Lower GI

Question 1

What organs are in the lower GI system?

Answer 1

Jejunum and ileum of the small intestine, rectum and anus.

Question 2

What is acute appendicitis?

Answer 2

Sudden onset of inflammation in the appendix.

Obstruction of lumen causing increased pressure and bacterial invasion.

Question 3

What is the difference between visceral and parietal pain?

Answer 3

Sensory innervation of abdominal viscera is less than other parts of the body. As a result visceral pain is reffered- felt in different location to pathology.

Parietal pain is localised.

Question 4

What are the signs of acute appendicitis?

Answer 4

Pain starts in the umbilical region of the abdomen and then migrates to lower right abdomen,
Tenderness in right quandrant- and involuntary palpitations due to peritonitis.

Question 5

What is anti-biotic associated colitis/pseudomembranous colitis?

Answer 5

Acute inflammation of the colon due to mucosal injury.
Caused by toxins produced by C.Diff that as grown after bowel organisms have been eliminated by antibiotics.
Treatment is hydration and antibiotics.

Question 6

What is inflammatory bowel disease.

Answer 6

Chronic inflammatory conditions of unknown aetiology affecting the GI tract.
Two main forms of IBD are ulcerative colitis and Crohns disease.

Question 7

Explain Crohn’s disease.

Answer 7

Lower GI disorder.
Contain skip lesions so aren’t contagious.
Often perianal skin involments.
Transmural inflammation. Active chronic inflammation with non-caeseating granulomas. Fistulas can form.

Question 8

What are some complications of Crohns disease?

Answer 8

Anaemia
Malabsorption- vitamines ADEK, bile salts
Fistulas
Extra-intestinal- eyes, skin, joints. 
Increased risk of bowel carcinoma. 
Bowel obstruction and perforation.

Question 9

Explain idiopathic IBC ulcerated colitis.

Answer 9

Occurs only in the colon.
Contagious disease- no skip lesions.
Mucosal disease- no transmural involvement.
Can involve the whole colon and appendix.

Question 10

What are the complications of idiopathic IBC ulcerated colitis?

Answer 10

Anaemia and iron deficiency- due to blood loss.
Electrolyte loss due to the shits. 
Extra-intestional- skin, eyes, joints. 
Increased risk of carcinoma
Query dysplasia.

Question 11

Explain neoplasia in lower GI disorders.

Answer 11

Benign polyps- adenomas.

Cancer- malignant adenocarcinomas.

Question 12

Explain colorectal carcinoma.

Answer 12

Cancer.
Caused by genetic factors- familial adenomatous polyposis, lynch syndrome.
Chronic inflammation- IBU, UC, Crohns.
Dietary factors- Low fibre, red meat, lack of vitamins, antioxidants.

Question 13

What are the signs and symptoms of bowel cancer?

Answer 13

Altered bowl habit
Blood PR
Iron deficiency anaemia
Weight loss.

Question 14

Explain the different stages of spread in colorectal cancer.

Answer 14

Duke’s Stage A- above muscle layer.
Duke’s Stage B- into serosal fat- LN negative.
Duke’s Stage C- LN involvement.

Question 15

Explain the different stages of T in the TNM classification

Answer 15

T= primary tumour. 
Tx= tumour not accessable. 
T0= no tumour. 
Tis= tumour in situ
T1=Submucosa
T2=Muscularis propria
T3=Suberosa and perirectal tissues. 
T4=Perforates peritoneal or invades other organ

Question 16

Explain the different stages of N in the TNM classification of colorectal cancer.

Answer 16

N= regional lymph nodes.
NX=not accessible. 
N0=No LN metastasis. 
N1= 1-3 N+
N2= >4 N+

Question 17

Explain the different stages of M in the TNM classification

Answer 17

MX= metastasis not accessible. 
M0= no distant metastasis
M1= distant metastases.