the proximal colon. What is meant by "non propulsive segmentation"?


Non-propulsive segmentation is generated by slow wave activity which produces circular muscle contraction. This produces the appearance of segments or haustra). Mixing/ absorption of contents is the purpose, not propulsion.
 

39

How often does mass peristalsis occur in the proximal colon?

1-3 X a day.

40

What is the primary activity of the distal colon?

 

Non-propulsive segmentation.

41

What directly controls the contracitle behaviour of the colon?

 

The intramural plexi.

42

What are the stimulatory neurotransmitters of gut motility?

 

Acetylcholine and substance P.

43

What are the inhibitory neurotransmitters of gut motility?

VIP and Nitric Oxide.

44

45

Where is Auerbach's plexus located.?

Auerbach's plexus exists between the longitudinal and circular layers of muscularis externa in the gastrointestinal tract.

46

What is Hirschsprung's disease?

Hirschsprung's disease (HD) is a disorder of the abdomen that occurs when part or all of the large intestine or antecedent parts of thegastrointestinal tract have no ganglion cells and therefore cannot function.

47

What pathology/complication is a result of Hirschsprung's disease?

The affected segment of the colon cannot relax and pass stool through the colon, creating an obstruction.

48

Which part of the colon is usually affected by Hirschsprung's disease.

In most affected people, the disorder affects the part of the colon that is nearest the anus. In rare cases, the lack of nerve bodies involves more of the colon. In five percent of cases, the entire colon is affected.

49

During normal fetal development, cells from the neural crest migrate into the large intestine (colon) to form two nerve networks. What are they called?

During normal fetal development, cells from the neural crest migrate into the large intestine (colon) to form the networks of nerves called Auerbach's plexus and Meissner's plexus.

50

51

Can you name the two types of Automimmune Microscopic colitis?

- Collagenous Colitis

- Lymphocytic Colitis

52

Week 209. What does this GI histology slide show?

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This is Collagenous Colitis. Note the thickened subepithelial collagenous band >15 micrometer (2RBC diameter).

53

Week 209. What does this histology slide show?

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This is Lymphocytic colitis. Note the increased number of lymphocytes in the Epithelium. 

54

Which two parts of the GI tract does Ulcerative Colitis tend to affect?

The Colon and the Rectum.

55

What is the commonest cause of bloody diarrhoea in the UK?

Ulcerative Colitis. 

56

What is Proctitis?

Inflammation of the rectum and anus

57

What is Proctocolitis?

This is a general term used to describe inflammation of the rectum and/or colon. 

58

What is meant by the term Pancolitis?

Pancolitis is a very severe form of ulcerative colitis. Pan refers to the fact that the disease is spread throughout the large intestine, from the cecum to the rectum. Symptoms are very similar to those of any ulcerative colitis patient except more severe.

59

Week 209. What risk is associated with Fulminant Ulcerative Colitis?

Perforation through muscle, and bowel wall. 

60

Week 209. What does this image show?

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This image shows Ulcerative Colitis. Note the more obvious changes at the DISTAL end. 

61

Week 209. What does this image show?

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This image shows Fulminant Colitis (Super de' Deuper bad Ulcerative Colitis)

62

Week 209. What does this histology slide show?

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This shows Ulcerative Colitis. Note that the inflammation is contained within the mucosa and submucosa - the luscle layer is unaffected. 

63

Week 209. The following sample was taken from a patient with Ulcerative colitis. What histological feature is prominent?

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Crypt Abscess. Crypts become distended with neutrophils to produce crypt abscesses

64

Week 209. In most patients, Crohn's disease is confined to which area of the GI tract?

In 66% of Crohn's patients, disease is confined to the small Bowell alone

65

Week 209. With reference to Crohn's Disease, what is meant by the term "Skip lesions"?

The term "skip lesions" refers to lengths of diseased bowel, separated by normal bowel.

66

As best as you can, describe the pathology of Crohn's Disease. 

  • Segmental – lengths of diseased bowel, separated by normal bowel – “skip lesions”.
  • Initially - shallow aphthoid ulcers
  • Later - longitudinal ulcers and fissures
    ‘cobblestone appearance’
  • Full thickness of wall involved
  • Transmural inflammation
  • Develop fibrosis and strictures

67

Week 209. What disease does this image show? What parts of the Bowel can you see here?

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This is Crohn's Disease. Both the terminal ileum, and the Caecum are visible here. 

68

Week 209. Which disease does this image show? What is the name of this abnormality?

