Colon and Rectum Flashcards by Martha Innes

What are the parts of the large colon?

Ascending, transverse, descending, sigmoid

How well did you know this?

Not at all

Perfectly

What are the teniae coli?

Three bands that complete the longitudinal muscle layer.

They produce the haustral pattern

How well did you know this?

Not at all

Perfectly

Describe the mucosa of the large intestine

Mucosa is lined with epithelial cells and goblet cells.

There are crypts but no villi so the surface is flat

How well did you know this?

Not at all

Perfectly

Which muscles are contracted and relaxed in defecation?

Diaphragm and abdominal muscles are contracted

Pelvic floor and anal sphincter are relaxed

How well did you know this?

Not at all

Perfectly

Which GI diseases can cause constipation?

Intestinal obstruction and pseudo-obstruction
Colonic disease (e.g. carcinoma, diverticula)
Aganglionitis (Hirschsprung’s, Chaga’s)
Painful anal conditions (e.g. fissures)

How well did you know this?

Not at all

Perfectly

What investigation is indicated when there has been a recent change in bowel habit in association with other significant symptoms?

Colonoscopy or CT

How well did you know this?

Not at all

Perfectly

What are the three categories of constipation, and which is the most common?

Normal transit time (most common)
Defecatory disorders
Slow transit

How well did you know this?

Not at all

Perfectly

What is normal transit constipation?

Stool frequency is normal but people believe they have constipation due to passage of hard stools
Patients may have abdominal pain or bleeding

How well did you know this?

Not at all

Perfectly

What investigation distinguished between normal and slow transit constipation?

Marker studies of colonic transit

How well did you know this?

Not at all

Perfectly

What is defecatory disorder induced constipation?

Where contraction rather than relaxation of the puborectalis and external anal sphincter may prevent evacuation

How well did you know this?

Not at all

Perfectly

What is the most common cause of a defecatory disorder?

Dysfunction of the anal sphincter and pelvic floor

How well did you know this?

Not at all

Perfectly

Who predominantly experiences slow transit constipation?

Young women with infrequent bowel movements

How well did you know this?

Not at all

Perfectly

What are the symptoms of slow transit constipation?

Infrequent urge to defecate
Bloating
Abdominal pain and discomfort

How well did you know this?

Not at all

Perfectly

What treatment measure should be taken in normal and slow transit constipation?

Increase in fibre in the diet and increased fluid intake

How well did you know this?

Not at all

Perfectly

What are examples of bulk-forming laxatives?

Dietary fibre
Methylcellulose
Sterculia
Ispaghula husk

How well did you know this?

Not at all

Perfectly

What are some examples of stimulant laxatives?

Senna
Glycerol suppository
Bisacodyl
Docusate sodium
Sodium picosulphate

How well did you know this?

Not at all

Perfectly

What are some examples of osmotic laxatives?

Lactulose
Macrogols
Phosphate enema
Citrate enema

How well did you know this?

Not at all

Perfectly

How do stimulant laxatives work?

By stimulating motility and intestinal secretion

How well did you know this?

Not at all

Perfectly

How do osmotic laxatives work?

By increasing fluids and electrolytes which stimulates contraction

How well did you know this?

Not at all

Perfectly

Which type of laxatives are preferred?

Osmotic

How well did you know this?

Not at all

Perfectly

What is megacolon?

A term for conditions where the colon is dilated

How well did you know this?

Not at all

Perfectly

What can megacolon be secondary to?

Chronic constipation

Chaga’s disease

How well did you know this?

Not at all

Perfectly

Which condition should be excluded in megacolon, and what is this condition?

Hirschsprung’s disease

An aganglionic section of the rectum causes constipation and subacute obstruction

How well did you know this?

Not at all

Perfectly

What is minor and major incontinence?

Minor: inability to control flatus and liquid stool, causing soiling
Major: frequent and inadvertent evacuation of stool of normal consistency

How well did you know this?

