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Block 32- GI/surgery > altered bowel habit > Flashcards

altered bowel habit Flashcards

1
Q

4 important things to ask about in assessment of diarrhoea

A

red flag symptoms
frequency
antibiotics
travel

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2
Q

4 causes of acute diarrhoea

A

dietary indiscretion
infection
constipation with overflow
pseudomembranous colitis

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3
Q

pseudomembranous colitis after

A

oral antibiotic use

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4
Q

chronic diarrhoea=

A

> 4 weeks history with no response to medicaitons or treatment

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5
Q

causes for chronic diarrhoea (7)

A
  • IBD
  • coeliac disease
  • colonic and pancreatic cancer
  • whipples disease
  • laxative abuse
  • IBS
  • infection
  • cystic fibrosis
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6
Q

5 causative agents of gastroenteritis

A 
campylobacter 
salmonella 
escherichia coli 
cryptosporidium 
norovirus
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7
Q

most common cause of infectious diarrhoea in the UK

A

campylobacter

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8
Q

when do symptoms start occuring with campylobacter

A

2-5 days after ingestion

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9
Q

what foods are infected with campylobacter

A

milk or poultry

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10
Q

presentation of campylobacter (3)

A

malaise
bloody diarrhoea
abdo pain

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11
Q

management pf campylobacter

A

usually self-limiting

erythromycin or ciprofloxacin if needed

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12
Q

salmonella usually in contaminated

A

poultry
meat
eggs

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13
Q

symptoms of salmonella

A

vomiting
diarrhoea
abdominal pain
fever

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14
Q

loperamide=

A

m-opioid anti-diarrheal

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15
Q

E.coli causative agent for gastroenteritis

A

E-coli 0157:H7

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16
Q

what toxin does E.coli produce

A

shiga toxin

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17
Q

what does shiga toxin do (2)

A
  • premature destruction of erythrocytes

- damage to GI mucosa

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18
Q

what condition can shiga toxin cause

A

hemolytic uremic syndrome

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19
Q

how is E.coli transmitted (5)

A
  • infected vegetables
  • undercooked meat
  • raw milk products
  • touching infected person
  • infected water
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20
Q

treatment of E.coli

A

self limiting - water and ORT

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21
Q

cryptosporidium=

A

protozoan disease

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22
Q

how is cryptosporidium spread

A

through infected water

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23
Q

presentation of cryptosporidium (5)

A
  • profuse watery diarrhoea
  • abdo cramps
  • nausea
  • anorexia
  • fever and malaise
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24
Q

treatment of cryptosporidium

A

ORT

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25
Q

most common cause of infectious gastroenteritis in UK

A

norovirus

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26
Q

norovirus especially common in

A

hospitals and schools

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27
Q

IBS=

A

chronic relapsing and remitting condition of unknown cause

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28
Q

symptoms of IBS (5)

A
  • crampy abdominal pain
  • bloating
  • change in bowel habit
  • excessive flatulence
  • nausea and fatigue
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29
Q

treatment of IBS

A
  • lifestyle changes -more water, less fiber and lower intake of resistant starch
  • antispasmodics
  • probiotics
  • antidiarrhoeals
  • antiemetic
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30
Q

what antispasmodics are available

A

mebeverine
peppermint oil
hyoscine

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31
Q

Ondansetron=

A

5-HT3 antagonist

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32
Q

clinical features of chronic constipation (5)

A
  • high pitched bowel sounds with hyper-peristalsis
  • nausea
  • emesis
  • colicky abdo pain
  • inability to pass flatulence
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33
Q

management of chronic constipation

A
  • bowel rest with NG tube
  • IV fluids
  • bowel decompression
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34
Q

symptoms of colonic carcinoma causing a stricture (6)

A
  • change in bowel habits
  • nausea and vomiting
  • anorexia
  • weight loss
  • hematochezia
  • abdominal pain
35
Q

investigations in colorectal cancer suspected

A 
FBC 
LFTs
U&Es
Colonscopy 
double contrast barium enema
36
Q

what may be seen with colorectal cancer on a double contrast barium enema

A

apple core colonic lesions

37
Q

which side is abdominal cramping in diverticular disease

A

left usually

38
Q

treatment of crohns (5)