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This is Crohn's Disease. The abnormality is a stricture

69

Week 209. As best as you can, summarise the microscopy findings typical in Crohn's Disease

  • Discontinuous, patchy inflammation.
  • Transmural inflammation with lymphoid aggregates in wall.
  • Fissuring ulceration.
  • Granulomas.

70

Week 209. What disease is shown in this TS slide? What are the defining features?

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  • This is Crohn's Disease
  • Transmural lymphoid aggregates (the dark purple dots)
  • Fissuring Ulcers

71

What disease is this? What is indicated by the black arrow?

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This is Crohn's disease. The arrow indicates a granuloma. 

72

Week 209. What three things can be associated with ischaemia of the colon?

  1. Acute small bowel ischaemia
  2. Hernia - strangulation
  3. Volvulus – Loop of bowel (usually sigmoid, can be caecum, twists around itself due to abnormally long mesentery)

73

74

75

Which three bacterial infections commonly cause inflammation of the colonic mucosa?

  1. Campylobacter
  2. Salmonella
  3. Shigella

76

Week 209. The bacterial infection Pseudomembranous colitis refers to infection with which organism? What commonly causes this organism to become pathogenic?

Pseudomembranous colitis is caused by infection with the toxin producing Clostridium difficile

This can be a normal commensal (2-3%).

Overgrowth occurs when the normal gut flora is disturbed, whether by antibiotics, enemas, or GI surgery.

77

What is the name given to this condition? What is the responsible organism?

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The condition shown here is Pseudomembranous colitis

This is caused by infection from Clostridium Difficile

78

What pathology is indicated on this slide? What key sign informs your decision?

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This is Pseudomembranous colitis

Key sign: Eruptive (volcano like) exudates.

79

Week 209. Which Viral infection can cause an inflamed colon (with an appearance very similar to that of Ulcerative Colitis)?

Cytomegalovirus (CMV)

80

Week 209. Which infection is indicated in this slide? What leads you to this conclusion?

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This is an infective viral condition - Cytomegalovirus.

This is indicated by Large intranuclear viral inclusion.

81

Week 209. Which infective protozoal condition, rare in temperate climates, presents with Diarrhoea and bloody stools?

 

For an extra mark - can you say what can develop as a result?

Amoebiasis (Entamoeba histiolytica)

This can develop:

  • Strictures
  • Metastatic amoebic abscesses

82

Week 209. Which organism causes this infection?

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Entamoeba histiolytica (This is Amoebiasis)

83

What ingredient in "Sugar-free" sweets has a laxative effect?

Sorbitol

84

What is the name given to the Iatrogenic pigmentation of large bowel mucosa due to chronic laxative abuse?

Melanosis coli. 

85

Week 209. What is the name given to this condition?

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Melanosis coli.

86

This sample was taken from a patient that chronically abuses laxatives. What can you see to support this history?

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There is deposition of lipofuscin pigment in macrophages, in the lamina propria.

87

Week 209. Benign neoplastic adenomas of the colon and rectum account for 90% of what?

Adenocarcinomas. Dysplasia brings about further change. 90% of adenocarcinomas of the colon and rectum arise from adenomas. 

88

Week 209. What are the four stages in the transformation of rectal/colon tissue into a carcinoma?

  1. Normal epithelium
  2. Adenoma (low-grade dysplasia)
  3. Adenoma (high-grade dysplasia)
  4. Adenocarcinoma

89

Week 209: What does this slide show (hint* it was taken during colonscopy).

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This shows a normal mucous membrane. 

90

Week 209. What does this slide show? Hint* It was taking during colonoscopy.

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This slide shows a benign neoplasm of the gut mucosa. This is Adenoma with low-grade dysplasia. 

91

Week 209. What does this image show? Hint* It was taken during colonscopy.

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This shows neoplastic benign adenoma with high-grade dysplasia. 

 

Next step....adenocarcinoma.

92

Week 209. What does this slide show? Hint* this was taken during colonoscopy. 

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Neoplastic benign Adenoma with high-grade dysplasia. 

93

Week 209. This is a sample from a removed benign adenoma (from the colon). But what type of adenoma is is? *Hint - look at the shape!

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This is a tubular adenoma!

94

Week 209. This is a sample from a benign Adenoma removed during surgery. But what type of adenoma is is?

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This is a Villous Adenoma.

95

Week 209. In which part of the GI tract are neoplastic malignant adenocarcinomas most often found? 