Not at all

Perfectly

What are some causes of incontinence?

``` Congenital abnormalities Anal sphincter dysfunction Rectal prolapse Faecal impaction with overflow diarrhoea Severe diarrhoea Neurological and psychological disorders ```

What are causes of anal sphincter dysfunction?

Structural damage Pudendal nerve damage Perianal descend

What us the initial medical management for incontinence?

Loperamide

What is ischaemic colitis caused by?

Occlusion of branches of the superior or inferior mesenteric artery

How does ishaemic colitis present?

Sudden onset abdominal pain Passage of bright red blood per rectum (with or without diarrhoea) May be signs of shock and CVD

Which is the most common part of the colon affected by ischaemic colitis?

The splenic flexure

Who most commonly experiences ischaemic colitis?

Elderly patients Young women on the pill Patients on nicorandil Those with thrombophilia and vasculitis

What are the characteristic investigative features of ischaemic colitis, and which investigation is diagnostic?

Characteristic: - Thumb-printing on AXR - Epithelial cell apoptosis and lamina propria fibrosis on biopsy Diagnostic: unprepared flexible signoidoscopy

Which signs on examination are symptoms of ischaemic colitis?

Abdomen may be distended and tender | Patients likely show signs of shock and may have lactic acidosis

Which investigations are done for suspected ischaemic colitis, and why?

Urgent CT to exclude perforation Un prepared flexible sigmoidoscopy for diagnosis Biopsy showing characteristic features Colonoscopy after recovery to exclude stricture formation

What investigation should be done in ishcaemic colitis if the patient has underlying CVD?

Screening for thrombophilia and vasculitis

What is the management for ischaemic colitis?

Symptomatic treatment | If peritonism or imminent perforation - surgery

What is diverticulosis?

The presence of diverticula

What is diverticulitis?

Inflamed diverticula

What is diverticular colitis?

Crescentic inflammation on the folds in areas of diverticulosis

How does diverticulitis occur?

Faeces obstructs the neck of the diverticulum, causing stagnation and allowing bacteria to multiply and produce inflammation

What complications can diverticulitis lead to?

``` Bowel perforation Abscess formation Fistulae Haemorrhage Generalised peritonitis ```

Are diverticula most often asymptomatic and discovered incidentally, or symptomatic and discovered due to symptoms?

Asymptomatic and discovered incidentally

What are the symptoms of diverticular disease?

Intermittent LIF pain or discomfort | Erratic bowel habit

What is the investigation of choice for diverticular disease?

Colonoscopy or virtual colonoscopy | Barium enema combined with flexible sigmoidoscopy can also be used

What does the term diverticular disease refer to?

The presence of diverticula, with or without inflammation

What is the management of diverticular disease?

Uncomplicated diverticular disease is managed with a well balanced fibre diet and smooth muscle relaxants if required

What are the pathological features of acute diverticulitis?

Altered gut motility Increased luminal pressure Disordered colonic micro-environment

How does acute diverticulitis present?

Severe pain in LIF Fever Constipation

What are signs of acute diverticulitis that can be found on examination?

Tenderness, guarding and rigidity on the left side of the abdomen Sometimes a palpable tender mass in LIF

What investigations are done in acute diverticulitis?

Blood tests (ESR and CRP raised) CT colonogrpahy Ultrasound (less sensitive than CT)

What will a CT colonography find in acute diverticulitis?

Colonic wall thickening Diverticula Often pericolic collections and abscesses

What is the management of a mild attack of acute diverticulitis?

Oral antibiotics

What is the management for acute diverticulitis if there is systemic upset, significant abdominal pain or co-morbidity?

Bowel rest | IV fluids and antibiotics

When might acute diverticulitis require surgery

Repeat attacks

What results when a diverticulum forms a fistula into the bladder or vagina?

Bladder: dysuria or pneumaturia Vagina: discharge

When might intestinal obstruction occur as a complication of diverticular disease?

After repeated attacks of acute diverticulitis

What are haemorrhoids?

Lumps inside, or around the anus

What does it mean when a haemorrhoid is classed as primary, second degree or third degree?

1 - internal 2 - prolapsing 3 - prolapsed

What can haemorrhoids cause?

Rectal bleeding, discomfort and pruritus ani

What is pruritus ani?

Itchy bottom

What is the most common cause of rectal bleeding?

Haemorrhoids

What is a likely sign of haemorrhoids?

Bright red blood on toilet paper

How is diagnosis of haemorrhoids made?

Inspection, rectal exam and proctoscopy

What is the management of mild haemorrhoids?

Just advice about avoiding constipation | Suppositories containing a local anaesthetic and steroids are helpful

What is the management of severe haemorrhoids?

Rubber band ligation or injection of a sclerosant | Haemorrhoid artery ligation operation

What is an anal fissure?

A tear in the skin-lined lower anal canal distal to the dentate line, which produces pain on defecation

How is diagnosis done for anal fissures?

History, confirmed on perianal exam PR exam often nor possible because of pain and sphincter spasm In sever cases proctoscopy and sigmoidoscopy should be done to exclude other disease

What is the treatment for anal fissures?

Local anaesthetic gel and stool softeners | Botulinum toxin in chronic fissures or lateral subcutaneous internal sphincterotomy

How do fistula in ano usually present, and when do they heal?

Present as abscesses and heal after abscess is incised

How can rectal prolapse, intussusceptions and solitary rectal ulcer syndrome be treated?

Treating underlying pathology