6. IBD Flashcards
what is the diagnostic criteria for diarrhoea ?
stools occur more than 3 times a day, and looser than usual.
Diagnostic levels is 200g/24 hr
at what point is diarrhoea considered chronic?
over 4 weeks
possible causes of acute diarrhoea?
Infections (often viral or toxins, usually self limiting)
possible causes of chronic diarrhoea?
organic
- Celiacs disease
- IBD
- infections
- neoplasms
functional
- IBS
- food allergy
- abuse of drugs or alcohol
what is the difference between organic and functional diarrhoea?
both are chronic
Organic diarrhoea can be detected or quantified by testing
Functional diarrhoea cannot be detected or quantified from testing
what are the main differentiating features between organic and functional diarrhoea?
organic
- duration ranges
- larger volume
- often blood
- often wakes patient up at night
functional
- over 6 months
- smaller volume
no blood
- often in morning
what are the main differentiating features between diarrhoea cased by small bowel and larger bowel problems?
Small bowel
- Larger volume
- Lower frequency
- yellow/grey colour
Large bowel
- Small volume
- Higher frequency
- Blood and mucous in stools
what investigations might you order if a patient presents with diarrhoea ?
esophageal endoscopy
Colonoscopy
Biopsies
CLASSIFYING DIARRHOEA BASED ON PATHOLOGY
what is osmotic diarrhoea?
water in lumen
Caused by malabsorption eg, celiac or osmotic laxatives
Symptoms resolved with fasting
Osmotic gap is often greater than 100 mOSM/kg
CLASSIFYING DIARRHOEA BASED ON PATHOLOGY
what is secretary diarrhoea?
Active secretion of water and electrolytes into lumen via activation of adenylyl/guanylyl cyclase
Caused by bacterial endotoxins eg. E coli or cholera
No response to fasting
No osmotic gap
CLASSIFYING DIARRHOEA BASED ON PATHOLOGY
what is Exudative diarrhoea?
Extended inflammatory damage
to intestinal mucosa
Blood and mucous seen
IBD - chrons, UC
No response to fasting
CLASSIFYING DIARRHOEA BASED ON PATHOLOGY
what is Diarrhoea due to altered motility ?
increase in peristalsis means less time for reabsorption
what are considered associated symptoms of diarrhoea?
- fever
- abdominal pain
- vomiting
- alternating with constapation
- dehydration
-extraintestinal manifestations of IBD
what are the extraintestinal manifestations of IBD?
Red eyes
Mouth ulcers
Skin rash
Nail changes
Back pain
Urethral discharge
History of IBD
Join pain
what are alarming symptoms of diarrhoea?
Weight loss if chronic
Dehydration if acute
Does someone they hang around with have the same symptoms ?
name some differential diagnosis of diarrhoea
IBS
infection
diet
medications
HIV
colon cancer
list some examples of PMH that are relevant when assessing a patent with diarrhoea
Bowel resection
Radiation
Any previous medical disease
Medications
surgery/hospital stays
Allergy
list some examples of family history questions that are relevant when assessing a patent with diarrhoea
has anyone in your immediate family had….
Colon cancer
IBD
Celiac disease
list some examples of social history questions that are relevant when assessing a patent with diarrhoea
home/work support
Social status
Sexual history
Smoking
alcohol
recreational drugs
what is a stoma?
an opening made during surgery.
It connects the bowel to the surface of the tummy.
The stoma is round or oval-shaped, and it looks pink and moist.
Having a stoma means poo (stools) will not pass out of the rectum and anus in the usual way.
Instead, it will pass out of the stoma, into a disposable bag that is worn over the stoma.
what are the types of stoma?
Colostomy = from an opening in the colon
Ileostomy = from an opening in the small bowel (ileum)
Temporary stoma - can be reversed
permanent stoma - for cancer patients, rarer
language for bodily excretions:
is wee, urine or pee preferred?
pee
then urine
language for bodily excretions:
is stool, poo or faeces preferred?
poo
then stool
language for bodily excretions:
is fart, passing wind or flatulence preferred?
fart
what is IBD?
referes to ulcerative colitis and crohns.
