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Year 2 - Medicine > Week 209 - IBS/Constipation > Flashcards

Week 209 - IBS/Constipation Flashcards

1
Q

Which Portacaval anastomosis will result in Anorectal Varices?

A

Superior Rectal Veins draining via Middle+Inferior Rectal Veins directly into systemic circulation

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2
Q

Which Portacaval anastomosis will result in Caput Medusae?

A

Paraumbilical Veins draining via Superior epigastric veins directly into systemic circulation

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3
Q

Which Portacaval anastomosis will result in Oesophageal Varices?

A

Left Gastric Vein draining via the azygous directly into systemic circulation

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4
Q

Which Portacaval anastomosis will result in Ascites?

A

R, L and Middle Colic Veins draining via Paravertebral, Renal, Gonadal, Adrenal, Paravertebral Veins into the systemic circulation

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5
Q

Which Portacaval anastomosis will result in Splenomegally?

A

Portal Vein will directly drain into the IVC

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6
Q

Where do Secondary Metastases from Colon Cancers end up?

A

Liver

Paraaortic Lymph Nodes

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7
Q

What is a Carcinoid Tumour?

A

Tumour of Endocrine Cells

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8
Q

What is Carcinoid Syndrome?

A

Bronchial wheezing, Skin Flushing & Diarrhoea caused by 5-HT (serotonin) release by a Carcinoid Tumour

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9
Q

Where are Peyer’s Patches found?

A

Terminal Ileum

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10
Q

What does the Myenteric Plexus supply in the Gut?

A

Motor to Longitudinal & Circular Muscle

Secretomotor to mucosa

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11
Q

What does the Myenteric Plexus supply in the Gut?

A

Motor to Muscularis Mucosae

Mucosal Receptors

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12
Q

Which transmitters have a Stimulatory effect on the colon?

A

ACh & Substance P

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13
Q

Which transmitters have an Inhibitory effect on the colon?

A

VIP & NO

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14
Q

What Neuromuscular Disease can give rise to Constipation?

A

Spinal Cord Lesions

Hirschsprung’s Disease

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15
Q

What Metabolic Disease can give rise to Constipation?

A 
Diabetes
Hypothyroidism - slow transit+motility
Hypercalcaemia
Hypokalaemia
Phaeochromocytoma
Uraemia
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16
Q

What drugs can give constipation?

A 
Opiates
Iron
Ganglion-blockers
Non magnesium antacids
Calcium-channel blockers
Inadequate thyroid supplementation
Anticholinergic
Many psycotropic drugs
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17
Q

What innervation does the Internal Sphincter have?

A

Only Autonomic (i.e. involuntary)

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18
Q

What are the possible causes of Faecal Incontinence (categories)?

A

Neurogenic incontinence
Myogenic incontinence
Combination of both

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19
Q

What are the possible causes of Obstructed Defaecation Syndrome (ODS)?

A

Rectocoele
Rectal Intussusception
Anismus
Idiopathic megarectum

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20
Q

What effects does Sacral Neuromodulation (SNS) have?

A 
Increases propagated (ante grade) colonic contractions
Normalises pathologies/physiologies common to both continence & constipation
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21
Q

What are the two causes of Constipation?

A 
Functional Constipation (aka Primary)
Organic Constipation (aka Secondary) - e.g. due to drug or medical condition
22
Q

What are the Rome criteria for constipation?

A

Bowel movements <3 times a week

23
Q

What CNS diseases can give constipation?

A

Parkinson’s Disease
Multiple Sclerosis
CVA
Spinal Injury

24
Q

What is the Colonic Transit Study?

A 
Pt takes one capsule daily for 3 days
X-ray on day 5
If <5 remain = normal
Most rings SCATTERED= hypomotility
Most rings in rectosigmoid = Outlet obstruction
25
Q

Which laxatives should be offered first for constipation?

