Conditions of the Large Intestine Flashcards

1
Q

What is the definition of chronic constipation?

A

2 or more of (over a 3 month period):

  • straining or manual movements required
  • lumpy / hard stools
  • sensation of incomplete evacuation
  • less than 3 bowel movements a week
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 5 medications used to treat constipation?

A
  1. bulking agents
    - increase faecal bulk to stimulate peristalsis
  2. osmotic laxative
    - creates an osmotic effect which increases intraluminal pressure
  3. stool softeners
    - promotes retention of water in faeces
  4. bowel stimulants
    - directly sitmulates nerve endings in colonic mucosa
  5. opioids antagonists
    - competitive antagonist at GIT opioid receptors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the risk factors and red flags for chronic constipation?

A

Risk factors:

  1. dietary
    - low fibre
    - low water
  2. sedentary lifestyle
  3. meds
    - analgesics
    - anti depressants
    - iron supps
    - diuretics
  4. psycho
    - chronic stress
    - refusal
  5. disease
    - diverticulitis
    - IBD
    - GIT malignancy

Red flags:

  • onset in middle to old age
  • PR bleed
  • Hx / family Hx colorectal cancer
  • rectal pain
  • weight loss / anorexia
  • nausea, vomiting
  • fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the common causes, red flags and management strategies for diarrhea?

A

Causes:

  1. acute
    - infectious gastroenteritis (salmonella, ecoli, rotavirus)
    - dietary (allergies, bingeing)
    - adverse drug reactions to antibiotics
  2. chronic
    - HIV
    - intestinal disorders (IBS, IBD, coeliac)
    - adverse drug reactions to alcohol abuse or other

Red flags:

  • severe or worsening in patients over 70 or immunocomprimised
  • bloody / mucoid / prurulent stool
  • severe abdo pain
  • SSX infection

Management:

  • treat causative factor
  • rehydration and electrolytes
  • antibiotics for bacterial infections
  • anti-diarrhoael agents (not if food poisoning present)
  • synthetic opioids (reduce peristalsis by acting on GIT opioid receptors)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe the condition of IBS, including incidence, pathophysiology and SSX

A
  • diagnosis of exclusion
  • consists of abdo discomfort with constipation and/or diarrhea

Incidence:

  • most common bowel disorder in West
  • 10% Australians
  • most common in women 20-40

Pathophysiology: (proposed):

  • disturbance of ENS / ANS / CNS
  • abnormal intestinal motility and secretion

SSX:

  • abdo pain in Rt or Lt iliac region or hypogastrium
  • pain usually relieved by defecation
  • constipation and/or diarrhea
  • abdo distension
  • excessive flatus and borborygmi
  • nausea
  • cramping
  • tenesmus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe the condition of diverticular disease, including incidence, pathophysiology, complications, SSX and management

A

Diverticulosis = saccular outpouching in colon wall

Diverticulitis = inflammation of pouches

Incidence:
5-10% across all ages, 30-50% in over 60

Aetiology:
- diet low in roughage (higher intraluminal pressures needed to move stool)

Pathophysiology:

  • high intraluminal pressure causes outpouching of colonic wall
  • most common site: sigmoid

Complications:

  • abscess formation (can perforate bowel wall and cause peritonitis)
  • fistula formation
  • fibrosis (can obstruct bowel)
  • haemmorhage

SSX:

  • usually asymptomatic
  • pain in left iliac fossa
  • changes in bowel habit (constipation alternating with diarrhea)
  • acute diverticulitis: severe pain, guarding, rigidity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are management options for diverticulitis?

A
  • antibiotics
  • analgesics
  • anti inflammatories
  • IV fluids
  • possibly naso gastric suction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe the condition of haemmorhoids, including types, classifications, risk factors, and SSX

A

Types:

a. internal (varicosity of superior rectal vein proximal to pectinate line)
b. external (varicosity of perianal venous plexus distal to pectinate line)

Classifications of internal:
1st degree - vein distended and may bleed but remains internal

2nd degree - prolapse during defecation but spontaneously reduces

3rd / 4th degree: prolapses remain protruding after defecation

Risk factors:

  • anything that increases venous pressure
  • low fibre diet increases intraluminal pressure neded to evacuate stool
  • chronic cough
  • obesity / pregnancy
  • obstruction (neoplasia)

