Lower GI disease

Question 1

Functions of lower GI tract

Answer 1

most of digestion and absorption already done

absorbs water and electrolytes from solid stool

Question 2

Acute appendicitis (inflammation)

Answer 2

inflammation of the appendix
obstruction by stool, stone, tumour or worms causing increased pressure and bacterial invasion
symptoms: pain (umbilical and R lower abdomen), nausea and vomiting, decreased appetite
signs: tenderness and guarding, fever, increased WBC
Treatment = open/laparoscopic surgery or antibiotics

Question 3

Inflammatory Bowel Disease (inflammation)

Answer 3

chronic inflammatory condition - Crohn’s disease and Ulcerative Colitis
idiopathic (cause unknown)
difference in signs and symptoms, pathology, treatment, and response to treatment

Question 4

Crohn’s disease

Answer 4

Affected area = lower small intestine, can be anywhere in GI tract
Pattern = spreads unevenly, inflamed areas between normal areas
Morphology = ulcerative at all layers, thickened wall, fistulae’s, fissures
Symptoms = abdo pain, weight loss, nausea and vomiting
Complications = fistulae’s, anaemia, malabsorption of fat and vitamins, skin, eye and joint involvement

Question 5

Ulcerative Colitis

Answer 5

Affected area = mostly rectum and colon
Pattern = spreads continuously from the rectum
Morphology = ulceration of first layer of bowel, dilated bowel
Symptoms = diarrhoea with blood and mucus
Risk of cancer = higher than Crohn’s
Complications = blood loss, electrolyte disturbance, toxic dilation of bowel, skin, eye, joint and liver involvement

Question 6

Treatment of IBD

Answer 6

Drugs:
- steroids
- amino salicylates
- imunosuppressants
- biological agents
Surgery:
- colectomy/ resection +/- stoma formation (ileostomy)
- strictureplasty

Question 7

Clostridium difficile (infection)

Answer 7

found in the gut, usually harmless, kept in control by other bacteria
some antibiotics change balance of bacteria in the gut = c.diff multiplies, toxins cause illness = diarrhoea, pain, fever
survives as spores for long periods of time on surfaces etc
complications:
-diarrhoea causes dehydration and spread to others
- toxic megacolon
- bowel perforation
- sepsis and death

Question 8

Management of c.diff

Answer 8

Isolate
Gloves and apron
Hand washing
Stop causative antibiotics
Start antibiotics for c.diff infection (vancomycin)
Daily assessment of stool type

Question 9

Bowel cancer

Answer 9

4th most common cancer
risk factors include age, family history, inherited conditions, benign polyps, IBD
> National Bowel Cancer screening programme
- 60-75 - faecal occult blood test
- positive = colonoscopy to look for polyps/cancer
- refer for treatment

Question 10

Signs and symptoms of bowel cancer

Answer 10

blood from back passage
change in normal bowel habit - diarrhoea/constipation
iron deficiency anaemia - blood loss
weight loss
abdo pain
bowel obstruction

Question 11

Colon cancer

Answer 11

diagnosis:
> endoscopy - colonoscopy, sigmoidoscopy = biopsy
> histology
> radiology (CT scan)
treatment:
surgery = open or laparoscopic, colectomy +/- stoma formation
chemo