Lower GI Physiology and Endoanal Ultrasound (SPS320)

10 credits

Aim of this module

This module will provide trainees with a higher specialised body of knowledge that underpins the specialist rotation of Lower GI Physiology. This rotation will enable trainees to perform a range of clinical diagnostic investigations undertaken to investigate disorders of the lower gastrointestinal system, interact with patients and demonstrate safe, patient-centred practice. Trainees will be expected to undertake a range of routine investigations, build practical skills in setting up and maintaining the equipment used, produce reports, interpret results, explain procedures to patients and gain consent, while developing and building their professional practice.

  1. Continue to perform and produce reports on non-invasive breath tests (hydrogen, methane – if there is a methane analyser available – and urea breath testing).
  2. Perform rectal digital examination to ensure safe rectal intubation with manometric and ultrasound equipment.
  3. Perform anorectal manometry procedures in patients presenting with a range of conditions, for example obstetric trauma, pre- and post-surgical defaecatory problems, slow transit constipation, obstructive defaecation, neurological disorders.
  4. Perform endoanal ultrasound investigations in patients presenting with a range of conditions, including obstetric and surgical trauma, sepsis, fissures, faecal incontinence and obstructive defaecation.
  5. Interpret the data and produce clinical reports with respect to non-invasive breath testing, anorectal manometry, balloon distension, compliance, capacity and sensory awareness; endoanal ultrasound being able to differentiate between artefact and physiological occurrence.
  6. Carry out routine maintenance and calibration procedures on equipment used in anorectal manometry and endoanal ultrasound.
Number Work-based learning outcome Title Knowledge
1 1,2,3,4

Control infection risks in accordance with departmental protocols.

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2 1,2,3,4

Minimise risks and hazards in compliance with health and safety policies.

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3 1,3,4

Select suitable technology for each type of investigation, choosing and adapting the appropriate diagnostic technique, patient position, machine settings and transducer for each patient.

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4 1,3,4

Set up equipment ready for use for each type of investigation.

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5 3

Ensure that all anorectal manometry complies with all current safety standards, confirmed by trust BME commissioning number, and that the equipment has been regularly safety-tested and regularly maintained in accordance with the manufacturer’s  recommendations.

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6 1,2,3,4

Obtain a suitably completed request form, greet the patient, check patient identity and ensure that the patient’s identity is confirmed as correct and fully identified on each type of recording system.

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7 1,2,3,4

Explain the procedure for each type of investigation to the patient and address any questions they may have relating to the procedure, including the process after the procedure and how the patient will be informed of the results.

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8 1,2,3,4

Gain informed consent for each type of investigation.

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9 1,2,3,4

Obtain a clinical history as appropriate for each type of investigation, allowing the patient time to describe symptoms and document full relevant history.

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10 1,2,3,4

Treat patients in a way that respects their dignity, rights, privacy and confidentiality.

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11 1,2,3,4

Take appropriate action to respond to the specific needs of as defined by department protocol.

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12 1,2,3,4

Undertake each investigation.

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13 3

Perform further tests, e.g. RAIR, rectal compliance to evaluate the patient’s defaecatory disorder or faecal incontinence as appropriate.

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14 1,3,4

Review the results from each type of investigation, taking into account artefacts, necessary adjustments of values and planned/unplanned events occurring during the test.

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15 1,3,4,5

Compare the values/traces obtained with the normal range/values related to each type of investigation procedure.

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16 1,3,4,5

Produce a clear written report of each type of investigation.

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17 6

Carry out routine maintenance and calibration procedures on the equipment used for each type of investigation.

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18 6

Accurately complete equipment maintenance records and ensure that calibration records and fault reports are accurate, legible and complete for the equipment used for each type of investigation.