These are most often found in the Rectum.

other areas (descening most to least common):

  • Sigmoid
  • Caecum
  • Rest of colon

96

Week 209. This prosection shows which disease?

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Adenocarcinoma, likely arising from benign neoplastic adenoma of the colon. 

97

Week 209. This biopsy shows advanced pathology. But what is it?

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This is neoplastic malignant adenocarcinoma

98

Week 209. In the staging of Bowel cancer, what do the letters TNM stand for?

T = Tumour      

N = Node         

M= Metastases 

99

Week 209. In Bowel cancer staging, T1 means what?

T1 means the tumour is only in the inner layer of the bowel.

100

Week 209. In bowel cancer staging T2 means what?

T2 means the tumour has grown into the muscle layer of the bowel wall.

101

Week 209. In bowel cancer staging T3 means what?

T3 means the tumour has grown into the outer lining of the bowel wall.

102

Week 209. In bowel cancer staging T4 means what?

T4 means the tumour has grown through the outer lining of the bowel wall. It may have grown into another part of the bowel, or other nearby organs or structures. Or it may have broken through the membrane covering the outside of the bowel (the peritoneum)

103

Week 209. In bowel cancer staging N0 means what?

N0 means there are no lymph nodes containing cancer cells.

104

Week 209. In bowel cancer staging N1 means what?

N1 means that 1 to 3 lymph nodes close to the bowel contain cancer cells.

105

Week 209. In bowel cancer staging N2 means what?

N2 means there are cancer cells in 4 or more nearby lymph nodes.

106

Week 209. In bowel cancer staging M0 means what?

M0 means the cancer has not spread to other organs.

107

Week 209. In bowel cancer staging M1 means what?

M1 means the cancer has spread to other parts of the body.

108

Week 209. Relate Dukes' cancer staging (colorectal cancer) to TNM staging.

A: T1/2 N0 M0        

B: T3/4 N0 M0        

C: Any T, Any N, M0

D: Any T, any N, M1 

109

This is a squamous cell carcinoma of whic part of the body?

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The anus. 

110

Week 209. Describe the the fundamental histological difference between Adenocarcinoma and Squamous Cell carcinoma

In malignant adenocarcinoma, histology shows malignant gland like structures (they look like pink blobs often).

In Malignant Squamous cell carcinoma, the deformity is excessive Keratinisation.

111

What is another term for Hirschprung's disease? How would you concisely describe it's symptoms?

Congenital aganglionic megacolon.


Enlarged, dilated proximal large bowel because of obstruction.

112

What is the name given to the disease in this slide? What informs your decision?

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This is Hirschprung's disease. There are no ganglion cells in the myenteric plexus. 

113

Week 209. Which congenital disorders cause GI blockage?

Intestinal atresia (compromised blood supply leading to incomplete bowel)

Imperforate anus (no anus present). 

114

Which degenerative disease of the bowel is associated with herniation of mucosa through the bowel wall?

 

What can this develop into, and what are the signs/symptoms?

This is Diverticular disease of the colon. 

 

This can cause inflammation with fibrosis, and can lead to stricture formation. 

 

Patients may present with:  pain, altered bowel habit, bleeding, perforation and/or obstruction.

115

Week 209. Which disease is shown in this picture?

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This is Diverticular disease. Note the outpouching of the mucosa through the wall of the bowel. 

116

Week 209. Which Endocrine disorder can cause diarrhoea, and why?

Thyrotoxicosis. 

 The effect of Thyroid hormones on the sympathetic nervous sytem causes increased gut motility and diarrhoea. 

 

117

Week 209. What is the effect of hypothyroidism on bowel habit?

Constipation. 

118

Week 209. Which autosomal dominant condition causes multiple adenomas of the colon (which usually progress to adenocarcinomas)?

Familial Adenomatous Polyposis (FAP)

Most commonly due to mutation in APC (Adenomatosis polyposis coli) gene.

Usually require colectomy before 25 YO. 

119

Week 209. Where is the APC gene located, and what is its function?

This is a tumour supressor gene, located on the long arm of chromosome 5

120

Week 209. This is a piece of removed colon. What is the name given to this disease?

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This is Familial adenomatous polyposis. Note the plethora of small benign adenomas. 

121

Week 209. What is the difference between primary and secondary constipation?

Primary: Dysmotility, or mechanical obstruction.

Secondary: Other obstruction, drugs, or metabolic causes. 

122

Week 209. Cleveland and Vaizey scores are used to assess what?

Quality of life (QOL).

123

What are the classical signs of idiopathic slow transit constipation?

