GIT 2 Flashcards
How many adults suffer from haemorrhoids ?
4%
what can haemorrhoids cause?
pain
bleeding
problems when going to toilet
tenesmus
why do ppl get haemorrhoids?
increase in abdominal pressure eg. pregnancy and straining (low fibre diet)
what type of sensation do we feel in anus ?
somatic
what sensation do we feel in rectum?
non somatic
what type of nerve supply do organs have?
visceral nerve supply
what do pts feel if there is inflammation in the rectum?
- bit of discomfort
- tenesmus
- but no pain
when do pts feel pain in rectum?
- skin of anus and the dentate line which is the junction between the rectum and anus
- if s3 nerve damaged (sciatica) leads to numbness of muscle and incontinency
what are the 2 types of piles?
internal - rectal mucosa above dentate line - pain free (gives tenesmus) discomfort but no pain
external - painful as they have somatic sensation, itch (bacteria), bleeding, discharge, fresh red blood in paper to toilet water, ulceration, difficulty with continence
how do piles arrise?
from the anal cushion
what is the anal cushion?
Lots of blood vessels (sometimes swell causing haemorrhoids)
Contributes to continence - helps to identify Solid vs liquid vs gas
what are the 2 types of sphincters we have in our anus?
internal and external anal sphincter
what is an external sphincter
- voluntary muscle
- striated muscle
- keep tight naturally
what Is an internal anal sphincter?
- involuntary muscle apart of autonomic nervous system
how do we manage haemorrhoids?
Symptomatic: relieve itching (anti inflam cream)
Hygiene
High fibre diet, fluid intake, keep stool soft
May require surgery.
- internal, prolapsed sphincter= elastic band, necrotic and die
- cryotherapy
how can we tell where the problem of blood in bowel motions is coming from?
colour of stool and blood distribution
blood in motions: stomach and upper GI
Digested partially, black colour stool
Melena stools (thick, sticky black poo)
Blood in bowel motions: colon
Blood mixed in with stool
- as contents get pushed through the colon hence mixing
Blood in bowel motions: sigmoid/rectum
blood coating stool
blood in bowel motions: rectum/anus
blood on toilet
paper or toilet water
what type of sensation is angina an eg of?
viceral
what type of sensation is gastrienetritis an eg of?
viceral
what type of sensation does the GIT have?
visceral
what is the parietal peritoneum ?
lining of the abdominal cavity
what sensation does the parietal peritoneum feel?
somatic
- can feel pain but still don’t know exactly where or which organ is the source of innervation
define visceral sensation
Nerves that supply the organs and blood vessels
Generalised
define somatic sensation
Pain in the muscles, bones or soft tissues
Localised
when do we get visceral sensation of the gut ?
when there is inflammation, infection or obstruction (colicky pain)
how do we categorise abdominal location
abdominal pain q’s to ask
- Where is it?
- When is it?
- Associated nausea and vomiting
- When did you last move your bowels?
- When did you last pee?
- When was your last menstrual period?
what is the appendix
- lower right quadrant
- 5-10cm long
- arises from first section of colon
what are end arteries?
terminal artery - the only supply of oxygenated blood to a part of a tissue eg. brain, finger and appendix
No collateral blood flow or venous drainage
Inflammation may compromise blood flow
Becomes increasingly inflamed, necrotic
what are some signs and symptoms of appendicitis ?
- initially poorly localised abdominal pain
- constipation diarrhoea
- anorexia malaise
what happens when appendicitis advances ?
-leakage of bugs into parietal periotneiam causes pain around anpendix therefore tender when u press down as there are somatic peritoneal nociceptors which are innervated due to inflammation
what is the tx for appendicitis?
surgery to remove necrotic appendix
what are the 3 types of gastrointestinal infections ?
viral, parasitic and bacterial
what is a viral gastroenteritis ?
- noravirus
- vomiting bug
- highly transmissible
what are the symptoms of viral gastroenteritis ?
nausea / vomiting
diarrhoea
malaise
fever
no management - just fluids and rest, handwashing
how does bacterial gastroenteritis
occur?
From contaminated food:
Raw/incompletely cooked food
Dairy
Poorly stored food
Unwashed salad.
Salmonella Campylobacter E.Coli
Bacterial superinfection
what are the symptoms of B.G
Nausea/vomiting
Diarrhoea and bleeding
Adbominal pain
Fever
Dehydration Fluid and electrolyte balance
who are at a high risk of B.G?
Pregancy
Infants
Immunocompromised
Elderly
what is a bacterial superinfection?
When pt gets prescribed antibiotics, can give pt a bacterial superinfection, which kills off other stomach bacteria and give C. Dificile an opportunity to grow can lead to death
may need stool culture to detect and give the right antibiotics to treat
Caused by prescription of amoxicillin, clindomycin, and metronidazole
what are GIT parasites?
- children get them more
- developing countries
- tx is praziquantel
what are the signs of GIT parasites?
Worms or parts of worm in poo
Itchy anus, especially at night
Diarrhoea/vomiting/abdominal pain
what is the prevalence of colorectal cancer ?
1 case per 1000 in uk
> 50 yrs
family history
history of colorectal polyps
risk factors for C.C
Diet
- red meat and dairy high risk
- fish, nuts, fresh veg low risk
Smoking
Alcohol
how does polyps progress into cancer
what is the survival rate of c.c? and why?
- 50%
- Due to late presentation
- Often asymptomatic until late Abdominal pain, diarrhoea, constipation, anaemia
c.c tx
surgery
radiotherapy
chemotherapy
how do we stage c.c and grade?
TNM (T1 (earliest)-T4(latest))
Tumour Thickness
Node involvement
Distant metastases
c.c survival and stage
how do we screen for c.c?
Asymptomatic disease
Faecal occult blood: detects blood in poo(old) - not the best test as if u consume food with animal blood u can get a false positive
Faecal immunochemical test: detects human blood in poo
what happens if the test is positive for c.c?
colonoscopy
- pts who have family that have polyps also get tested
signs of bowel cancer?
Change in bowel habit (2/3 weeks)
Abdominal pain (2/3 weeks)
Anaemia Blood or mucus in poo
Weight loss
Refer to GP for 2 week wait referral
how do we reduce the risk factors for bowel cancer ?
- Smoking cessation
- Alcohol reduction
- Ask about diet
- Encourage patient to participate in all screening programmes
- ASK about symptoms
- Refer to GP
