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Medicine Notes Gastrointestinal (GI) System Notes

Disorders Of Colonic And Anorectal Function Notes

Updated Disorders Of Colonic And Anorectal Function Notes

Gastrointestinal (GI) System Notes

Gastrointestinal (GI) System

Approximately 57 pages

These notes helped me achieve a mark of 73% in my GI exam, which is the equivalent of a 1st. The notes are based on a series of lectures on the subject. They are very clearly laid out and easy to follow. They cut out unnecessary information on the topic, making the notes very concise, and fast to get through. Anyone studying medicine, or any other subject requiring knowledge of the GI tract (e.g. physiology or anatomy), would benefit greatly from these notes. There are lecture in the series on th...

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The following is a more accessible plain text extract of the PDF sample above, taken from our Gastrointestinal (GI) System Notes. Due to the challenges of extracting text from PDFs, it will have odd formatting:

Lecture 20

Disorder of colonic and anorectal function

  • Colonic function

    • Absorbs water- 1L into caecum- 100ml in stool

    • Storage

    • Mass peristalsis

    • Nutritional role

  • Anorectal function and anatomy

    • Rectal reservoir

    • Internal anal sphincter/External anal sphincter

    • Puborectalis

    • Pudendal nerve

  • Constipation

    • General

      • Range of BM 3/day- 1/3 days

      • Variable- history important

      • Infrequent BM

      • Straining Passage of hard stool

    • Signs

      • Examination may be unhelpful

      • General signs- Myxoedema

      • Loaded colon on abdo palpation

      • PR presence of large amount of stool

    • Investigation

      • Rules out organic disease (e.g. obstruction); metabolic disorders

      • Colonic transit

      • Anorectal physiology

      • Proctography

    • Slow transit constipation

      • Exceedingly rare

      • May be associated with visceral myopathy/neuropathy

      • If visceral myopathy=small bowel transit problems

  • Evacuatory disorders

    • Epi

      • Predominately females

      • Parous (given birth) middle aged

      • Young nulliparous

    • Types

      • Outlet obstruction

        • Prolonged straining at stool

        • Spending hours on toilet

      • Normal/slow transit constipation

      • Pelvic floor dysfunction

      • Obstructed defecation

      • Paradoxical pelvic floor contraction

      • Anismus

        • Normal response to decrease activity in EAS and puborectalis

        • Anismus- increased recruitment of striated muscle in pelvic floor

      • Dysfunctional defecation

    • Investigations

      • Anorectal physiology

        • Manometry; EMG; Paradoxical contraction; Muscle recruitment; RAIR

      • Colonic transit

      • Defecating proctography

      • MRI proctography

      • Scintigraphic proctography

      • Balloon expulsion

    • Management of evacuatory disorders

      • Conservative

      • Dietary advice

      • Laxatives if appropriate

      • Establish routine

      • Suppositories/enema

      • Squatting posture

      • Biofeedback

        • Attempts to train pelvic floor relaxation

        • Can use EMG or manometric feedback devices

        • Used in conjunction with dietary advice and bowel retaining

      • Surgical treatment

        • Rarely indicated

        • Subtotal colectomy and ileorectal anastamosis

        • Puborectalis...

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