  • Young females
  • BO 1 / 2-3 weeks
  • Absence of call to stool
  • Abdominal discomfort
  • Family history
  • Abnormal motility
  • Small proportion of patients

124

Week 209. Name three surgical options for bowel dysmotility.

  1. Colectomy and IRA (Ileorectal anastamoses)
  2. Sacral Nerve stimulation 
  3. Antegrade colonic Enema

125

Week 209. Describe, in very basic terms, what happens in a colectomy and IRA.

A image thumb
126

Week 209. When considering a surgical colectomy, what other factors should you exclude/take into account?

 

 

  • Disorders of defaecation
  • Small bowel motility is normal
  • Weak sphincters
  • Other causes
  • Inappropriate expectations from patient and family

127

Week 209. Sacral nerve stimulation allows for mechanical control over defaecation. What are it's advantages?

  • Increased frequency of defaecation

• Reduced incomplete evacuation
• Decrease abdominal pain and bloating
• Reduced Cleveland Clinic constipation score
• Quality of life significantly improved

128

Week 209. How might a patient with obstructed defaecation present?

  • External prolpase

• Rectocoele
• Rectal intussusception
• Anismus
• Idiopathic megarectum

129

Week 209. What is a rectocoele?

This is like a prolapse, only internally, like a large distended loop off of the rectum. 

130

Week 209. What is Anismus?

Anismus refers to an inability to defecate as a result of failed relaxation of the Pelvic Floor muscles. 

131

Week 209. If transverse distension of the colon is what leads to rectocele, what does longitudinal distension of the colon lead to?

Internal intussception/external prolapse.

132

Week 209. Can you name two surgical procedures, directed at the correction of rectal redundancy?

  1. Rectopexy
  2. Perineal approach (Delormes procedure)

133

Week 209. A Rectocoele is a protrusion of the ___ rectal/_____ vaginal wall, which is commonly found following childbirth. 

Anterior Rectal

Posterior Vaginal

134

Define Constipation

Constipation is defecation that is
unsatisfactory because of infrequent stools,
difficult stool passage, or seemingly
incomplete defecation.

135

Week 209. What is Functional Constipation?

Functional constipation is chronic constipation without a known cause. Functional constipation is also known as primary constipation and idiopathic constipation.

 

136

Week 209. What is meant by the term Secondary Constipation?

This is constipation caused by a drug or a medical condition - there is a reason for it. 

137

Week 209. What is meant by the term(s) Faecal loading/impaction?

This is retention of faeces to the extent that spontaneous evacuation is unlikely. Retained faeces are usually palpable on abdominal examination, and may be felt on internal rectal examination or by external palpation around the anus. 

138

Week 209. The Rome criteria for constipation states a definition as being bowel movements that occur how frequently?

Bowel movements occuring less than three times a week is one of the Rome criteria for constipation. 

139

Week 209. Could you list a few basic medications that would contribute to constipation?

  • Narcotics

• Iron supplements
• Nonmagnesium antacids
• Calcium-channel blockers
• Inadequate thyroid hormone supplementation
• Many psychotropic drugs
• Anticholinergic agents

140

Please look at this Abdominal X-Ray film. The patient feels bloated and has not passed stools for four days. What do you think?

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This is Chronic Constipation

141

Week 209. What are the Rome II Criteria for identifying Irritable Bowel Syndrome (IBS)?

•Abnormal frequency of stools
•Abnormal form
•Abnormal passage
•Presence of mucous
•Bloating with distension

142

Week 209. What test could you perform to evaluate the degree of constipation in a patient?

Evaluation of Constipation can be via Colonic transit study (this is a radiological study). 

143

Week 209. 5 days after beginning a colonic transit study, an abdominal X-ray is performed. No markers are seen on the film. What can you deduce from this?

If 5 or fewer markers remain, patient has grossly normal colonic transit.

144

Week 209. 5 days after beginning a colonic transit study, an abdominal X-ray is performed. Most markers are scattered about the colon. What can you deduce from this?

It is most likely that this patient has hypomotility or colonic inertia

145

Week 209. 5 days after beginning a colonic transit study, an abdominal X-ray is performed. Most markers are gathered in the rectosigmoid. What can you deduce from this?

It is most likely that the patient has a functional outlet obstruction

146

Week 209. How do bulk forming laxatives work?

Bulk-forming laxatives retain fluid within the stool and increasing faecal mass, stimulate peristalsis. They also have stool-softening properties.

