Lower Gastrointestina tract disorders:

Question 1

Intestinal Obstruction

Answer 1

Effects on Intestinal wall

Simple→ obstruction without impairment of blood supply

Strangulated→ obstruction with occlusion of blood supply

Closed Loop → obstruction at each end of intestina segment

Consequences:
Fluid & electrolyte losses, shock, perforation of
intestinal wall

Question 2

Small intestine disorder (celiac Disease) Treatment and Symptoms:

Answer 2

• Only known effective treatment is lifelong gluten-free diet
  Reaction to wheat proteins

Symptoms:
- pain, discomfort, constipation, diarrhoea, 
anaemia, fatigue 
- Asymptomatic in some individuals 
- Vitamin deficiency is often noted 
- reduced ability of 
small intestine to properly absorb nutrients from food 
- 1/1,750 worldwide, 1/100 Australia

Question 3

Malabsorption Syndromes:

Answer 3

Impaired digestion or absorption of nutrients

Classified as:
- Maldigestion → failure of chemical process of digestion

• Malabsorption →
  failure of intestinal absorption

Question 4

Malabsorption Syndromes

1. Pancreatic Insufficiency:

Answer 4

• Insufficient enzyme production for CHO, fat & protein
  digestion
• Fat maldigestion → Steatorrhea (fat in stools)
• Absence of Bicarbonate —↓
  pH — prevents activation of
  pancreatic enzymes

Question 5

Malabsorption Syndromes

2. Lactose Enzyme Deficiency

Answer 5

• Inhibits lactose breakdown into monoCHO — prevents
  lactose digestion and absorption
• Develops in adulthood
• Lactose not absorbed — osmotic diarrhoea

Question 6

Malabsorption Syndromes

3. Bile Salt Deficiency

Answer 6

• Bile salts necessary for fat digestion
• Causes fat malabsorption
• Inadequate secretion of bile or impaired reabsorption of bile salts
• Treatment: exogenous intake of fat soluble vitamins
  vitamins, A, K, D, E

Question 7

Inflammatory Bowel Disease

Ulcerative Colitis:

Answer 7

• Chronic Inflammatory disease causing ulceration, abscess formation and necrosis of colonic & rectal mucosa only
• Cramping pain, bleeding, diarrhoea, dehydration, weight loss
• Remissions and exacerbation = common

Question 8

Inflammatory Bowel Disease

Crohn’s Disease:

Answer 8

Inflammation – bacteria

• Affects large and small intestine, oesophagus to rectum
• Ulceration involves all layers of lumen
• Granulomas and skip lesions of small intestine
• Abdominal tenderness and weight loss
• Remissions and relapses

Question 9

Diverticular Disease:

Answer 9

• Outpouching
of colonic mucosa through muscle
layers of colon wall (weak spots)
• Colonic obstruction, fistulas can result
• Usually discovered during diagnostic procedures
for other problems

Diverticulosis: Presence of
outpouching

Diverticulitis: Inflammation of diverticula

Question 10

Large Intestine Alterations:

- Appendicitis:

Answer 10

• Inflammation of the appendix
• Affects 12% of the population
• Most common surgical emergency of the abdomen
• Perforation and abscess formation — most serious
complication

Symptoms: nausea, pain, low grade fever, diarrhoea
in children

Question 11

Large Intestine Alterations

- Polyps:

Answer 11

• Benign growth into lumen of large intestine
  Could be:
• Non-neoplastic —hyperplastic, raised lesions on colonic mucosa

Neoplastic — adenomatous, proliferation of crypt cells

• Close relationship with colon carcinoma
• Surgery required

Question 12

Rectal Alterations:

Haemorrhoids:

Answer 12

• Dilation of venous plexus surrounding rectal and anal
  areas
• Dilated venous sacs protrude into rectal and anal canals — exposed, ulcerate, bleed

Blood loss: insignificant
Due to: constipation, pregnancy

Question 13

Rectal Alterations:

Anal fissure:

Answer 13

• Break or tear in skin of anal canal
• Bright red anal bleeding on toilet paper
• Pain
• Due to – constipation, pregnancy, stretching of the
  mucosa beyond its capability, Chron’s disease,
  Ulcerative colitis
• Chronic – deep and do not heal