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Gastro & Abdomen 02.15 > Constipation & IBS > Flashcards

Constipation & IBS Flashcards

1
Q

Main 3 functions of the colon?

A
  1. Waste products - modification, storage, evacuation
  2. Water & electrolyte absorption (converts 2L of stool to 200g)
  3. Bacterial flora & absorption of nutrients from bacterial digestion. Esp short chain FAs not absorbed in SI
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2
Q

What is the function of the proximal colon (ascending and transverse?)

A

Fluid / electrolyte absorbtion and bacterial fermentation.

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3
Q

What is the function of the distal colon (descending and sigmoid?)

A

Reservoir function - stool storage

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4
Q

Normal colonic transit time?

A

24-40 hrs

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5
Q

Proximal or distal?
Non-propulsive segmentation – generated by slow wave
activity which produces circular-muscle contraction
(produces appearance of segments or haustra)
– Mixing/ absorption of contents
• Mass peristalsis (1 to 3 x/day) – simultaneous SM
contraction over large confluent areas-portion of
contents propelled distally. Main form of propulsive motility.

A

Proximal

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6
Q

What are the two major branches of the Enteric Nervous System in the GI tissues

A

Myenteric (Auerbach’s)

Submucosal (Meissner’s)

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7
Q

Which parts of ANS innervate and what is function of Myenteric ENS

A

Parasymp and sympathetic

Motor control of both circular and longitudinal muscle = peristalsis

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8
Q

Which parts of ANS innervate and what is function of Submucosal ENS

A

Parasympathetic only - secretomotor inervation of mucosa

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9
Q

This disorder is when there is loss of ENS ganglia in the distal part of the colon, leading to potential blockage and enlargment of proximal colon.

A

Hirschprungs

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10
Q

Two main types of contraction in normal colonic motility

A

LAPC - 100mmhg, 6x/day, moves more solid poo along & assoc with defecation

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11
Q

This neurotransmitter increases contraction by prolonging the duration of HAPC

A

Acetylcholine

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12
Q

Middle aged women, normal colonoscopy, watery diarrhoea - on histological exam= thickened subepithelial collagenous band OR incr lymphocytes in epith.

A

AUTOIMMUNE COLITIS = Collagenous or Lymphocytic

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13
Q

2 most common idiopathic inflammatory bowel diseases?

A

Crohns & UC

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14
Q

Young adults, malaise, anorexia, wt loss, bloody drha & mucus PR. Commonest cause of bloody drha in UK

A

UC = distal colon

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15
Q

Vague pain and mild diarrhoea, young adult. Symptoms come and go. Apthous ulcers in mouth.

A

Crohns

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16
Q

Most common location of volvulus, leading to ischaemia of bowel.

A

Splenic flexure - v long mesentery here, bowel easily twisted.

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17
Q

3 most common infective causes of inflammation of colonic mucosa leading to bloody diarrhoea?

A

Campylobacter, Shigella, Salmonella

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18
Q

Patient in hospital on long term antibiot. / enema / post-GI surgery. Diarrhoea caused by? Up to 20% of patients have this.

A

C difficile - causes Pseudomembranous colitis

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19
Q

Virus that causes colitis - mucosa will look similar to UC

A

Cytomegalovirus CMV

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20
Q

Protozoa, common in tropics not in UK, cause bloody diarrhoea, can lead to strictures and metastatic abcesses.

A

Amoebiasis - Entamoeba histiolytica

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21
Q

Melanosis coli - pigmentation of bowel wall is caused by what type of medication?

A

Laxative excess

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22
Q

A congenital condition malformation of part of colon - leading to blockage requiring surgery. Poss. assoc with Down’s.

A

Intestinal atresia

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23
Q

Herniation of mucosa through bowel wall - form little pouches.
Can become inflamed with fibrosis.
Can lead to stricture formation.
Present with pain, altered bowel habit, bleeding, perforation, obstruction.

A

Diverticular disease

24
Q

Affect of hyper and hypo thyroidism on gut motility?

A

Hyper - increases gut motility & diarrhoea (hormones act on sympathetic system)
Hypo - constipation and reduced gut motility

25
Q 
Intermittent, long standing symptoms.
Alternating constipation and diarrhoea.
Abdominal pain/cramps.
4x more common in women.
age 20 - 40
Functional / idiopathic
A

Irritable Bowel Syndrome

26
Q

Aut dominant condition - mutation in APC gene ( a tumour suppressor gene on chr 5)
Causes multiple adenomas (100+) - develop adenocarcinoma of colon.
Treatment surgery / colectomy before 25yo

A

Familial adenomatous polyposis.

