Approach to the patient with luminal disease Flashcards
What is dysphagia
Difficulty in swallowing
What is odynophagia
Pain on swallowing
What is flobus
a functional syndrome of the sensation of a lump in the throat in the absence of an organic cause
What is the first choice investigation for dysphagia
Endoscopy
What might be seen in a barium swallow
Irregular stricture - malignant,
smooth stricture - benign
If hilar lymphadenopathy is seen on a CXR what might this be
Oesophageal malignancy
What is vomiting
Violent expulsion of gastric and intestinal content induced by contraction of the abdominal musculature and diaphragm
What is regurgitation
The passive passage of gastric content without abdominal contration
What is nausea
The perceptual component of vomiting
If dysphagia comes on shortly after meals, what does this suggest
A gastric cause
If dysphagia comes on long after meals, what does this suggest
Distal intestinal cause
If a patient vomits large volumes, what does this suggest
Obstruction or gastric problem
If a patient is vomitting small volumes, what does this suggest
Functional problem
If undigested food is present in the vomit, what does this suggest
A gastric cause is very likely
If bile is present in the vomit, what does this suggest
The pylorus is patent and gastroparesis is unlikely
What are phenothiaxines best for
Neuroological causes and metabolic nausea
What are 3 side effects of phenothiazines
Sedation, orthostatic, hypotension
What is used for drug induced nausea
5-HT3 antagonist
What is an example of a prokinetic agent
Domperidone
What are the side effects of prokinetic agents
Gynaecomastia
extrapyramidal effects
What is constipation
infrequent stools
passage of hard stools
straining to empty the rectum
sensation of incomplete evacuation
What is one of the most common GI complaints
Constipation
Constipation is more common in who?
Women and elderly
Patients who have a colon of normal diameter with constipation are classified into what 3 groups
Normal transit consitpation
slow transit constipation
disordered defaecation
What is the normal transit constipation
the commonest type - characterised by a normal rate of stool movement through thte colon but the patient feels constipated.
Usually secondary perceived difficulty with defaecation and hard stools
What is slow transit constipation
Most common in young women
characterised by inferequent bowel movements and slow movement of stool through the colon
What are some other symptoms of slow transit consitpation
Bloating
abdominal pain
infrequent urge to defaecate
What is disordered defaecation
Usually due to dysfunction of the pelvic floor or anal sphincters
What is constipation with a dilated colon secondary to
neuromuscular disorders of the colon
hirschsprung’s disease
idiopathic megacolon
chronic intestinal pseudo-obstruction
What is constipation with a dilated colon secondary to
neuromuscular disorders of the colon
hirschsprung’s disease
idiopathic megacolon
chronic intestinal pseudo-obstruction
How often would a patient defaecate with slow transit
Every 2 days or less
What is suggestive of idiopathic megacolon
faecal impaction and faecal soiling
What are 4 alarm symptoms needing urgent imaging
Rectal bleeding
recent onset of symptoms
weight loss
family history of colon cancer
What 2 things are important to ask about in the dietary history
meal frrequency
fibre intake
What 5 blood tests would you want in constipation
FBC - anaemia U&E - uraemia Thyroid function est Calcium Glucose
What 3 imaging investigations could be done for a patient with constipation
Colonoscopy
Barium enema
CT colonography
What does evacuation proctography detect
Functional abnormalities and structural abnormalities
Plain abdominal Xray is a sensitive diagnostic test of constipation. True or false
False - it is not
What is the first treatment for constipatino
Diet - increase fibre and liquid intake
Does fibre help to accelerate transit
No - it tends to exacerbate bloating instead
What type of laxative is useful in slow transit
Osmotic agents
Is surgery useful in constipation
Not usually unless there is an underlying pathology
Is surgery useful in constipation
Not usually unless there is an underlying pathology
What is diarrhoea defined as
An increase in stool weight above 200g - mostly occurring as a result of an increase in stool water content
What is chronic diarrhoea
> 4 weeks of symptoms
What are the 3 main types of diarrhoea
Osmotic
Secretory
Dysmotility
What does osmotic diarrhoea look like
porridgey stool
how do symptoms resolve
fasting
What are 4 causes of osmotic diarrhoea
Laxative misuse
Lactose intolerance
Bacterial overgrowth
Steatorrhoea cauases
What does secretory diarrhoea look like
Watery stool in huge volumes
Does secretory diarrhoea settle with fasting
No
What are the 2 common causes of secretory diarrhoea
Toxins (E. Coli, Clostridium, V choler)
Tumour
Describe the stool consistency of dysmotility diarrhoea
It varies day to day
What are 3 causes of dysmotility diarrhoea
IBS
Post GI resection
Drugs
What do pale, fatty stools that are hard to flush away suggest
Steatorrhoea
What might morning diarrhoea suggest
IBD
IBS
Alcohol misuse
If the patient has night -time diarrhoea what diagnosis can e excluded
IBS
What investigations should be done for diarrhoea
Stool microscopy
Stool Culture
Blood tests
What investigation should be done if the patient has diarrhoea associated with fresh rectal bleeding
Flexible sigmoidoscopy
What is suggested for patients with normal stool and blood tests
Colonoscopy and ileoscopy with biopsies
What is the main treatment required for patients with diarrhoea
Supportive - fluids and treating pyrexia
What drug could be given to help treat the symptoms
Codeine
What is anal incontinence
The involuntary passage of rectal content and it is a cource of major embarrassment to the sufferrer
Incontinence arises when there is disturbance in what 3 things
Anus
Rectum
Co-ordination between anus and rectum
What are the 2 forms of anal incontinence
Urge incontinence
Passive incontinence
What is urge incontinence
when there is marked urgency to void the bowel with incontinence occurring before the patient can get tot eh toilet
What is passive incontinence
Due to leaking of stool without perception of any urge
What is the general treatment for anal incontinence
To optimise the stool consistency - antidiarrhoeals
Dietary advice - ration fibre and avoid caffeine and alcohol
Review medications
Anal sphincter exercises
How is BMI calculated
weight in kg / height m^2
What is a normal BMI value
20-25
What are 4 findings in a general examination for iron-deficiency anaemia
Angular stomatitis
glossitis
cheilosis
koilonychias
