A Gut feeling Flashcards
What is health-related quality of life?
Broad concept that incorporates the patient’s perceptions, illness experience and functional status as related to a medical condition. It is influenced by social, cultural, psychological and disease-related factors.
Why is it useful to assess health-related quality of life?
The patient can communicate how the illness has made an impact in his or her life.
The physician can assess the patient’s HRQoL as a tool in describing their level of functioning, and objectively track this function to gauge response to treatment.
How is quality of life assessed in IBS?
There are a number of different questionnaires that can be used to assess the patient’s quality of life e.g. IBS-QOL
Commonly assessed areas include impact on daily activities, social relationships, sleep and emotional and mental ability to cope.
What aspects of IBS have a negative impact on a patient’s quality of life?
Their bloating and diarrhoea symptoms were reported to have the greatest impact on quality of life
- Concerns about having an accident
- Limits engagement in daily activities like work, travel, and other social/leisure activities
- Social isolation and mental health problems
- Body image due to bloating
What aspects of IBD have a negative impact on a patient’s quality of life?
Frequent recurrence of symptoms, extraintestinal manifestations, the effect of medical and surgical treatments and their side effects, stress of developing cancer, and needing surgery.
Sleep disturbance - fatigue and low mood
Taking time off work
Concerns with being near a toilet
What aspects of coeliac disease have a negative impact on a patient’s quality of life?
Impact on social life 🡪 Unable to take part in social activities as easily, Difficult to access gluten-free alternatives
Mental health problems 🡪 Lack of public understanding, Constant worry
What is diarrhoea?
The passage of three or more loose or liquid stools per day (or more frequent passage than is normal for the individual).
How would you categorize diarrhoea by time frame?
Acute diarrhoea is defined as lasting for less than 14 days
Persistent diarrhoea is defined as lasting more than 14 days
Chronic diarrhoea is defined as lasting for more than 4 weeks
How would you take a history for diarrhoea?
Onset – when did it start?/was the onset acute or gradual?
Duration – hours/days/weeks
Severity – e.g. Bristol stool chart
Course – is the symptom worsening, improving, or continuing to fluctuate?
Intermittent or continuous? – is the symptom always present or does it come and go?
Fresh red blood (anal fissure/haemorrhoids/IBD)
Melaena (upper gastrointestinal bleed)
Precipitating factors – are there any obvious triggers for the symptom? E.g. any previous infections, IBS/IBD
Relieving factors – does anything appear to improve the symptoms e.g. increasing dietary intake
Associated features – are there other symptoms that appear associated (e.g. fever/malaise), any recent antibiotics, food poisoning
Previous episodes – has the patient experienced this symptom previously?
What are the red flags of diarrhoea?
Blood in the stool
Recent hospital treatment or antibiotic treatment
Weight loss
Evidence of dehydration
What might be some of the underlying causes of acute diarrhoea?
Infection - recent exposure, meals out, travel abroad, high risk group New drugs - antibiotics/laxatives Stress or anxiety IBD, IBS, UC Radiation to the pelvis Immunosuppressive treatments Background medical conditions Diet and alcohol use
What are the signs of dehydration?
Increased pulse rate, reduced skin turgor, dryness of mucous membranes, delayed capillary refill time, decreased urine output, hypotension (check for postural changes), and altered mental status.
What examinations would you perform in the presentation of diarrhoea?
Perform an abdominal examination to assess for pain or tenderness, distension, mass, increased or decreased bowel sounds, or liver enlargement.
Consider a rectal examination to assess for rectal tenderness, stool consistency, and for blood, mucus, and possible malignancy.
When would you send a faecal specimen for investigation in someone with acute diarrhoea?
Systemically unwell
Blood or pus in the stool
Immunocompromised
Recently received antibiotics or been in hospital
Recently travelled abroad
Amoebae, Giardia, or cryptosporidium are suspected
If infectious or chronic diarrhoea are suspected
When would you refer someone for colorectal cancer referral?
They are aged 40 and over with unexplained weight loss and abdominal pain, or
They are aged 50 and over with unexplained rectal bleeding, or
They are aged 60 and over with iron deficiency anaemia or changes in their bowel habit, or tests show occult blood in their faeces.
Adults with a rectal or abdominal mass.
Adults aged under 50 with rectal bleeding and any of the following unexplained symptoms
or findings: abdominal pain, change in bowel habit, weight loss, iron-deficiency anaemia.
What blood tests would you request for someone with chronic diarrhoea?
Full blood count — to detect anaemia.
Urea and electrolytes.
Liver function tests, including albumin level.
Calcium.
Vitamin B12 and red blood cell folate.
Iron status (ferritin).
Thyroid function tests.
ESR and CRP
Testing for coeliac disease — immunoglobulin A (IgA), and IgA tissue transglutaminase (tTG), or IgA endomysial antibody (EMA).
Note that antibodies usually will become negative when a person is on a gluten-free diet, so the test should be carried out when they are eating a diet containing gluten.
What are the differential diagnoses for diarrhoea?
Irritable bowel syndrome Inflammatory bowel disease Coeliac disease Microscopic colitis Colorectal cancer Drugs - antibiotics, antihypertensives, NSAIDs, hypoglycemic drugs, PPIs, SSRIs, furosemide
What is Crohn’s disease?
An idiopathic chronic inflammatory bowel disease characterised by transmural (deep) granulomatous inflammation affecting any part of the GI tract/gut from mouth to anus – especially terminal ileum in 70% and colon.
How is Crohn’s disease different to ulcerative colitis?
Unlike UC there is areas of unaffected bowel between areas of active disease and inflammation –> skip lesions (patchy).
Who gets Crohn’s disease?
Typically presents between 20-40 years old. Smoking increases risk x3.
What is thought to cause Crohn’s disease?
Thought to be caused by an abnormal mucosal immune response to luminal bacteria in genetically susceptible individuals.
What are the symptoms of Crohn’s disease?
Diarrhoea (80% cases, usually not bloody)
Abdominal pain (crampy right iliac fossa)
Weight loss/failure to thrive
Systemic symptoms may include, fatigue, fever, malaise anorexia
What are the signs of Crohn’s disease?
Bowel ulceration
Abdominal tenderness
Right iliac fossa mass
Anal and perianal present in 25% of cases often before GI symptoms therefore should always examine anus –> perianal abscess/fistulae, skin tags
What investigations would you do with a patient with suspected Crohn’s disease?
Bloods - raised ESR, CRP, WBC, platelets are common, anemia is common
Stools test
Small bowel imaging
Capsule endoscopy
How would you manage Crohn’s disease?
Mild to moderate: Glucocorticosteroids work as immunosuppressants (oral prednisolone)
Dietary approach: based on ‘elemental’ and ‘polymeric’ diets’ effective in children
Severe: IV hydration/electrolyte presentation, IV steroids, consider blood transfusion and nutritional support
What’s the prognosis of Crohn’s disease?
Good prognosis - older age at diagnosis, limited ulceration at index investigations–> may not require maintenance treatment.
Poor prognosis - young age at diagnosis, deep colonic ulceration, may require long term maintenance immunosuppression.
