Back Module: S-GI-S3

Lower Gastrointestinal Physiology 2

Module information

Module details

Title
Lower Gastrointestinal Physiology 2
Type
Specialist
Module code
S-GI-S3
Credits
10
Phase
3
Requirement
Compulsory

Aim of this module

This module will build on the skills and competencies gained during Lower Gastrointestinal Physiology 1. It will provide trainees with a deeper understanding of anorectal physiology investigations, enabling the learner to confidently manage more complex patients Trainees will be expected to undertake more complex anorectal physiology investigations (anorectal manometry, rectal sensation testing and balloon expulsion testing) and build practical skills in performing and interpreting endoanal ultrasound scans, demonstrating safe, patient-centered practice. Trainees will be introduced to pelvic floor neuromodulation, and providing pressure biofeedback therapy and pelvic floor re-education.

Work-based content

Training activities

# Learning outcome Training activity Type Action
# 1 Learning outcome 1,4 Training activities

Explain the procedure and obtain written informed consent from patients for endoanal ultrasound scanning

 Type ETA Action View
# 2 Learning outcome 2 Training activities

Safely perform endoanal ultrasound scans for patients with a variety of indications

 Type ETA Action View
# 3 Learning outcome 2 Training activities

Interpret and report a range of normal endoanal ultrasound scans for both male and female patients

 Type ETA Action View
# 4 Learning outcome 2 Training activities

Interpret and report a range of abnormal endoanal ultrasound scans for both male and female patients

 Type ETA Action View
# 5 Learning outcome 4 Training activities

Obtain a history for lower gastrointestinal physiology investigations, including patients with complex social and/or mental health issues

 Type ETA Action View
# 6 Learning outcome 3 Training activities

Safely perform and report anorectal physiology investigations for patients with the following presentations:

  • Faecal incontinence
  • Obstructive defaecation syndrome
  • Anal fissure
  • Obstetric injury
  • Anal fistula
  • Pre- and post-surgical
 Type ETA Action View
# 7 Learning outcome 5 Training activities

Present a complex patient at a pelvic floor multidisciplinary team and make recommendations for further treatments

 Type ETA Action View
# 8 Learning outcome 4,6 Training activities

Provide pressure biofeedback therapy and pelvic floor re-education to patients, adapting approach to the patient’s symptoms

 Type DTA Action View
# 9 Learning outcome 4,5 Training activities

Review a patient’s symptoms and history and make recommendations for bowel management techniques

 Type ETA Action View
# 10 Learning outcome 7 Training activities

Recognise the indications for pelvic floor neuromodulation and its uses

 Type DTA Action View

Assessments

Complete 2 Case-Based Discussions

Complete 2 DOPS or OCEs

Direct Observation of Practical Skills Titles

  • Perform an endoanal ultrasound scan according to local protocol.
  • Interpret and report an endoanal ultrasound scan.
  • Identify and rectify an equipment artefact for an anorectal physiology investigation.
  • Perform routine maintenance of anorectal manometry equipment.
  • Place a needle for percutaneous tibial nerve stimulation and start a treatment session.

Observed Clinical Event Titles

  • Present a patient at a pelvic floor multidisciplinary team for discussion by the clinical team.
  • Provide a patient with suitable pelvic floor re-education appropriate for their symptoms.
  • Obtain a detailed patient history for anorectal physiology investigations.
  • Provide suitable guidance and reassurance to a patient who is nervous about their anorectal physiology investigation.
  • Summarise the findings from an anorectal physiology investigation to another healthcare professional.

Learning outcomes

# Learning outcome
1

Explain the procedure for endoanal ultrasound scanning to patients, answer questions about the procedure and obtain the patient’s informed consent.
2

Perform and interpret endoanal ultrasound scans safely for a range of conditions, identifying normal and abnormal findings, and produce high-quality reports.
3

Perform and interpret anorectal physiology investigations safely in a range of anorectal conditions, identifying normal and abnormal findings, and produce high-quality reports.
4

Apply advanced history taking skills to explore a patient’s more complex social history with compassion and empathy.
5

Summarise and present patients at a pelvic floor multidisciplinary team meeting and contribute to the decision-making process for patient care.
6

Provide pelvic floor re-education and pressure biofeedback therapy.
7

Identify indications for the use of percutaneous tibial nerve stimulation (PTNS) and sacral nerve neuromodulation (SNM).

Clinical experiences

Clinical experiences help you to develop insight into your practice and a greater understanding of your specialty's impact on patient care. Clinical experiences should be included in your training plan and you may be asked to help organise your experiences. Reflections and observations from your experiences may help you to advance your practice and can be used to develop evidence to demonstrate your awareness and appreciation of your specialty.

