year 4 CMS > GIT 2 > Flashcards

GIT 2 Flashcards

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1
Q

What are haemorrhoids also known as?

A

piles

Haemorrhoids affect around 4% of adults.

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2
Q

What condition may tenesmus be linked to?

A
  • Colorectal cancer
  • Inflammatory bowel disease

Tenesmus is a feeling of incomplete defecation.

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3
Q

What are some factors that can increase the likelihood of developing haemorrhoids?

A
  • Increases in intraabdominal pressure
  • Pregnancy
  • Straining
  • Diets low in fibre

These factors can lead to constipation, which is a risk for haemorrhoids.

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4
Q

How does the visceral nerve supply sense changes compared to somatic sensation?

A

Not in the same way

This difference is more apparent near the junction of the rectum and the anus.

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5
Q

What sensation is associated with the rectum?

A

No somatic sensation

Inflammation in the rectum leads to discomfort and tenesmus, but not actual pain.

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6
Q

What sensation is associated with the anal skin?

A

Somatic sensation

This allows for the perception of pain in the anal region.

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7
Q

What is the pectinate line (or dentate line)?

A

A line that divides the upper two-thirds and lower third of the anal canal

It marks the transition between visceral and somatic innervation.

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8
Q
A
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9
Q

What are internal haemorrhoids characterized by?

A
  • Above the dentate line
  • Generally pain-free
  • Reduced feeling of tenesmus
  • Can cause a bit of discomfort

Internal haemorrhoids are located higher in the anal canal and are less likely to cause pain compared to external haemorrhoids.

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10
Q

What are external haemorrhoids known as?

A

External piles

External haemorrhoids are located below the dentate line and are more likely to cause pain due to somatic sensation.

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11
Q

What do piles arise from?

A

The anal cushion

The anal cushion helps identify the state of stools (solid, liquid, or gas) during defecation.

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12
Q

What is the role of anal cushions?

A
  • Provide good sensation
  • Help identify gas vs. solid/liquid stools
  • Contribute to anal continence

Anal cushions are soft, flexible, and adaptable structures that play a significant role in maintaining continence.

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13
Q

What are anal cushions made up of?

A

Lots of blood vessels

These blood vessels contribute to the ability to keep solids and liquids in and release gas.

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14
Q

What are sinusoids in the context of anal cushions?

A
  • Small irregularly shaped blood vessels
  • Have a fairly good blood supply
  • Can swell up like varicose veins

Sinusoids are larger in the anal cushions and contribute to the formation of haemorrhoids.

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15
Q

True or false: Haemorrhoids are considered varicose veins in the anus.

A

TRUE

Haemorrhoids can be classified as either external or internal, both stemming from the anal cushions.

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16
Q

What is the involuntary anal sphincter?

A

Involuntary muscle with a resting tone

Controlled by the autonomic nervous system.

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17
Q

What type of muscle is the voluntary anal sphincter?

A

Striated voluntary muscle

It is controlled by the visceral nerve supply and somatic nerve supply.

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18
Q

True or false: The voluntary anal sphincter requires concentration to keep it tight.

A

FALSE

You do it voluntarily, not requiring thought.

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19
Q

How is the involuntary anal sphincter controlled?

A

By the autonomic nervous system

It maintains a resting tone.

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20
Q

How is the voluntary anal sphincter controlled?

A

By the visceral nerve supply and somatic nerve supply

It does not require conscious thought to maintain tension.

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21
Q

What are the two types of haemorrhoids?

A
  • Internal haemorrhoids
  • External haemorrhoids

Internal haemorrhoids arise from above the dentate line and are usually painless, while external haemorrhoids tend to be painful and can itch.

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22
Q

What are the common symptoms of external haemorrhoids?

A
  • Pain
  • Itching
  • Superficial infection
  • Bleeding
  • Unwanted discharge

External haemorrhoids can present with various symptoms, including pain and bleeding.

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23
Q

List the problems that can occur with haemorrhoids.

A
  • Bleeding
  • Discharge
  • Pain
  • Itching
  • Ulceration
  • Difficulty with continence

These problems can significantly affect the quality of life for individuals with haemorrhoids.

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24
Q

What is a common treatment for symptomatic haemorrhoids?

A

Haemorrhoid cream

This cream acts as a local anaesthetic and anti-inflammatory, relieving symptoms such as itching.