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You must complete
3 Case-based discussion(s)
2 of the following DOPS / OCEs
Assessment Title Type
Conduct an infection control assessment appropriate to a piece of equipment DOPS
Accurately input patient demographics. DOPS
Safely intubate the anorectum and confirm catheter correctly positioned within the anal canal to obtain accurate rectal and anal canal pressures. DOPS
Obtain baseline measurements and during standard manoeuvres according to local and national standards. DOPS
Perform sensory awareness tests using balloon distension according to local and national guidance. DOPS
Safely extubates the patient. DOPS
Describe the test results to the patient to aid pelvic floor retraining. DOPS
Set up of the transducer probe including sheath and Selection and use of appropriate transducer characteristics. DOPS
Safe intubation and extubation of anorectum DOPS
Obtain clearly labelled images to support the patient report. DOPS
Appropriate disposal of consumables and cleaning and disinfection of equipment. DOPS
Accurate use of equipment and software. DOPS
Explain procedure and the risks and benefits with respect to the patients comorbidities and medication to the investigation to obtain written and informed consent. OCE
Safely perform a digital rectal examination OCE
Interpret the data acquired and produce a detailed technical report from a range of patient conditions OCE
Use safe working methods to reduce cross infection. OCE
Accurate Input of patient demographics. OCE
Produce accurate patient report OCE
Manage a patient during the endoanal ultrasound OCE
Take accurate and appropriate clinical history and take informed consent for a procedure OCE

Important information

The academic parts of this module will be detailed and communicated to you by your university. Please contact them if you have questions regarding this module and its assessments. The module titles in your MSc may not be exactly identical to the work-based modules shown in the e-portfolio. Your modules will be aligned, however, to ensure that your academic and work-based learning are complimentary.

Learning Outcomes

  1. Describe lower gastrointestinal (GI) anatomy, physiology and neurophysiology, and apply knowledge to the pathophysiology, investigation and treatment of lower GI disorders.
  2. Describe the pathophysiology of lower GI disorders.
  3. Explain the principles of sacral nerve and posterior tibial nerve neuromodulation in the treatment of faecal and urinary incontinence.
  4. Explain the principles of ultrasound and its use in lower GI investigations and critically evaluate the accuracy, precision and sources of errors.
  5. Discuss and critically evaluate a range of technologies, instrumentation and techniques used to investigate the lower GI tract, including endoanal ultrasound and anorectal manometry.
  6. Explain the indications, modes and choice of technology to investigate lower GI disease, including small bowel motility disorders.
  7. Discuss the techniques used to assess GI motility.
  8. Explain the principles and procedure for performing a digital rectal examination and the role of the technique in the assessment of GI disorders.
  9. Describe intubation and extubation techniques and apply knowledge to discuss and justify the clinical concepts of safe intubation of the lower GI tract, including infection control and asepsis.
  10. Discuss and justify the investigation of benign lower GI disease in a broad patient range, e.g. paediatric, adult, elderly.

Indicative Content

Anatomy and physiology

  • Structure and function of the lower GI tract, including large and small bowel, anal sphincter complex

Neurophysiology

  • Parasympathetic and sympathetic nerves
  • Intrinsic nerve plexuses
  • Neuromodulation and concept of neurotransmitters
  • Hormones in relation to lower GI tract

Pathophysiology of lower GI disorders

  • Inflammatory bowel disease
  • Irritable bowel syndrome
  • Eosinophilic oesophagitis
  • Small bowel pathology
  • Obstructive defaecation
  • Faecal incontinence
  • Slow transit constipation
  • Haemorrhoids
  • Congenital and acquired anatomical defects
  • Sepsis
  • Obstetric trauma 

Pharmacology

  • The effect of lidocaine
  • Bulking, osmotic and stimulant laxatives
  • Loperamide
  • Opiods, opioid-receptor agonist
  • Diltiazem
  • Nitrates
  • Botox
  • Colonic irrigation

Device design and technology

  • Types of manometric systems
  • Modes and principles of ultrasound and its application in lower GI investigation
  • Sacral nerve and posterior tibial nerve stimulation