Assessment Questions

Test and refresh your knowledge with these assessment questions:

1.Briefly explain the categories of primary constipation.

Answer:

·    Normal transit constipation: also known as functional constipation and involves a normal frequency of passing stools but evacuation is difficult. It is linked to sedentary lifestyle, low residue diet (limited intake of high fibre foods) or low fluid intake.

·    Slow transit constipation: involves infrequent bowel movements, straining to pass stools and mild abdominal distension caused by impaired colonic activity.

·    Pelvic floor/outlet dysfunction: dysfunction of the pelvic floor muscles or anal sphincter leads to difficulty or inability to defecate.

2.Explain the difference between osmotic and secretory diarrhoea.

Answer:

·    Osmotic diarrhoea: nonabsorbable substances are hyperosmotic and excess water is pulled into the bowel and increases the volume and weight of stools. It can be due to lactose intolerance, excessive use of antacids or decreased transit time.

·    Secretory diarrhoea: occurs due to increased mucosal secretions of fluid and electrolytes. It can be caused by infectious agents, e.g. viruses, bacteria, excess bile agents or overgrowth of small bowel microbiome and leads to large volume diarrhoea. Small volume diarrhoea is commonly caused by acute or chronic inflammation of the colon.

3.Identify the hormones that are associated with the development of obesity.

Answer: Insulin, ghrelin, leptin, adiponectin, glucagon-like peptide-1 and peptide YY

4.Identify the various classifications of intestinal obstruction.

Answer:

·    Mechanical – blockage of the intestinal limen by intrinsic lesions, i.e. occurring within the lumen, e.g. foreign body, or by extrinsic lesions, i.e. originate outside the lumen, e.g. hernia, tumour.

·    Functional – paralysis of musculature usually caused by trauma, infection (peritonitis) or electrolyte imbalances

·    Acute – sudden onset due to twisting or herniation

·    Chronic – slow, protracted onset due to tumour growth or formation of strictures

·    Partial - incomplete obstruction of lumen

·    Complete – complete obstruction of lumen

·    Simple – obstruction of lumen does not lead to impairment of blood supply

·    Strangulated – obstruction of lumen causes decreased blood supply

·    Closed loop – obstruction occurs at the end of each segment of intestine

5.What signs and symptoms would you expect if someone presented with appendicitis?

Answer:

·    Initially the person may complain of abdominal or periumbilical pain that occurs due to inflammation and stretching of the appendix. Pain increases in intensity and becomes localised in lower right quadrant (extension of inflammation to surrounding tissues).

·    Anorexia, nausea and vomiting accompany the pain,

·    Low-grade pyrexia, leucocytosis.

·    In children, diarrhoea is commonly experienced.

6.What type of pathogens cause infectious enterocolitis? Provide examples.

Answer:

·    Viruses, e.g. rotavirus

·    Bacteria, e.g. Staphylococcus aureus, Escherichia coli (E. coli), non-typhoid salmonella, Campylobacter, Clostridium difficile (C. diff) and E. coli O157:H7

7.Identify the predisposing factor for inflammatory bowel disease.

Answer:

·    Causes of Crohn’s and  UC are largely uncertain.

·    Genetic factors – predispose to an immune response, greater risk when there is an affected family member (more common in Crohn’s). Both have been linked to specific major histocompatibilty class II (HLA alleles), high levels of various antibodies, interlukin and T-lymphocytes that are toxic to the mucosa.

·    Immunological factors – cellular events involved in pathogenesis of Crohn’s and UC involve activation of macrophages, lymphocytes, polymorphonuclear cells with the release of inflammatory mediators.

·    Microvasculature – vascular injury and focal arteritis early pathological events leading to micro-infarction

·    Environmental factors

·    Stress

·    Smoking

·    Dietary factors

8.Differentiate between Crohn disease and ulcerative colitis.

Answer:

Crohn’s

·    Recurrent granulomatous type of inflammatory response that can affect any part of the GI tract, slowly progressive, often disabling disease.

·    All layers of bowel involved (transmural) but sub-mucosal layer greatest affected.

·    Sharply demarcated granulomatous lesions surrounded by normal-appearing mucosal tissue – skip lesions (skip lesions as they are interspersed amongst normal areas of bowel).

UC

·    A nonspecific inflammatory condition of the colon, usually begins in rectum and spreads proximally affecting primarily the mucosal layer (may extend into submucosal layer); Confined to rectum and colon.

·    Lesions form in the crypts of Lieberkühn (crypts of Lieberkühn – base of mucosal layer [mucus-secreting goblet cells]).

·    Inflammatory process leads to formation of pinpoint haemorrhages – these suppurate and become crypt abscesses that become necrotic and ulcerate.

·    Bowel wall thickens in response to repeated ulcerations.

9.What are the three different types of gallstones?

Answer:

·    Cholesterol

·    Pigment

·    Mixed

10.Identify the risk factors associated with development of pancreatitis.

Answer:

·    Peptic ulcer disease

·    Cholelithiasis

·    Genetic factors, e.g. hereditary pancreatitis, cystic fibrosis

·    Obesity

·    Excessive alcohol intake

·    Smoking

·    Hyperlipidaemia

·    Hypercalcaemia

·    Smoking