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25
What dietary changes can help manage **haemorrhoids**?
* High fibre diet * Increased fluid intake * Keeping stools soft ## Footnote These changes can help alleviate symptoms and prevent worsening of haemorrhoids.
26
True or false: Surgery is never required for **haemorrhoids**.
FALSE ## Footnote Surgery may be required for severe cases, such as internal piles that prolapse.
27
What is one surgical method for treating **internal piles**?
Rubber band ligation ## Footnote This method constricts the blood supply to the piles, causing them to become necrotic and drop off.
28
What is another treatment option for haemorrhoids besides surgery?
Cryotherapy ## Footnote Cryotherapy is an alternative treatment that can be used for haemorrhoids.
29
What does the **type of blood** in bowel motions indicate?
The location of the blood source ## Footnote Different colors and characteristics of blood can help identify whether it is from the stomach, colon, or rectum.
30
Blood from the **stomach/upper gastrointestinal tract** appears how?
* Digested, partially digested: black in color * Melena stools: thick, sticky, tar-black ## Footnote The black color is due to the iron from blood.
31
What is the role of the **colon** in digestion?
* Continue mixing to extract nutrients * Extract water * Push stools through via peristaltic motions ## Footnote Stools may change slightly but won't appear black.
32
How does blood appear when it originates from the **sigmoid/rectum**?
Blood will coat the stool on the surface ## Footnote This indicates bleeding from the lower part of the gastrointestinal tract.
33
What does blood from the **rectum/anus** look like?
* Blood on toilet paper * Blood in toilet water * Fresh blood rather than coating the bowel ## Footnote This suggests a more immediate source of bleeding.
34
What is **visceral sensation** a result of?
The sensation of nerves that supply organs ## Footnote Examples include angina and stomach ache due to gastroenteritis.
35
Name two examples of **visceral sensations**.
* Angina * Stomach ache due to gastroenteritis ## Footnote Visceral sensations are not felt the same way as somatic sensations.
36
True or false: **Visceral sensations** are designed to locate pain exactly.
FALSE ## Footnote Visceral sensations do not work the same way as somatic sensations.
37
Which organs are located inside the **abdominal cavity**?
* Liver * Pancreas * Kidneys * Spleen ## Footnote These organs have visceral sensation.
38
What type of sensation do the organs within the lining of the **peritoneal cavity** have?
Somatic sensation ## Footnote Somatic sensation allows for better localization of pain.
39
What are **dermatomes** and which segments supply the parietal peritoneum?
Dermatomes are areas of skin supplied by specific spinal nerves. * T6 to L3 supply the parietal peritoneum ## Footnote This allows for better localization of pain in the abdominal area.
40
What are the **triggers** for visceral innervation to the gut?
* Inflammation * Infection * Obstruction ## Footnote Obstruction leads to colicky-type pain when peristaltic waves reach the obstruction, causing visceral sensation in the gut.
41
What type of pain is associated with **inflammation** of the gastrointestinal tract?
Poorly localised abdominal pain and malaise ## Footnote Visceral pain does not localize like somatic pain, making it difficult to identify the specific organ causing the pain.
42
How can the abdomen be divided for processing **visceral pain**?
* Lower left: descending colon, sigmoid colon, left ovary, fallopian tube, left ureter * Upper left: stomach, spleen, left lobe of liver, body of pancreas, left kidney, adrenal gland, splenic flexure of colon, parts of transverse and descending colon * Upper right: liver, gall bladder, duodenum, head of pancreas, right kidney, adrenal gland, hepatic flexure of colon * Lower right: cecum, appendix, ascending colon, right ovary, fallopian tube, right ureter ## Footnote This division helps in identifying potential sources of abdominal pain.
43
What structures are located in the **lower left quadrant** of the abdomen?
* Descending colon * Sigmoid colon * Left ovary * Fallopian tube * Left ureter ## Footnote This quadrant contains parts of the digestive and reproductive systems.
44
List the structures found in the **upper left quadrant** of the abdomen.
* Stomach * Spleen * Left lobe of liver * Body of pancreas * Left kidney * Adrenal gland * Splenic flexure of colon * Parts of transverse and descending colon ## Footnote This quadrant includes major organs involved in digestion and filtration.
45
What organs are located in the **upper right quadrant** of the abdomen?
