GIT 2

Question 1

what are Haemorrhoids/Piles? what are the two types, aetiology and where would you feel the pain?

Answer 1

swellings in and around the anus

types:
internal piles - arise from rectal mucosa - generally pain-free - above the dentate line
external piles - painful due to somatic sensation, itchy and painful - below the dentate line

aetiology
- increased abdominal pressure - pregnant woman and a diet without fibre - constipation, always straining

the rectum has no somatic sensation, the anal skin does, so you would feel the pain here

Question 2

what are anal cushions?

Answer 2

specialised submucosal tissue lining the anal canal

• with lots of blood vessels
• contributes to continence - control movements of the bowel

Question 3

what is the internal anal sphincter?

Answer 3

muscle wrapped around the anal canal

two parts:
internal - involuntary
external - voluntary muscle

Question 4

symptoms and management of haemorrhoids

Answer 4

• bleeding
• discharge
• itchy ass
• pain
• ulceration
• difficulty with continence

management:
- gel to soothe with itch
- good hygiene
- high fibre diet
- lots of fluid intake
- if extreme - surgery - if its internal and prolapsed, rubber band it, necrotises, drops off

Question 5

how can you tell where the blood has originated from if there is blood in bowel motions?

Answer 5

stomach/upper GI
- melena, black stools

colon
- mixed in with stool

sigmoid/rectum
- coating the stool

rectum/anus
- blood on toilet paper/ in the toilet water

Question 6

what’s the difference between visceral and somatic sensations

Answer 6

visceral - the nerves supply organs are excited
- can’t tell exactly where sensations originate, very poorly localised

somatic - the nerves supplying other areas of the body are excited

Question 7

what can trigger visceral sensation to the gut?

Answer 7

• inflammation
• infections
• obstructions

Question 8

what sensation does the parietal peritoneum have?

Answer 8

somatic sensation
- but you can’t tell which organ is the source of innervation triggering the pain

Question 9

what questions would you ask to a px with abdominal pain?

Answer 9

• where is it
• when it is
• any associated nausea/voming
• last shit?
• last pee?
• last period?

Question 10

what is appendicitis?
- the symptoms
- the treatment
- how may it lead to Peritonitis?

Answer 10

an inflammation of the appendix at the beginning of the colon, 5-10cm

symptoms
- poorly localised pain
- constipation or diarrhoea
- malaise
- anorexia

tx:
- surgery to remove the necrotic appendix

• inflammation may compromise blood flow from the appendicular artery (an end artery)
  = leads to necrosis
  = leads to bowel contents being leaked
  = peritonitis

Question 11

what are end arteries?

Answer 11

arteries which are the sole blood supply to a portion of tissue

Question 12

how can gastrointestinal infections arise?

Answer 12

viral
bacterial
parasitic

Question 13

describe viral gastroenteritis?
- aetiology
- symptoms
- tx

Answer 13

the winter noravirus bug

spreads via faecal-oral route, so because ur not washing ur hands properly

symptoms:
- fever, malaise, voming, nausea, diarrhoae

tx:
- rehydration, rest up in bed, take time off work

Question 14

describe bacterial gastroenteritis
- aetiology, 3 types of bacteria
- symptoms
- tx
- high risk groups

Answer 14

• raw, uncooked food, dairy, poorly stored food, unwashed salad
• salmonella
• campylobacter
• e.coli

symptoms:
- nausea, vomming, diarrhoea, abode pain, fever

tx:
- stool sample
- antibiotics
- fluid and electrolyte balance

high risk groups:
- pregnant, infant, elderly, immunocompromised

Question 15

why is there a risk of giving px’s a bacterial superinfection when prescribing antibiotics? specifically it was clostridium difficile a few years ago …

Answer 15

• antibiotics can kill off other microbiota
• gave rise to c.diff to propagate

Question 16

describe GIT parasites
- epidemiology
- symptoms
- tx

Answer 16

• common in children and can cause failure to thrive
• worms in poo
• itchy anus
• diarrhoea, vomiting, abdo pain

tx:
- praziquantel

Question 17

describe colorectal cancer
- epidemiology
- risk factors
- symptoms
- tx

Answer 17

• 1 in 1000, usually >50 years
• if there is fam history or history of colorectal polyps, diet, smoking, alcohol
• px usually asymptomatic until its too late as can feel the obstruction
• abdo pain, diarrhoea, constipation, anaemia, weight loss, change in bowel habits

tx:
- surgery, radiotherapy, chemotherapy

Question 18

how is cancer staged with the TNM system?

Answer 18

1. tumour thickness
2. what nodes are involved
3. has there been any distant metastases

Question 19

how can you screen people for colorectal cancer?

Answer 19

• faecal occult blood test - detects blood in poo - wasn’t specific e.g. if u had steak yesterday
• faecal immunochemical test - detects human blood in poo
• colonoscopy of bowel polyps and biopsy

Question 20

what can a dentist do to reduce risk of colorectal cancer?

Answer 20

• smoking cessation and alcohol reduction
• ask about diet
• encourage px to screen
• ask about symptoms
• refer to GP