A

1) Bulk-forming laxative
2) If stools still hard, Osmotic Laxative
3) If stools soft but person still finds them hard to pass, stimulant laxative

26
Q

Give some examples and the action of BULK-FORMING LAXATIVES

A

Ispaghulahusk, methylcellulose

Retain fluid, increasing faecal mass -> Stimulate Peristalsis

27
Q

Give some examples and the action of OSMOTIC LAXATIVES

A

Lactulose, Macrogols

Increase fluid in large bowel (soften + stim. peristalsis)

28
Q

Give some examples and the action of STIMULANT LAXATIVES

A

Peristalsis by stimulating colonic nerves (Senna)

Or Colonic & Rectal Nerves (Bisacodyl, sodium picosulfate)

29
Q

How should you treat constipation?

A

1) Adjust any constipating medication
2) Advise about exercise, fluid intake, dietary fibre
3) Offer oral laxatives

30
Q

How do you manage Pain in IBS?

A

Antispasmodics
Anticholinergics (dicyclomine/hyoscine)
Antimuscarinic agents (mebeverine/alverine citrate)
Peppermint oil (Colpermin)

31
Q

Which antidepressants are likely to give DIARRHOEA as a side-effect?

A

Amitryptyline
Imipramine
Clomipramine

32
Q

Which antidepressants are likely to give CONSTIPATION as a side-effect?

A

Citalopram
Sertaline
Paroxetine
Fluoxetine

33
Q

What effect do Probiotics have in IBS?

A

Improvement in symptoms - including pain and bloating

34
Q

What is Lubiprostone?

A

A selective C-2 chloride channel activator that stimulates water secretion into the lumen

35
Q

What is Prucalopride?

A

Selective Serotonin 5-HT4 Receptor Agonist

Stimulates Peristalsis

36
Q

What is a Fistula?

A

Abnormal Tract between two epithelial or endothelial lined surfaces

37
Q

What autoimmune conditions can affect the large bowel?

A

Microscopic Colitis

either Collagenous colitis or lymphocytic colitis

38
Q

Which areas of the bowel does Ulcerative Colitis affect?

A

Colon & Rectum
Crypt Abscesses
Commonest cause of bloody diarrhoea

39
Q

Which areas of the bowel does Crohn’s Disease affect?

A

Mouth to Anus

Full thickness of wall involved, “cobblestone appearance”

40
Q

What viruses can affect the colon?

A

CMV

41
Q

What protozoal infections can affect the colon?

A

Amoebiasis (entamoeba histolytica)

42
Q

What is Hirschsprung’s Disease?

A

Congenital aganglionic megacolon
No ganglion cells in submucosal & myenteric plexuses
Enlarged dilated proximal large bowel because of obstruction

43
Q

What effects on the bowel will Thyroid Disease have?

A

Hyperthyroidism - ↓Gut motility + Diarrhoea

Hypothyroidism - Constipation

44
Q

What is FAP?

A

Most commonly mutation in APC
Autosomal Dominant
Multiple Adenomas
Develop Adenocarcinoma of colon

45
Q

What are the imaging modalities for Colorectal Cancers?

A 
Ultrasound
Barium Enema
CT
CT Colonography
MRI
46
Q

What are the advantages of CT Colonography?

A

Quicker and less technically demanding than either colonoscopy pr barium enema

47
Q

What is good and bad about Endo-Rectal USS?

A

Great for T1-T4
Large Bulky Tumours = not so good
Painful Tumours = not so good

48
Q

What are the possible PRIMARY CAUSES of Constipation?

A

Never Learnt
Dysmotility
Mechanical (e.g. ODS)

49
Q

What are the possible SECONDARY CAUSES of Constipation?

A

Obstruction
Drugs
Metabolic

50
Q

What are the possible Surgical Options for dysmotility?

A

Colectomy & IRA (ileo-rectal anastomoses)
SNS
ACE (Anterograde colonic enema)

51
Q

What are the operations that can help with rectal prolapse?

A

Open rectopexy - mesh put in front

Perineal procedure - stitched up

Year 2 - Medicine (25 decks)

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