FI

Question 1

6 components necessary to maintain anal continence

Answer 1

1. stool consistency
2. bowel transit
3. rectal capacity/compliance
4. rectal sensation/sampling reflex
5. pelvic floor muscle integrity
6. competent anal sphincters

Question 2

Internal anal sphincter

how think is it?
how much does it contribute to the resting tone?

Answer 2

70%

external anal sphincter provides 30% of the resting

Question 3

What innervates the external anal sphincter

Answer 3

inferior branch of the pudendal nerve

Question 4

what is a normal anorectal angle at rest?

Answer 4

95 degrees

Question 5

what is a normal anorectal angle during a voluntary contraction?

Answer 5

75 degree

Question 6

what is a normal anorectal angle with BM?

Answer 6

110 - 130 degrees

loss of puborectalis impression
funneling of anorectum

Question 7

MRI for FI

describe the scoring of levator ani injuries on MRI?

Answer 7

Each side is scored separately for a max of 6 points

0 = no defect
3= complete loss

0-3 is minor
4-6 is major

Question 8

What supplies motor innervation to the puborectalis?

Answer 8

sacral plexus S3, S4, S5

Question 9

what mediates the sympathetic innervation of the IAS?

Answer 9

postganglionic fibers of hypogastric n.

Question 10

what nerves mediates the parasympathetic innervation of the IAS?

Answer 10

preganglionic fibers of the sacral n.

Question 11

describe the hemorrhoid grading system.

Answer 11

Internal - above the dentate line

grade I- no bleeding without prolapse
grade II- prolapse with spontaneous reduction
grade III- prolapse with manual reduction
grade IV- incarecated, irreducible prolapse

external - below dentate line

Question 12

describe the components of the digital rectal exam

Answer 12

-resting tone
-voluntarily squeeze lasting 5 sec.
-involuntary contraction with cough
-pain, fissures, hemorrhoids,
-consistency of the stool
-assess for enterocele with valsalva
-masses or lesions

Question 13

How does Loperamide
work?

Answer 13

opiod recepter agonist–> decreases activity of myenteric plexus in small intestines–>this causes smooth muscle relaxation which increases water absorption

-it also inhibits gastrocolic reflex

Question 14

does loperamide cross the BBB?

SE of loperamide

Answer 14

no

dry mouth, constipation

Question 16

Could SNM work for someone with anal sphincter tear?

Answer 16

yes, studies included patients with tears up to 120 degrees.

Question 17

OASI repair
suture type?
abx?
bowel regimen?

Answer 17

PDS or other absorbable
cefazolin
laxitives.

Question 18

Name the Rome III criteria to dx constipation

Answer 18

2 or more of the following:
-straining at least 25% of BM
-hard stool at least 25% of BM
-sensation of anorectal blockage at least 25% of the time
-manual maneuvers for BM at 25% of the time
-fewer than 3 BM per week
-insufficient criteria for IBS

Question 19

how is a transit study performed?

Answer 19

-24 markers in on tablet
-x-ray on day 5
-At least 80% should have been expelled
-if more than 6 markers are left, then its either slow transit or obstruction

Question 20

How many grams of fiber is recommended per day?

Answer 20

20-35g

Question 21

How does fiber work to increase stool volume?

Answer 21

stool is mostly bacteria, fiber provides a substrate to increase bacteria growth, thereby increases the volume of stool

undigested fiber absorbs fluid

Question 22

Name three categoroies of laxitives

Answer 22

1. bulk laxatives like fiber
2. osmotic laxatives like mag citrate or polyethylene glycol,
   3, stimulant laxatives like senna and biscodyl
3. pharmacotherapy- refer to GI

Question 23

how do you dx dyssynergia?

Answer 23

MR defecography
digital rectal exam

Question 24

what is the bubble test?

Answer 24

put water in the vagina and push air into the rectum. you will see bubbles in the vagina

Question 25

classification of Fistula

-high
-midlevel
-low

-small vs large

Answer 25

high- apical
midlevel-above the sphincter
low-involves sphincter or distal

small is <2.5 cm
large >/= 2.5cm