* Liver * Gall bladder with biliary tree * Duodenum * Head of pancreas * Right kidney * Adrenal gland * Hepatic flexure of colon ## Footnote This quadrant is crucial for digestion and metabolism.
46
Identify the structures in the **lower right quadrant** of the abdomen.
* Cecum * Appendix * Ascending colon * Right ovary * Fallopian tube * Right ureter ## Footnote This quadrant contains parts of the digestive and reproductive systems.
47
What are the **key questions** to ask for abdominal pain?
* Where is it * When is it * Any nausea and vomiting? * When did you last move your bowels? * When did you last pee? * When was your last menstrual period? ## Footnote These questions help in diagnosing the cause of abdominal pain.
48
If abdominal pain occurs **after a meal**, what conditions might it indicate?
* GORD tends to be more chest pain * Peptic ulcer disease can be epigastric, can come after meals ## Footnote Understanding the timing of pain can help differentiate between conditions.
49
Right upper quadrant pain tends to indicate which conditions?
* Cholecystitis * Infected gall bladder ## Footnote Location of pain is crucial for diagnosis.
50
What symptoms might indicate an **obstructed bladder**?
* Suprapubic pain * Lower abdominal pain * Sensation that you really need to pee ## Footnote These symptoms can help identify urinary tract issues.
51
Where is the **appendix** located?
In the lower right quadrant, the right ileac fossa ## Footnote Right before the ileum joins the colon.
52
What is the approximate length of the **appendix**?
5-10 cm ## Footnote The appendix is thin, requiring blood supply from its base.
53
What happens if there is an obstruction to the **blood supply** of the appendix?
* Tissues lose blood supply * Tissues become necrotic and die ## Footnote This highlights the concept of end arteries.
54
What are **end arteries**?
Arteries that only supply one area ## Footnote Examples include certain arteries in the brain, which can lead to strokes if obstructed.
55
In which areas do we have very few **end arteries**?
In the mouth, face, and neck ## Footnote This allows for lots of co-lateral circulation.
56
What is the consequence of an obstructed **end artery**?
Everything distal to the obstruction will die off ## Footnote This can lead to necrosis in the affected area.
57
What is the state of **blood flow** and **venous drainage** in the appendix?
There is no collateral blood flow or venous drainage ## Footnote Inflammation can compromise blood flow, leading to necrosis.
58
What can necrosis of the appendix lead to?
Leakage of bowel contents, known as **peritonitis** ## Footnote The peritoneum extends from the diaphragm to the pelvis.
59
What are the **initial symptoms** of appendicitis?
* Poorly localised pain, may be central * Constipation/diarrhoea * Malaise, anorexia ## Footnote These symptoms indicate the early stages of appendicitis before pain localises.
60
As appendicitis progresses, pain localises to the **________**.
right lower quadrant ## Footnote This localisation occurs due to the end artery situation from above.
61
What causes inflammation in the **parietal peritoneum** during appendicitis?
Leakage of bugs into the peritoneum ## Footnote This leakage leads to somatic sensation and increased tenderness.
62
What happens to tenderness in appendicitis as **peritoneal inflammation** increases?
Increased tenderness ## Footnote Somatic peritoneal nociceptors become more sensitive.
63
If you press on the **right ileac fossa** in a patient with appendicitis, what will be the response?
Very tender ## Footnote This tenderness indicates peritoneal inflammation.
64
What is the **treatment** for appendicitis?
* Provision of antibiotics * Surgery to remove the necrotic appendix ## Footnote These treatments address the infection and remove the source of pain.
65
What are **gastrointestinal infections** considered in terms of patient care?
Relatively common and important in recognizing significant infection ## Footnote Gastrointestinal infections can indicate serious underlying health issues.
66
What is the most common virus associated with **viral gastroenteritis**?
Noravirus ## Footnote Commonly referred to as the *winter vomiting bug*, it is highly transmissible.
67
List the **symptoms** of viral gastroenteritis.
* Nausea/vomiting * Diarrhoea * Malaise * With or without fever * Normally self-limiting ## Footnote Symptoms can vary in severity and duration.
68
How is viral gastroenteritis primarily **transmitted**?
By the faecal-oral route ## Footnote This transmission is primarily due to poor handwashing techniques.
69
What is the primary **treatment** for viral gastroenteritis?
Rehydration ## Footnote The condition is usually self-limiting, meaning it resolves on its own.
70
What is the most common bacteria associated with **bacterial gastroenteritis**?
* Salmonella * Campylobacter * E.coli ## Footnote These bacteria often come from contaminated food sources.
71
List the sources of **contaminated food** that can cause bacterial gastroenteritis.
* Undercooked food * Unpasteurized dairy products * Poorly stored food * Unwashed salad ## Footnote Eating food that hasn’t been properly prepared can lead to gastroenteritis.
72
What are the **symptoms** of bacterial gastroenteritis?
* Nausea/vomiting * Severe diarrhoea (possibly with bleeding) * Abdominal pain * Fever ## Footnote Symptoms can be similar to viral gastroenteritis but may be more severe.
73
What is the general management for most people suffering from bacterial gastroenteritis?
* Dehydration management * Fluid replacement * Electrolyte balance ## Footnote Management is crucial, especially for vulnerable populations.
74
Which groups may require **more interventional support** when managing bacterial gastroenteritis?
* Pregnant individuals * Infants * Immunocompromised patients * Elderly ## Footnote These groups are at higher risk for complications.
75
True or false: The use of **antibiotics** can lead to a bacterial superinfection such as **Clostridium Difficile**.
TRUE ## Footnote Antibiotics can provide an opportunity for Clostridium Difficile to grow, leading to serious gastroenteritis.
76
What is the antibiotic most associated with **Clostridium Difficile** infections?
Clindamycin ## Footnote Other antibiotics can also lead to this risk, but Clindamycin is the most notable.
77
How is **Clostridium Difficile** diagnosed?
By taking a stool sample to culture and sensitivity test ## Footnote This helps determine the appropriate antibiotics for treatment.
78
What are common **parasitic infections** associated with poor conditions?
* Tapeworms * Flatworms ## Footnote Particularly problematic in developing countries due to poor water supply and food networks.
79
What is a significant risk factor for **parasitic infections**?
* Hand hygiene * Being around animal faeces ## Footnote These factors contribute to the spread of infections, especially in children.
80
What are common **symptoms** of parasitic infections?
* Diarrhoea * Vomiting * Abdominal pain ## Footnote These symptoms can indicate the presence of parasitic infections.
81
What is the **treatment** for parasitic infections?
Praziquantel ## Footnote This is a human dewormer used to treat various parasitic infections.
82
What is the incidence of **colorectal cancer** in the UK?
1 in 1000 ## Footnote For comparison, oral cancer has an incidence of 1 in 10,000.
83
What are the **risk factors** for colorectal cancer?
* Over 50 years old * Family history of colorectal cancer * History of colorectal polyps ## Footnote These factors significantly increase the likelihood of developing colorectal cancer.
84
What type of polyps in the colon suggest a high likelihood of developing **cancer**?
Adenomatous polyps ## Footnote Hyperproliferation can lead to these polyps, which may undergo severe dysplasia.
85
What dietary factors are thought to be **preventative** against colorectal cancer?
* Healthy foods * Legumes * Fish ## Footnote A healthy diet may reduce the risk of developing colorectal cancer.
86
True or false: **Smoking cessation** advice is linked only to gum disease.
FALSE ## Footnote Smoking cessation is also linked to colorectal cancer and various systemic issues affecting the gut.
87
What are some health issues associated with **alcohol consumption**?
* Liver disease * Heart disease * Stroke * Dementia ## Footnote Alcohol consumption can lead to multiple health problems, including an increased risk of colorectal cancer.
88
What is the approximate **survival rate** for colorectal cancer?
50% ## Footnote The survival rate is low as it often presents late and is usually asymptomatic until advanced stages.
89
What are some **symptoms** of late-stage colorectal cancer?
* Abdominal pain * Diarrhoea * Constipation * Anaemia ## Footnote These symptoms can indicate advanced colorectal cancer and highlight the importance of early detection.
90
What does the **staging** of colorectal cancer indicate?
The later the stage, the worse the prognosis ## Footnote Staging helps determine the severity and spread of cancer.
91
What is the **TNM system** used for in colorectal cancer?
* Tumour thickness * Node involvement * Distant metastases ## Footnote The TNM system classifies cancer based on these three criteria.
92
What is the purpose of **screening** for colorectal cancer?
Detect asymptomatic disease ## Footnote Screening aims to identify cancer early when treatment is more effective.
93
What does the **faecal occult test** detect?
Blood in the poo ## Footnote It is not specific for human blood and can be affected by diet.
94
What is the advantage of the **faecal immunochemical test** over the faecal occult test?
