Case 12- sap 2 Flashcards
Things to consider for a differential diagnosis of UC
For Bloody diarrhoea 18-35 Colicky abdominal pain Tiredness Aphthous ulcers Family history Cutaneous manifestations
Against
Smoking - decreases risk
Things to consider for a differential diagnosis of CD
For Age Smoking - increases risk Diarrhoea - not usually bloody Abdominal pain Tiredness Cutaneous manifestation Mouth ulcers
Against
Chronic presentation - CD tends to have acute excerbations followed by remissions
Things to consider for a differential diagnosis of lactose intolerance
For
Water diarrhoea
Abdominal discomfort
Against
If symptoms occur even when lactose not taken
Dont expect tiredness
Don’t expect cutaneous manifestations
Dont expect pallor, apthous ulcers, conjunctival pallor
Things to consider for the differential diagnosis of coeliac disease
For
Unexplained symptoms
Fatigue (iron deficiency anemia present in 50% of patients)
Dermatitis herpetiformis i.e. prutitic rash on elbows and knees
Persistent mouth ulcers
Unexpected weight loss
Family history
First choice serological testing = plasma tTG which will be positive
Histology of a biopsy will show subtotal villous atrophy
Things to consider for a differential diagnosis of IBS
For Age (20-30) Diarrhoea Abdominal pain eased by bowel openings Stress More common in women Change in bowel habit
Against
Dont expect conjunctival pallor, cutaneous manifestations or apthous ulcers
Doesnt cause rectal bleeding
Doesnt explain weight loss
Things to consider for a differential diagnosis of gastroenteritis
For
Diarrhoea
Abdominal pain
Fever, nausea and vomiting
Against
Chronic presentation - this is more acute
Not expected to have apthous ulcers, rash, pale conjunctiva
Things to consider for a differential diagnosis of colon cancer
For Diarrhoea Abdominal pain Chronic history Smoking Pale conjunctivae Weight loss Old age Smoking and type 2 diabetes are risk factors
Against
Young age
Doesnt explain rashes
Things to consider for a diagnosis of diverticular disease
For Diarrhoea Abdominal pain Chronic history Smoking Pale conjunctivae Weight loss
Against
Young age
Doesnt explain rashes
Diverticular disease
A group of diseases which cause small sacs to develop in the wall of the colon
Diverticulitis
An inflammation or infection of the pouches in the colon
Things to consider for a differential diagnosis of diverticulitis
For Common Affect older people (>50) Left lower quadrant pain Rectal bleeding Acute inflammation i.e. fever
Against
Long history - tends to not last that long
Difference between diverticulitis, diverticulosis and diverticular disease
Diverticular disease = symptomatic diverticulae
Diverticulitis = diverticular inflammation
Diverticulosis = asymptomatic diverticulae
Things to consider for a differential diagnosis of haemorrhoids
For Common Constipation Chronic cough is a risk factor Rectal bleeding
Against
Dont expect to get abdominal pain
Dont expect weight loss - more worrying
Things to consider for hyperthyroidism
For
Diarrhoea
Fatigue
Against
Would expect other symptoms like heat intolerance, sweating, tremors, weight change, appetite
No Colicky pain
No rash or ulcers
What do you see in coeliac disease
Microcytic anaemia
Plasma tTG IgA
Biopsy- subtotal villous atrophy
Tests for IBD
Faecal calprotectin is a measure of colonic inflammation. A negative result excludes a diagnosis of inflammatory bowel disease
The 2 week referral criteria for suspected colorectal cancer
1) Aged 50 or over with unexplained rectal bleeding
2) Aged 40 or over with unexplained weight loss and abdominal pain
3) Aged 60 or over with changed in bowel habit
4) Test shows occult blood in faeces
5) Aged 60 or over with iron deficient anaemia
What would you see in diverticulitis
High inflammation numbers (white cell count and CRP)
What would you see in diverticulae
Holes in the colon
If the diverticulae are symptomatic (PR bleeding, abdo pain) causes Diverticular disease
The 3 approaches to the treatment of severe acute diarrhoea
1) Maintenance of fluid and electrolyte balance.
2) Use of anti-infective agents
3) Use of spasmolytic or other antidiarrheal agents
What bristol stool chart denotes diarrhoea
Type 6 or 7
What is used to treat diarrhoea and faecal incontinence
Loperamide
What is the mechanism of action of Loperamide
Opioid-receptor agonist on μ-opioid receptors in the myenteric plexus of the large intestine. Decreases activity of myenteric plexus decreasing the tone of the longitudinal and circular smooth muscles of the intestinal wall. Thus increases time material stays in the bowel so more water is absorbed from bowel contents
Side effects of loperamide
Dizziness, flatulence, headache, nausea
Loperamide does not cause significant CNS side effects due to poor penetrance of the CNS so no analgesic or addictive properties
Common treatment for travellers diarrhoa
Most infections are mild and self limiting requiring only oral replacement of fluid and salt. Ciprofloxacin
Common cause of travellers diarrhoea
GI symptoms such as diarrhoea due to enterotoxin-producing E. coli.
Infections include Escherichia coli, Salmonella and Shigella, as well as protozoa such as Giardia and Cryptosporidium spp
Risk factors for constipation
Women, the elderly and during pregnancy
How quick can Bisacodyl have its effect
It stimulates the rectal mucosa, inducing defecation in 15-30 mins. It increases electrolyte and water secretion, may also stimulate enteric nerves increasing peristalsis.
How does a faecal softner work?
They decrease surface tension and increase penetrance of intestinal fluid into the faecal mass, softening it. I.e Docusate sodium and glycerol