Activities

  1. Observe advanced pelvic floor ultrasound e.g., transrectal ultrasound or transperineal ultrasound.
  2. Observe a range of lower gastrointestinal imaging investigations e.g., colonoscopy, flexible sigmoidoscopy, proctogram, colonic transit study, barium enema or MRI proctography.
  3. Observe a range of relevant surgical procedures to appreciate how these interventions may impact anorectal physiology investigations e.g., prolapse repair, cancer operations, haemorrhoidectomy, sphincter repair or fistula repair.
  4. With permission, follow a patient pathway through the assessment for SNM suitability, trial stimulator, implantation of the permanent stimulator and subsequent follow-up.
  5. Shadow a clinical psychologist and consider the impact of emotional stress on bowel function.

Academic content (MSc in Clinical Science)

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

On successful completion of this module the trainee will be able to:

  1. Differentiate between lower gastrointestinal conditions and critically appraise the range of investigations available and the surgical and conservative interventions.
  2. Critically evaluate the clinical application of technologies used to investigate and treat lower gastrointestinal conditions.
  3. Interpret a range of male and female endoanal ultrasound scans, including normal and abnormal findings and the identification of artefacts.
  4. Critically appraise the key requirements for advanced clinical history taking from patients requiring lower gastrointestinal system investigations.

Indicative content

Revisiting and building upon content from Lower Gastrointestinal Physiology 1:

  • Structure and function of the lower gastrointestinal tract (including the large and small bowel, rectum and anal canal) and anatomy of the pelvic floor
  • Structure and function of the pelvic floor, including pelvic floor disorders (types of pelvic organ prolapse, passive and urge faecal incontinence, urinary incontinence and dyssynergic defaecation)
  • Neurophysiology and endocrinology of the lower gastrointestinal tract and pelvic floor
  • Obstetric anal sphincter injuries, risk factors, how they can be avoided and surgical repair options
  • Lower gastrointestinal pharmacology, including biologic agents, laxatives (types, mechanism of action, indications and contraindications), loperamide, and the effects of opioids
  • Pathophysiology of the lower gastrointestinal tract: Crohn’s disease, ulcerative colitis, diverticulitis, irritable bowel syndrome, passive and urge faecal incontinence, obstructive defaecation, slow transit constipation, haemorrhoids, Hirschprung’s disease, anal fissure, fistula-in-ano, sepsis, sexually transmitted diseases, congenital and acquired defects, colorectal and anal cancers
  • Overview of surgical interventions for treatment conditions effecting the lower gastrointestinal tract: Delorme’s procedure, Hartmann’s procedure, anterior resection, colonic resection, colostomy, ileostomy, MACE procedures, STARR procedure, THD SphinKeeper, bulking agents, artificial anal sphincter and BOTOX
  • Overview of trans-anal irrigation, including indications and contraindications, therapeutic effects and types of equipment available
  • Overview of conservative treatments for bowel symptoms: anal plugs, pelvic floor physiotherapy, biofeedback therapy, cognitive behavioural therapy and relaxation training
  • Psychology and the lower gastrointestinal tract: psychological stress, anxiety, depression, eating disorders, laxative abuse, obsessive compulsive disorder and impact of abuse
  • Diet and the lower gastrointestinal tract: dietary fibre, low FODMAP diet, probiotics, caffeine and dietary laxatives.
  • Clinical history taking skills pertinent to lower gastrointestinal physiology

Additional content for Lower Gastrointestinal Physiology 2:

  • Technologies used to investigate and treat lower gastrointestinal conditions: endoanal ultrasound, pelvic floor neuromodulations and pressure feedback biotherapy
  • The ranges of endoanal ultrasound equipment available and the principles of how endoanal ultrasound works
  • The interpretation of a normal male and female endoanal ultrasound scans, including the identification of anatomical landmarks
  • Identifying and reporting grades of obstetric anal sphincter injuries using endoanal ultrasound scanning
  • Identifying and reporting abnormalities on endoanal ultrasound scanning, including: sphincter defects, anal fistula, abscesses, haemorrhoids and rectal prolapse
  • The identification of artefacts on endoanal ultrasound scanning
  • In-depth pelvic floor neuromodulation: sacral nerve neuromodulation and percutaneous tibial nerve stimulation, including: stimulator settings and principles of programming, the theory and mechanism of action, process of implantation and lead placement, patient selection, indications and contraindications
  • The principles of pressure biofeedback therapy, evidence for its use, indications and contraindications
  • Advanced clinical history taking skills, including addressing safeguarding issues (e.g., female genital mutilation and suggestions of domestic violence or abuse) and approaching patient anxieties surrounding intimate examinations
  • Patient information and involvement
  • Patient centered care

Module assigned to

Specialties

Specialty code Specialty title Action
Specialty code SPS3-1-22 Specialty title Gastrointestinal Physiology [2022] Action View
Specialty code SPS3-2-22 Specialty title Urodynamic Science [2022] Action View
Specialty code SPS3-1-23 Specialty title Gastrointestinal Physiology [2023] Action View
Specialty code SPS3-2-24 Specialty title Urodynamic Science [2024] Action View
Specialty code SPS3-1-24 Specialty title Gastrointestinal Physiology [2024] Action View
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