 

Examples: (ispaghula husk, methylcellulose, and sterculia) 

147

Week 209. How do Osmotic laxatives work? Give an example. 

Osmotic laxatives increase fluid in the large bowel. Produces distension, leading to stimulation of peristalsis. Lactulose and macrogols also have stool-softening properties.

Example: lactulose

148

Week 209. How do Stimulant Laxatives work?

These cause peristalsis by stimulating colonic nerves (senna) or colonic and rectal nerves (bisacodyl, sodium picosulfate).

Example: Senna (hydrolyzed to the active metabolite by bacterial enzymes in the large bowel.)

149

Week 209. How do Surface Wetting Agent Laxatives work?

Surface-wetting agents reduce the surface tension of the stool, allowing water to penetrate and soften it.

150

Week 209. What is the "order of draw" of laxative treatments, from first to last?

  1. Bulk forming
  2. Osmotic
  3. Stimulant

151

Week 209. What is a probiotic? Which strain has shown to be effective in some cases of IBS?

A Probiotic is a live non-pathogenic microorganism that is believed to have beneficial effects when ingested. 

 

Some changes in cytokine profile seen with Bifidobacterium strain.

152

Week 209. What is the effect of Selective Type-2 Chloride Channel activator Therapies?

These work from the luminal side of the mucosa to stimulate chloride and water secretion into the lumen.

153

Week 209. Manometry is used to measure what?

Resting Pressure (Internal Sphincter)

Maximum Squeeze (External Sphincter)

154

Week 209: What is a Fistula?

An abnormal tract between two epithelial or endothelial lined surfaces.

155

Week 209. What is a Sinus?

Granulation or epithelized blind-ending tract.

156

Week 209. What is a Fistulotomy?

fistulotomy is the surgical opening of a fistulous tract.

157

Week 209. A 50 YO M presents with Painless bright rectal bleeding on defecation, chronic constipation and lumps (prolapse). What could this be?

Engorged arterio-venous plexuses (Haemorrhoids!)
•Normal variant
•15% contribution to continence

158

Week 209. Approximately to what volume does the rectum fill (in normal defecation)? 

In normal defecation, the rectum fills to approximately 200 mls

159

Week 209. What is the Recto-rectal reflex?

In normal Defecation, the Recto-Rectal reflex is: Proximal bowel constriction syncronous with distal bowel relaxation

160

Week 209. What is the Recto-anal inhibitory reflex?

The rectoanal inhibitory reflex (RAIR) is an involuntary IAS relaxation in response to rectal distension, allowing some rectal contents to descend into the anal canal where it is brought into contact with specialized sensory mucosa to detect consistency.

161

Week 209. To which lymph nodes does the anus drain?

Drainage is via inguinal lymph nodes if low (not Superior Rectal).

162

Week 209. What is the name given to the "lines" that do not completely cross the large bowel?

Haustra

163

Week 209. What is the name given to the "lines" that completely cross the small bowel?

Valvuli coniventes

164

Week 209. Is an appendic thicker than 6mm normal?

Usually - No.

165

Week 209. Tumours of endocrine cells are called ___ Tumours.

Carcinoid Tumours. 

166

Week 209. What is the anatomical difference between the Transverse/sigmoid colon, and the caecum/ascending colon/descending colon?

The transverse and sigmoid colon are intra-peritoneal.

The Caecum, ascending colon and descending colon are retroperitoneal

167

Week 209. What are the clinical signs of Appendicitis?

  • Peri-umbilical pain
  • vomiting
  • fever
  • Pain localised to right iliac fossa, guarding and rebound tenderness 
  • Generalised abdominal pain, guarding and rebound tenderness

168

Week 209. What are the complications of Appendicitis?

Perforation -septic shock and death if not treated
Sub phrenic abscess leading to persistent signs of infection
A walled off abscess may result in a chronic appendix mass. This may lead to fistulas to other organs
Infection may involve the portal veins causing portal vein thrombosis or hepatic abscesses

 

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Week 209. Which cells are involved in acute inflammation?

Neutrophils and eosinophils (polymorphonuclear leukocytes).

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Week 209. Which cells are involved in Chronic inflammation?

Lymphocytes, plasma cells, macrophages (mononuclear leukocytes).

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What proportion of appendicectomies are normal?

1 in 5

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Week 209. What does this image show?

Q image thumb

Endocrine cells. 

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Week 209. What does this image show?

Q image thumb

Threadworm/Pinworm

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Week 209. What does this image show?

Q image thumb

Mucosal Crypts (Appendix).

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