Lower GI disease

Question 1

Which structures does the lower GI consist of?

Answer 1

Large intestine - ascending colon, transverse colon, descending colon, sigmoid colon, rectum, anus, appendix.

Question 2

What is the main function of the large intestine and the rectum?

Answer 2

Mainly absorbs water and electrolytes to form a solid stool.

Question 3

What is acute appendicitis?

Answer 3

Sudden onset of inflammation of the appendix, caused by an obstruction of appendiceal lumen by faeces, calculus, tumour or worms.

Question 4

What is the difference between Visceral and Parietal pain?

Answer 4

Visceral = referred pain, the pain is felt in a different location from where the pathology is.
Parietal = pain is much more localised.

Question 5

What is peritonitis?

Answer 5

Inflammation of the lining of the abdominal cavity and the lining of the organs. Due to a variety of causes - most commonly infection.

Question 6

How can you treat acute appendicitis?

Answer 6

Surgery and/or antibiotics.

Question 7

What is antibiotic associated colitis (Psuedomembraneous colitis)?

Answer 7

Acuet inflammation of the Colon characterised by the formation of adherent inflammatory pseudomembranes overlying the sites of mucosal injury.

Question 8

How is antibiotic associated colitis caused?

Answer 8

Classically caused by toxins produced by C.Difficile that has over grown. Typically develops in patients treated with broad spectrum antibiotics.

Question 9

What are the symptoms of Pseudomembranous colitis?

Answer 9

Fever and lower abdo tenderness.

Question 10

How do you treat Pseudomembranous colitis?

Answer 10

Speak to microbiology - stop current abx and possibly introduce a new one. Hydration. Specific antibacterial therapy.

Question 11

What is Inflammatory Bowel Disease?

Answer 11

Chronic inflammatory conditions of unknown aetiology affecting the GI tract. Two main forms = Crohn’s disease and Ulcerative Colitis.

Question 12

What is IBD caused by?

Answer 12

Genetics, Environment, Constitutional Susceptibility.

Question 13

Which areas of the body does Crohn’s disease affect?

Answer 13

Affects from mouth to anus: terminal ileum (30%), colon alone (20%) and ileum and colon (50%). It is non continuous - skip lesions - uninvolved areas of the bowel.

Question 14

What are the complications of Crohn’s Disease?

Answer 14

Anaemia, malabsorption: fats, vitamins, bile salts. Fistulas. Increased risk of bowel carcinoma. Bowel obstruction or perforation.

Question 15

What are the symptoms of Crohn’s disease?

Answer 15

Extreme bloating, abdo pain and constipation. Diarrhoea and weight loss.

Question 16

Which areas of the GI system does Ulcerative Colitis affect?

Answer 16

Colon only. Starts in rectum, spreads proximally. Continuous disease - no skip lesions. May involve who colon and also appendix.

Question 17

What are the complications of ulcerative colitis?

Answer 17

Anaemia - iron deficiency from blood loss. Electrolytes lost from diarrhoea. Increased risk of carcinoma.

Question 18

What are the causes of colorectal carcinoma?

Answer 18

Genetic factors. Chronic inflammation from UC and Crohn’s. Dietary factors - low fibre, red meats, lack of vitamins and nutrients.

Question 19

What is the National Bowel Cancer Screening Programme (NBCSP)?

Answer 19

All populations 60-75 years. faecal Occult Blood Test (FOBT), If +++ refer for colonoscopy. Look for polyps and carcinomas. Refer for treatment.

Question 20

What are the symptoms of Colorectal Carcinoma?

Answer 20

Depends on the site of lesion, altered bowel habit, blood PR, iron deficiency anaemia, weight loss.