SSX:

  • bright red bleeding
  • prolapse
  • variable pain

Complications:

  • strangulation (haemmorhoids compressed by anal sphincter, acute pain)
  • thrombosis
  • persistent blood loss causes anaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the condition of appendicitis, including incidence, pathophysiology, and SSX

A
  • inflammation of appendix

Incidence:

  • most common abdo surgical emergency
  • 7-12% of pop

Pathophysiology:

  • obstruction of lumen prevents proper drainage
  • mucosal secretions continue and increase intraluminal pressure
  • ulceration occurs and promotes bacterial invasion
  • inflammatory response
  • gangrene develops from thrombosis of luminal blood vessels
  • perforation of appendix

SSX:

  • abdo pain beginining in gastric region and increasing over 3-4 hours as inflammation spreads to parietal peritoneum
  • nausea / vomiting
  • anorexia
  • fever
  • altered bowel habits
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the condition of colorectal carcinoma

A
  • 2nd most common malignancy, and 2nd highest cause of cancer deaths

Risk factors:

  • low fibre, high fat diet
  • tobacco use
  • family Hx of CRC
  • IBD
  • familial adenomatous polyposis

Pathophys:
- most tumours develop in adenomatous polyps

Common sites:
- rectum, sigmoid, caecum & ascending colon

SSX:

  • ulcerated polyps: bloody/ mucoid diarrhea, frank or occult bleeding
  • low abdo pain
  • palpable mass
  • constipation if bowel restricted
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe the condition of IBD, including description, aetiology, complications, and management

A

Inflammatory Bowel Disease

  • chronic inflammatory disease affecting bowel
  • Ulcerative Colitis or Crohn’s Disease

Aetiology:

  • mix of genetics and environment
  • autoimmnune dysfunction
  • disrupted gut microbiota

Complications:

  • increased risk for colorectal cancer
  • fibrosis caused by repeated inflammation can obstruct bowel
  • biliary tree disorders (cirrhosis, gallstones)
  • renal disorders (kidney stones)
  • skin disorders and eye disorders
  • toxic megacolon in UC

Management:

  • anti-inflammatories (corticosteroids, 5-aminosalicyclic acids)
  • biological agents (anti TNFa antibodies)
  • immunosuppressants
  • anti-diarrhoeal agents
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe the condition of Ulcerative Colitis, including pathophysiology and SSX

A
  • one of the IBD conditions (chronic inflammatory disease of the bowel)
  • affects colon only

Pathophysiology:

  • inflammation begins in crypts of LI and spreads to mucosa
  • small erosions form in mucosa and develop into ulcers
  • healing with fibrosis leads to psudopolyp formation (clumps of granulomatous tissue)
  • oedema and thickening of muscularis narrows lumen

SSX:

  • series of remissions and exacerbations
  • diarrhea and maybe constipation
  • low abdo pain, tenderness, cramping
  • tenesmus
  • severe episodes: dehydration, tachycardia, fever, anaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe the condition of Crohn’s DIsease, including pathophysiology and SSX

A
  • one of the IBD conditions
  • chronic inflammatory bowel disease
  • can affect any part of the GIT (most common in terminal ileum, ascending and descending colon)

Pathophysiology:

  • inflammation begins in submucosa and spreads to entire thickness of intestinal wall
  • chronic inflammation leads to development of granulomas
  • intestinal wall adopts a cobblestone appearance (lines of ulceration surrounding areas of mucosal swelling)

SSX:

  • can mimic IBS or peptic ulcer
  • vary depending on site affected
  • diarrhea
  • abdo pain
  • weight loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the differences between Ulcerative Colitis and Crohn’s Disease?

A

Site affected:

  • UC: affects LI / colon only
  • CD: can affect any part of GIT

Thickness of inflammation:

  • UC: inflammation restricted to mucosa and submucosa only
  • CD: inflammation affects entire thickness of intestinal wall

Site where inflammation begins:

  • UC: begins in crypts of LI and spreads to mucosa
  • CD: begins in submucosa and spreads to entire wall

Most common sites:

  • UC: sigmoid / rectum
  • CD: terminal ileum, ascending and transverse colon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly