Lower GI

Question 1

What is acute appendicitis ?

Answer 1

sudden onset inflammation of the appendix

Question 2

What can cause appendicitis?

Answer 2

• obstruction of appendiceal lumen by a fecalith (poo), calculus, tumour or worms
• this causes an increased intraluminal pressure and bacteria invasion

Question 3

What is the difference between visceral and parietal pain?

Answer 3

visceral - referred pain, pain in a different location

parietal - pain more localised

Question 4

What are the symptoms of appendicitis?

Answer 4

• pain centrally and then moves down to the right iliac fossa

Question 5

What is peritonitis?

Answer 5

when appendix is inflamed it comes into contact with the abdominal wall causing localised peritonitis (inflammation of the peritoneum)
- all the cavity can become inflamed in other conditions

Question 6

What is the treatment of appendicitis ?

Answer 6

• removing by surgery

- sometime antibiotics

Question 7

What is anti-biotic associated colitis/ pseudomembraneous colitis?

Answer 7

• Acute inflammation of the colon

- characterised by the formation of adherent inflammatory pseudomembranes overlying the site of mucosal injury

Question 8

What are the causes of antibiotic associated colitis/ pseudomembraneous colitis?

Answer 8

• c.diff that has over grown after competing bowel organisms were eliminated by broad spectrum antibiotics

Question 9

What are the symptoms of antibiotic associated colitis/ pseudomembraneous colitis?

Answer 9

• fever

- lower abdominal tenderness

Question 10

What are the treatments for antibiotic associated colitis/ pseudomembraneous colitis?

Answer 10

• consult microbiologist
• stop current antibiotics
• possibly introduce new antibiotics (specific)
• hydrate patient
• move to side room

Question 11

What is inflammatory bowel disease?

Answer 11

• chronic inflammation conditions of unknown reason affecting the GI tract
• two main forms:
• crohns disease
• ulcerative colitis

Question 12

What is Crohns disease?

Answer 12

• It affects from mouth to anus
• especially effects ileum and colon
• it is not continuous along tract, more patches that it affects
• transmural inflammation (affects whole thickness of the wall)

Question 13

What are the complications of crohns disease?

Answer 13

• can have fistula formation

- can fuse bowel to other places ( can get fecal matter passing to other places)

Question 14

What symptoms may a patient present with in Crohns disease? (includes some complications)

Answer 14

• anaemia
• malabsorption: fat, vitamins A D E K, bile salts
• fistulas
• extra-intestinal: skin, eyes, joints
• increased risk of bowel carcinoma
• bowel obstruction and perforation

Question 15

What is ulcerative colitis?

Answer 15

• affects colon only
  -Starts in rectum spreads proximally
• Continuous disease
  (No skip lesions)
• Mucosal disease
  (No transmural involvement)
• May involve whole colon
  also appendix

Question 16

What are the complications of ulcerative colitis?

Answer 16

• Anaemia: iron deficiency from blood loss
• Electrolyte loss from diarrhoea
• Extra-intestinal disease: skin, eyes, joints, bile ducts (PSC)
• Increased risk of carcinoma: related to duration and severity of disease
• Need for surveillance for dysplasia

Question 17

What contributes to cancer in the GI tract?

Answer 17

- genetics
FAP, lynch syndrome  
- chronic inflammation 
UC, Crohns 
- dietary factors

Question 18

What are the symptoms of bowel cancer? these normally only appear when cancer has developed?

Answer 18

• depends on the site of the lesion
• PR bleed
• altered bowel habit
• iron deficiency anaemia
• weight loss
• disease can be advanced at the time of the presentation

Question 19

How do we screen for bowel cancer?

Answer 19

• in 60-75 year olds
• faecal occult blood test
• if positive refer for colonoscopy
• look for polyps
• see if adenomas or carcinomas
• refer for definitive treatment

Question 20

What is the TNM staging process?

Answer 20

T - primary TUMOUR size
N - how many lymph NODES affected
M - any distant metastasis