27
Q

Four types of drugs that can cause CHRONIC constipation

  1. Common painkiller etc
  2. To treat anaemia
  3. Trtment for ganglions sending pain signals
  4. Similar to above - neuromuscular agent
A
  1. Opiates
  2. Iron
  3. Ganglion blockers (block paras and symp = nicotinic blockers)
  4. Anticholinergics eg atropine
28
Q

3 metabolic /endocrine causes of chronic constipation:

A
  1. Hypothyroidism
  2. Hypercalcaemia
  3. Hypokalaemia
29
Q

2 neuromuscular causes of chronic constipation

A

Hirschprungs

Spinal cord lesions

30
Q

“idiopathic” cause of constipation in person with learning difficulty - “never learnt” to toilet properly. Sounds like a transformer villain.

A

Megarectum - gets full and compacted.

31
Q

Other than megarectum, 3 causes of Obstructive Defecaetion Syndrome (ODS) (most common in multiparous women)

A
  1. Rectocoele
  2. Rectal intususseption
  3. Anismus
32
Q

Patient being treated for psychosis complaining of constipation - possible cause?

A

Antipsychotic medication e.g. haloperidol

33
Q

True / false, >40yo w. bleeding PR & loose stool for 4 weeks = Urgent Suspected Cancer (USC)?

A

FALSE - needs to be PR bleed and loose stool for 6 weeks in younger patients.

34
Q

True or False: >60yo with EITHER rectal bleed OR loose stool for >6 weeks = USC?

A

TRUE - only 1 req for more than 6 weeks in older patients

35
Q

True / false: RIF mass, rectal mass or unexplained anaemia are all possible symptoms for USC

A

True

36
Q

Constipation: In a colonic transit study (swallowing bits of plastic for 3 days then xrayday 5) the stuff is scattered throughout the colon. What is the main problem?

A

Colonic motility is low - hypomotility or colonic inertia

37
Q

Constipation: In a colonic transit study (swallowing bits of plastic then xray) after 24 hrs the stuff is concentrated in the rectum. What is the main problem?

A

Blockage of rectum / anus area.

38
Q

What does manometry measure (2)

A 
Resting pressure (internal sphincter)
Maximul squeeze (external sphincter)
39
Q

Primary investigation for chronic constipation? (old and new)

A

Barium enema, contrast CT

40
Q

Primary constipation caused by?

A

Functional / idiopathic

41
Q

Secondary / organic constipation caused by?

A

Drugs / medical condition

42
Q

Laxatives: 4 types, define and give examples:

1. Bulk forming

A 
Types: ispaghula husk, methylcellulose, sterculia
Action:
i. Retain fluid in stool
ii. Incr faecal mass
iii. Incr peristalsis
iv. Soften stool

For small hard stools/poor fibre

43
Q

Laxatives: 4 types, define and give examples:

2. Osmotic

A 
Type: Lactulose, macrogols
Action:
i. Incr fluid in colon = distension
ii. Stool softening
iii. Peristalsis stimulating

For impaction / chronic constip

44
Q

Laxatives: 4 types, define and give examples:

3. Stimulant

A

Stimulate colonic nerves=peristalsis (senna, bisocodyl, sodium picosulfate)

Acute - short term relief

45
Q

Laxatives: 4 types, define and give examples:

4. Surface wetting

A

Docusate, poloxamer
Reduce surface tension of stool - water can then penetrate & soften.

For hard dry faeces painful to pass.

46
Q

3 main methods of pain management, all antispasmodics, with IBS

A
  1. Anti cholinergics = SM relaxants (dicyclomine/hyoscine)
  2. Antimuscarinics (mebeverine/alverine)
    3, Peppermint oil (colpermin)
47
Q

Alternative pain management of IBS using drugs

A

Anti-depressants (serotonin & anti cholinergic effect)

48
Q

Anti-epilepsy drug, also used in bipolar disorder, causes constipation.

A

Carbamazepine

49
Q

These two metals can cause constipation (supplements or antacids)

A

Aluminium Calcium

50
Q

Calcium channel blocker used to treat HT - causes constipation

A

Verapamil

51
Q

First 2 steps of treating constipation before using pharamcology

A 
Incr fluids (2L / day,) reducing caffeine & diuretics
Incr fibre  18-30g/day min
52
Q

Contraindications for arachis oil enema (softner - used for impaction)

A

Peanut allergy

53
Q

Cautions for use for phosphate enema (osmotic)

A

Renal impairment Heart failure

54
Q

Selective serotonin 5HT4 receptor agonist with introduced for treatment of chronic constipation in women where other agents have failed.

A

Prucalopride

55
Q

Acetylocholine and substance P are stimulatory / inhibitory neurotransmitters in the ENS

A

Stimulatory

56
Q

VIP and Nitric oxide are stimulatory / inhibitory neurotransmitters in the ENS

A

Inhibitory

Gastro & Abdomen 02.15 (5 decks)

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