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209 Constipation and IBS > Colonic Function and Motility > Flashcards

Colonic Function and Motility Flashcards

1
Q

Where does the superior hypogastric plexus come from?

A

Nerves from L1-L2

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2
Q

Where does the inferior hypogastric plexus come from?

A

S2-4

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3
Q

how are the muscles organised in the bowel wall?

A

Circular and Longitudinal Muscle

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4
Q

What part of the ANS does the Myenteric plexus of Auerbach supply?

A

SNS and PSNS

Motor to L&C muscle

Secretomotor to mucosa

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5
Q

What part of the ANS does the sub-mucosal plexus of Meissner supply?

A

PSNS only

Motor to muscularis mucosae, mucosal receptors

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6
Q

What is the condition where there are no ganglia in the myenteric plexus? and what is the consequence of this?

A

Hirschprung’s

Absent Peristalsis

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7
Q

What does the proximal colon include?

A

The ascending and transverse parts of the colon.

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8
Q

What does the distal part of the colon include?

A

The descending and recto-sigmoid colon

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9
Q

What happens in the proximal colon?

A

Fluid/electrolyte and bacterial fermentation

Most contraction occurs here: Non-propulsive segmentation and Mass peristalsis

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10
Q

What is involved in non-propulsive segmentation?

A

Slow wave activity → Circular muscle contraction (appearance of segments/haustra)

For mixing and absorption of contents

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11
Q

What is involved with mass peristalsis?

A

Simultaneous smooth muscle contraction, contents propelled distally

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12
Q

What is the function of the distal colon?

A

Reservoir function - non-propulsive segmentation

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13
Q

Name two stimulators of colonic motility

A

Acetycholine and Substance P

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14
Q

Name two inhibitors of colonic motility.

A

Vasoactive Intestinal Peptide (VIP)

Nitrous Oxide (NO)

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15
Q

What is the outer border of circular muscle responsible for?

A

Myenteric potential oscillations → Flatus

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16
Q

What is the inner border of circular muscle responsible for?

A

High amplitude, low frequency waves → defaecation

17
Q

Describe the Gastro-ileal reflex

A

Caecal and ileo-caecal valve relaxation after food leaves the stomach → increased passage of chyme through ICV

18
Q

Delayed Gastrocolic reflex

A

Gastric distension **→ **desire to defaecate

(Gastrin)

19
Q

What type of muscle is the internal sphincter?

A

Smooth muscle

20
Q

What type of muscle is the external sphincter? Name the different portions.

A

Striated muscle

Deep portion

Superficial portion

Subcutaneous portion

21
Q

how is the internal sphincter controlled?

A

Involuntary

Sympathetic → excitation

(RAIR: rectal distension →) Parasympathetic → relaxation → defaecation

22
Q

What nerve innervates the striated muscle of the external sphincter?

A

Pudendal nerve

23
Q

What does rectal distension do to the external sphincter?

A

Increase the tonic contraction

24
Q

What happens during straining for defaecation?

A

Reflex inhibition → decrease anorectal angle

25
Q

What happens electrically post defaecation?

A

There is a burst of electrical activity → restore normal tonicity

26
Q

What is involved in the recto-rectal reflex?

A

Proximal bowel contracts, and distally relaxes

27
Q

What muscular changes occur in straining?

A

Decreased tone in pelvic floor/sphincters

Decreased ano-rectal angle

Increased tone in abdominal musculature

28
Q

What is involved in the rectoanal inhibitory reflex?

A

Rectal distension → Internal anal sphincter relaxation

29
Q

What is dyssynergic defaecation?

A

Rectal Hyposensitivity

Abnormal rectal compliance

Paradoxical anal sphincter contraction

Poor abdominal-rectal propulsive force

30
Q

What does mamometry of the anal canal measaure?

A

Pressure

Resting pressure - internal sphincter

Maximum squeeze - external sphincter

31
Q

What would the mamometry show for someone with incontinence?

A

Lower baseline pressure

No increase in anus pressure with increased rectal pressure

Cannot increase pressure with squeeze

32
Q

What is a rectocoele?

A

Protrusion of anterior rectal wall

33
Q

What is rectal intussusception?

A

May be preliminary to prolapse.

Feel rectal fullness - tenesmus

34
Q

What is anismus?

A

Damage to nerves supplying rectum (i.e. pudendal)

Failure to relax pelvic floor muscles

35
Q

What does a delayed transit and normal proctogram suggest?

What are the treatment options?

A

Idiopathic Slow Transit Constipation

Colectomy + Ileorectal Anastamoses, ACE (enema) , Sacral Nerve Stimulation

36
Q

What does a normal Transit but Abnormal Proctogram indicate?

And what is the treatment?

A

Intussusception or Prolapse

Resection rectopexy, Repair of rectocoele, ACE

209 Constipation and IBS (4 decks)

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