Detects human blood in poo ## Footnote This test is specific to human blood, making it more reliable.
95
What happens if a **faecal immunochemical test** is positive?
Referral for a colonoscopy ## Footnote Regular referrals occur for those with a family history of bowel polyps.
96
List the **red flags** for colorectal cancer.
* Change in bowel habit lasting 2-3 weeks * Abdominal pain * Iron-deficiency anaemia * Blood or mucous in the poo * Unintentional weight loss ## Footnote These symptoms warrant a referral to the GP for further investigation.
97
What can **dentists** do within their scope of practice regarding colorectal cancer?
* Provide smoking cessation * Alcohol reduction * Ask about diet * Encourage participation in screening programmes * Ask about symptoms * Refer to the GP ## Footnote Dentists can play a role in preventive health measures related to colorectal cancer.
98
What is the likely diagnosis for a 40 year old female with **colicky right upper quadrant pain** after eating fatty food and pale loose bowel motions?
Cholelithiasis ## Footnote Right upper quadrant pain and steatorrhoea indicate issues with the gall bladder.
99
What diagnosis fits a 54 year old male with **right upper quadrant pain**, jaundice, and systemic symptoms?
Cholecystitis ## Footnote Systemic symptoms and raised temperature suggest an infection.
100
A 67 year old with a history of alcohol abuse presents with **severe upper central abdominal pain** radiating to the back and raised serum amylase levels. What is the diagnosis?
Pancreatitis ## Footnote Typical presentation includes severe pain and elevated amylase.
101
What is the diagnosis for a 25 year old female with **bloody diarrhoea**, anaemia, and deep ulcers in the right colon?
Crohn's disease ## Footnote The presence of ulcers in the right colon without rectal involvement suggests Crohn's.
102
What are the symptoms of **Hepatitis**?
* Right upper abdominal pain * Palpable liver * Jaundice * Itchy skin * Fever * Weight loss * Malaise ## Footnote Risk factors include foreign travel, IV drug abuse, and sexual contacts.
103
Describe the symptoms of **Appendicitis**.
* Initially low-grade abdominal pain * Localisation to right iliac fossa * Tenderness on palpation * Fever * Malaise * Anorexia * Nausea/vomiting * Diarrhoea/constipation ## Footnote Pain typically starts centrally and then localises.
104
What are the symptoms of **Cystitis**?
* Urinary frequency * Dysuria * Central lower abdominal tenderness * May include fever and malaise ## Footnote Cystitis is a bladder infection.
105
What are the symptoms of a **Peptic Ulcer**?
* Upper central abdominal pain * Vomiting * Weight loss ## Footnote Risk factors include diet, smoking, alcohol, stress, and H. Pylori infection.
106
What distinguishes **Ulcerative Colitis** from Crohn's disease?
Involvement of the rectum ## Footnote Symptoms are similar, but rectal involvement is key for ulcerative colitis.
107
True or false: **Irritable bowel syndrome** would present with sustained bloody diarrhoea or anaemia.
FALSE ## Footnote Colonoscopy would be normal in cases of irritable bowel syndrome.
108
What are the arguments for **population screening for colorectal cancer** in terms of survival?
* Identifies asymptomatic disease * Early stage diagnosis improves survival * Better quality of life with less destructive treatment ## Footnote Early diagnosis is linked to better prognosis.
109
What are the arguments for **population screening for colorectal cancer** in terms of health service resources?
* Screening costs money * Earlier treatment is cheaper * Fewer post-treatment complications * Maintained quality of life leads to better societal contributions ## Footnote Screening requires many people to be screened to find one case of cancer.
110
What advice should be given to a staff member with **vomiting and diarrhoea** for the last 12 hours?
* Don’t come to work * Ask about recent food * Likely self-limiting * Rest and fluids * NSAIDs for pain, paracetamol for fever * Seek medical advice if not better in 48 hours ## Footnote Likely to be infectious (norovirus).
111
What is the technical term for the sensation of not completely emptying the bowel?
Tenesmus ## Footnote Questions to ask include any blood or mucus in bowel motions and history of bowel conditions.
112
Why are some **haemorrhoids** painless while others are painful?
* Internal haemorrhoids: visceral nerves (painless) * External haemorrhoids: somatic nerves (painful) ## Footnote Inflammation or ulceration in the anal region causes somatic pain.
113
What symptoms would indicate **piles**?
* Occasional fresh blood on toilet paper * Discharge or soiling * Possible tenesmus ## Footnote Symptoms should not be assumed to be piles without proper diagnosis.
year 4 CMS
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