63 - change in bowel habit, 64/65 diarrhoea / constipation

Question 1

is toddlers diarrhoea serious? mx?

Answer 1

no
usually resolves by 4

increase fibre

Question 2

Antibodies in coeliac

Answer 2

anti-gliardin

Question 3

Associations with coeliac

Answer 3

T1DM, / other autoimmune

dermatitis herpiformis

Question 4

progression of constipation

Answer 4

faecal impaction / obstruction

Question 5

2 main classes of constipation

Answer 5

Motility: hypothyroid, drugs, diet

Obstructive: mechanical, cancer and functional

Question 6

Mx of constipation

Answer 6

Adjust meds.
Increase dietary fibre and fluid intake

Relieve any impaction

Offer oral laxatives if this doesn’t work:

1. Bulk-forming laxative (avoid if opiate induced)
2. Osmotic laxative (macrogols and lactulose)
3. Stimulant laxative

Question 7

How do bulk forming laxitives work?

Answer 7

add bulk and water to stools. Fibre.

Question 8

How do emollient laxitives work

Answer 8

: stool softeners. Encourage fat and water content to be retained. Better for preventative therapy.

eg Docusate.

Question 9

How do osmotic laxitives work?

Answer 9

cause an osmotic retention of water in the intestines which encourages bowel movement.

Eg lactulose, sorbitol, Magnesium Sulphate

Question 10

How do stimulant laxitives work?

Answer 10

Act on gut nerve plexuses and stimulate electrolyte secretion and peristalsis.

eg Senna

Question 11

How does loperimide work? when should you not use it

Answer 11

anti-motility agent, an opioid which does not cross the BB barrier.

NO if blood in stool

Question 12

drugs with constipation as a side effect?

Answer 12

Opiates: decrease peristalsis.
Antidepressants and antipsychotics decrease peristalsis
Calcium and iron supplements
Diuretics
Aluminium based antacids

Question 13

what is hirschprungs ? classic signs?

Answer 13

Congenital illness; absence of ganglion cells in sections of the GI tract.

failure to pass meconium
explosive stools on PR.

Question 14

Dx of hirschprungs

Answer 14

suction rectal biopsy

Question 15

Mx hirschprungs

Answer 15

Resect and anastomose abnormal bowel.

Question 16

Gut bacteria aid in synthesis of what

Answer 16

Vit B and K

Question 17

4 types of diarrhoea

Answer 17

Secretory: increase in active secretion and reduction in absorption.

Osmotic: too much water in the bowels. Excess sugar and salt, laxatives, pancreatic and coeliac disease, lactose intolerance,

Exudative: pus and blood in stool. Inflammatory diseases. Indicates invasion of bowel tissue

Inflammatory: damage to mucosae. Passive loss of protein and fluid. Infection and IBD.

Question 18

Shiggella / e coli diarrhoea -> risk of?

Answer 18

HUS

Question 19

Camplylobacter -> risk of

Answer 19

guillian barre / reactive athritis