15 - chronic abdominal pain Flashcards
Welcome to week 14
https://youtu.be/dQw4w9WgXcQ
What is the ROME criteria
Used to diagnose functional gut disorders like IBS
Symptoms of IBS
Abdo pain - colicky
Bloating
altered bowel habit
Greater than 6 months
What are red flags for abdominal pain?
> 60 years
rectal bleeds
anaemia
weight loss
FH of colorectal cancer
Abdo/ rectal mass
Raised CRP/ESR
What dietary advice should be given to patients suffering from IBS?
Avoid fermentable carbohydrates - fructose lactose
What is Carnett’s sign?
Abdominal pain made worse on the site of palpation when a patient sits up.
If positive then pain is from the abdominal wall rather than the viscera.
What is loperamide?
Opioid agonist which focuses on the mesenteric plexus.
Used for diarrhoea
What is linaclotide?
Used for constipation (via CFTR) for constipatino > 12 months when laxatives dont work.
Used 2nd line (by definition) in IBS
When can you initiate psychological therapy for IBS (NICE guildlines)?
> 12 months of suffering from IBS whith it not getting better
How is ulcerative collitis diagnosed?
> 4 weeks of diarrhoea with evidence of acute and chronic inlfammation on endoscopic and biopsy
How is Crohns disease diagnosed?
endoscopic evidence and imaging with compatible clinical history
What is tenesmus?
Repeated need to empty bowels
What is the definition of diarrhoea?
Greater than 2 unformed stools per day
What is disentry?
Diarrhoea with blood in it
What is acute diarrhoae?
Diarrhoea lasting less than 4 weeks
What is chronic diarrhoea?
Diarrhoea lasting greater than 4 weeks
Having antibiotics for greater than 1 months increases the risk of diarrheoa due to…
Clostridium deficile
What is calportectin?
Indicates if there is any underlying inflammation in the GI tract. If negative would help to support a diagnosis of IBS
Is smoking protective or harmful with Crohns?
Smoking is harmful, smoking cessation should be part of the treatment for Crohns.
Is smoking protective or harmful with Ulcerative Collitis?
Smoking is protective with ulcerative colitis
What features of Ulcerative collitis are present on endoscopy?
Continoues erthematous inflammation with pseudo polyps.
What features of Crohns are during endoscopy?
Skipp lesions with a cobblestone appearence
What complications can occur due to Crohns?
Stenosis
Abcess
Fistula and performation
Increase rate of colorectal cancer
What complications can occur due to Ulcerative collitis?
Bleeds
Toxic megacolon
Ruptured bowel
increase risk of colorectal cancer
When can you no longer take stool cultures from a patient in hospital?
Stool samples should ont be takem after 3 days.
What is the commonest cause of gastroeneteritis in the UK?
Campylobacter
What is HUS?
Haemolytic urea syndrome, caused by a strain of E. coli and shigella dysentry
What is TTP?
thrombolytic thrombocytopenia purpura. Low platelet count caused by with many causes inculuding E.coli
Patient has rice water stool after coming from abroad. What is the cause?
Cholera
What is Giadrasis?
A parasite which can cause chronic diarrhoea
What is the red flag for ovarian cancer?
Female over 50 with bloating.
What does Ca125 indicate?
Marker for ovarian cancer
What is the true witts criteria?
A way of measuring the severity of IBD
Would be safe to do a colonoscopy during a flare up of US or Crohns?
NO due to risk of perforation, possibly flexible sigmoidoscopy
What is the definition of a fistula?
Abnormal connection between to 2 epithelial linings
When treating IBD TB should be excluded. How is TB tested for?
Quantifieron
UC is limited to the large bowel, how can it effect the small bowel?
Backwash ileuitis
What is the gold standard investigation for crohns?
Pilcam - a camera as a pil
What is the MUST score?
Greater than 2 indicates malnutrition
What is refeeding syndrome?
Fedding after MI which causes MI, due to washing over electrolytes over the cardiac tissue.
What condition are 5-ASA drugs like mesalazine used for?
Ulcerative collitis and not Crohns
What is first line for Crohn’s?
Azathiopurine or mertaptopurine
These can also be used for UC after mesalazine
What medicaiton is second line for Crohn’s disease?
Metotrexate
After 4 weeks of a flare up of UC. What mediation can be used to induce remission?
Glucocorticoids
What can be used for inducing remision of Crohns after a flare up?
1st glucocorticoids
2nd 5-ASA and 1st line therapy