A 
mesalazine 
budesonide 
infliximab 
azathioprine 
corticosteroid
39
Q

anal fissure symptoms (4)

A
  • pain on defecation
  • tearing sensation passing stools
  • rectal bleeding
  • anal spasm
40
Q

first line conservative treatment for anal fissures

A
  • high fiber diet,
  • fluid intake,
  • hot baths,
  • topical analgesia
41
Q

medical treatment for anal fissures

A
  • laxatives
  • topical glyceryl trinitrate
  • topical diltiazem
42
Q

what is used for opiate induced constipation

A

methynaltrexone

43
Q

methylnaltrexone =

A

peripheral opioid antagonist

44
Q

what other medications can cause constipation

A

SSRIs

45
Q

first line laxatives in adult constipation

A

bulk forming laxatives

46
Q

2 bulk forming laxatives

A

isphaghula husk

methylcellulose

47
Q

lactulose=

A

osmotic laxative

48
Q

2 stimulant laxatives

A

senna

sodium picosulphate

49
Q

possible stimuli of IBS

A
  • environmental -stress, smoking

- luminal -foods, dysbiosis, inflammation

50
Q

who gets IBS more

A

females

51
Q

coeliac disease=

A

autoimmune response to gliadin peptide antigens

52
Q

genetic predisposition to coeliac disease 2 mutations

A

HLA-DQ2

DQ8

53
Q

in coeliac what part of the immune system does gliadin stimulate

A

innate and adaptive

54
Q

which cytokine does gliadin stimulate

A

IL-5

55
Q

what does IL-5 do in coeliac

A

stimulates intraepithelial lymphocytes leading to epithelial damage

56
Q

what are gluten peptides deaminated by

A

tissue transglutaminase

57
Q

TH1 role in coeliac

A

cytotoxic lymphocytes cause cell death and villous atrophy

58
Q

Th2 role in coeliac

A

B plasma cell maturation to form anti-gliadin antibodies

59
Q

villous atrophy leads to (7)

A 
malabsorption 
steatorrhea 
weight loss 
diarrhoea 
abdo cramping 
bloating
N&V
60
Q

2 types of colorectal cancer

A

FAP

HNPCC

61
Q

FAP mutation =

A

APC tumour suppressor gene regulating beta-catenin

62
Q

signalling pathway beta-cat triggers

A

wnt

63
Q

HNPCC mutation=

A

mismatch repair genes correcting errors made by polymerase during DNA replication -microsatellite DNA mutations

64
Q

extra-intestinal manifestations of Crohn’s

A

arthritis
ankylosing spondylitis
aphthous ulcers

65
Q

complications of UC

A

bleeding
toxic megacolon
colonic perforation
colonic cancer

66
Q

most common cause of hypothyroidism

A

hashimoto thyroiditis

67
Q

symptoms of hypothyroidism (6)

A 
fatigue 
constipation 
weight gain 
poor appetite 
SOB 
carpal tunnel
68
Q

why constipation in hypothyroidism

A

weakened contractions of muscles of GI tract

69
Q

common area of diverticular disease

A

sigmoid colon -small diameter

70
Q

TNM not applicable to

A

leukaemia

CNS cancer

71
Q

Tx=

A

main tumour cannot be measured

72
Q

Tis=

A

carcinoma in situ

73
Q

T4=

A

invaded surrounding tissue

74
Q

N1=

A

presence of cancerous cells in one surrouding lymph node

75
Q

MX

A

metastasis cannot be measured

76
Q

M1=

A

cancer has spread to other parts of body

77
Q

most common place for metastasis

A

liver and lungs

78
Q

dukes tumour staging system used for

A

extent of rectal cancers

79
Q

Dukes tumour staging A=

A

tumour confined to mucosa = good prognosis

80
Q

dukes tumour staging D=

A

distant metastases <1% 5 year survival

81
Q

what does Dukes tumour staging use

A

CT, MRI, ultrasound

82
Q

neoadjuvant chemotherapy=

A

preoperatively reduce tumour size via chemo

83
Q

adjuvant chemotherapy=

A

post-operative chemotherapy

84
Q

what is a general margin in tumour resection to ensure all cancerous tumour is removed

A

2-5 cm

Block 32- GI/surgery (9 decks)

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