GI 8 Flashcards
What may visceral pain present?
- Pain receptors respond to mechanical and chemical stimuli, such a stretching, tension and ishaemia
- Dull, poorly localised, central
What are the three broad anatomical areas with association to visceral pain?
1) Foregut - middle - stomach/pancreas
2) Midgut - suprapubic - small intestine
3) Hindgut - lower abdomen - colon
How does somato-parietal pain present?
- This pain is characterised by sharp, more intense and more localised sensation
- Movement may aggravate -> patient will lay still
- Results from inflammation, stretching or tearing of the parietal peritoneum
What is referred pain?
- Well localised pain felt in distant areas of the same cutaneous dermatome as the effected organ
- It occurs when organs share common nerve pathway
- e.g. GB pain felt in right shoulder
What exclusions must be made immediately in the case of an acute abdomen admission?
- Pancreatitis
- Abdominal aortic aneurysms
What are the 6F’s that describe possible origins of abdominal masses?
1) Fat
2) Faeces
3) Fluid
4) Flatus
5) Foetus
6) Fatal growth
What are the different locations for a hernia?
- Epigastric hernia
- Paraumbilical hernia
- Umbilical hernia
- Inguinal hernia
- Femoral hernia
- Incisional hernia
- Spigelian hernia
- Lumbar hernia
- Parastomal hernia
What is a hernia?
An abnormal protrusion of a cavity’s contents through a weakness in the wall of the cavity
How do haemorrhoids present?
- Painless bleeding
- Fresh, bright red blood, not mixed with stool, usually on paper
- Perianal itchiness
- No change in bowel habits, or weight loss, no associated symptoms
What are the investigations for haemorrhoids?
- PR examination
- Rigid sigmoidoscopy
- Proctoscopy
- Flexible sigmoidoscopy in patients above age of 50
What is the classical management for haemorrhoids?
- Symptomatic
- Sclerosation therapy with 5% phenol in almond oil
- Rubber band ligation
- Open haemorrhoidectomy
- Stapled haemorrhoidectomy
- HALO/THD procedure
What is rectal prolapse?
in which the rectum (the last part of the large intestine before it exits the anus) loses its normal attachments inside the body, allowing it to telescope out through the anus, thereby turning it “inside out”
How does rectal prolapse present?
- Protruding mass from anus especially during defecation
- May reduce spontaneously
- Bleeding and passing mucus per rectum is common
- Examination usually shows poor anal tone
What is the management for complete rectal prolapse?
- Many patients too frail for surgery – bulking agent and education on manual reduction
- Delorme’s procedure
- Perineal rectopexy
- Abdominal rectopexy
- Anterior resection
What is the management for partial rectal prolapse?
- In children – dietary advice and treatment of constipation
- In adults – treatment similar to that of haemorrhoids
What is an anal fissure?
- Tear in the anal margin due to passage of a constipated stool
- Usually in the midline posteriorly but may be occasionally anterior
- Multiple fissure may be due to Crohn’s disease
How does an anal fissure present?
- Acute onset of severe anal pain usually following episode of constipation
- “Glass passing through the back passage”
- Pain lasts for up to ½ h after defecation
- Bright rectal bleeding
What is the treatment for an anal fissure?
- Dietary advice, stool softeners
- Pharmacological sphyncterotomy (0.3% GTN ointment, 2% Diltiazem ointment), PR for 6/52
- Lateral sphyncterotomy
- Botox injection
What is an anal fistula?
- Abnormal communication between two epithelial surfaces
- There is an internal opening in the anal canal and one or more external openings on the peri-anal skin
- Also rarely caused by Crohn’s disease, tuberculosis and carcinoma
