Lower GI- extra

Question 1

Causes of colitis

Answer 1

Crohn’s colitis

UC

Acute infective

• E. coli
• Thyphoid

C. difficile

Radiation

Ischaemic

Question 2

C. difficile colitis

• Association
• Signs and symptoms
• Treatment

Answer 2

Associated
- Antibiotic use: third generation cephalosporins

Toxin A produced by C. difficle.

Diarrhoea

• Green liquid stool
• Non-blood stools

Treatment

• Vancomycin PO
• Metronidazole PO

Question 3

Ischaemic colitis

• Description
• Cause
• Location
• Presentation

Answer 3

Inflammation and injury of the colon due to inadequate blood supply.
- Usually caused by clot of inferior mesenteric artery

Most common in upper left colon
- Due to poor collateral supply between middle and inferior colic arteries

Presents

• Acute bloody diarrhoea
• Abdominal pain

Question 4

True Haemorrhoids

• Definition
• Classifications
• Associations

Answer 4

Excess amounts normal endoanal cushions

• Anorectal mucosa
• Submucosal tissue
• Submucosal blood vessels

Classifications

• Internal= upper anal canal
• External= lower anal canal

Associations

• Constipation
• Chronic straining
• Obesity
• Childbirth

Question 5

True Haemorrhoids

- Complications

Answer 5

Prolapse

• Ulceration
• Inflammation

Question 6

True Haemorrhoids

- Position (when supine)

Answer 6

Located around main anal blood vessel pedicles

- 3, 7 and 11 o’clock

Question 7

True Haemorrhoids

- Clinical features

Answer 7

Commonest age of onset= young adulthood
- Rarely after 55

Irritation

• Anal pruritis
• Mucus discharge
• Perianal discomfort

Damage to mucosal lining

• Post-defecatory bleeds= bright red, not mixed with stool
• On paper, splash in toilet pan

Prolapse
- Intermittent lump at anal margin, especially after defecation

Question 8

True Haemorrhoids

- Imaging

Answer 8

Rigid sigmoidoscopy

Proctoscopy

Question 9

Anal canal histology

• Lower canal
• Upper canal

Include

• Tissue origin
• nerves
• Blood supply

Answer 9

Lower third canal

• Stratified squamous
• Somatic tissue origin
• Nerves= pudendal, distal sacral= very sensitive
• Poor blood supply and healing

Upper third canal

• Columnar epithelium
• Visceral tissue origin
• Insensitive
• Great blood supply and healing

Question 10

True haemorrhoids treatment

• medical/ conservative
• Surgical: bleeding, prolapse,

Answer 10

Medical
- Avoid straining: laxatives

Surgical
- Prolapse symptoms= banding

• Bleeding= phenol injections
• Haemorrhoidal devascularisation= ligation (HALO)
• Stapled anopexy
• Large external haemorrhoids/ failure to respond to conservatives= haemorrhoidectomy