Case 13: Change in bowel habit Flashcards

1
Q

VITAMIN CDE causes of diarrhoea

A

Vascular= bowel ischemia

Infectious= viral, parasitic Inflammatory= IBD

Traumatic= recent trauma Toxic= lead poisoning

Autoimmune= coeliac

Metabolic= neuropathic complication of diabetes

Iatrogenic= opiates such as codeine

Neoplastic= bowel and ovarian cancer

Congenital= N/A

Degenerative= diverticulosis

Endocrine= thyrotoxicosis

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1
Q

what would the presentation of bowel ischaemia be like

A

severe pain
worse after eating
pain out of proportion to symptoms

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2
Q

what is tenesmus

A

the feeling of incomplete defecation
could be a sign of cancer

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3
Q

what is mesenteric ischaemia

A

blood supply to the bowel is disrupted by arterial thrombosis or embolism

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4
Q

risk factors for mesenteric ischaemia

A

similar to those of CVD
much more common in those with CVD

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5
Q

what is a mechanical bowel obstruction

A

blockage of the bowel inhibiting movement. adhesions, hernia, tumors, impacted feces, volvus or twisting of the intestines, intussusception

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6
Q

what does mechanical bowel obstruction sound like on auscultation

A

tinkling bowel sounds

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7
Q

what is a functional bowel obstruction

A

the intestine muscles cannot move contents thought the bowel

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8
Q

what does a functional bowel obstruction sound like on auscultation

A

absent bowel sounds

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9
Q

difference between diverticular disease, diverticulosis and diverticulitis

A

diverticular disease= symptomatic diverticulosis

diverticulosis= multiple diverticula in the colon

diverticulitis= diverticula become inflamed

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10
Q

risk factors for diverticular disease

A

genetic predisposition
age over 40
diet low in fibre, high in fatty foods and red meat
obesity
sedentary lifestyle
smoking
alcohol
medication- NSAIDs

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11
Q

pathology of diverticular disease

A

increased pressure inside the colon

mucosa and submucosa bubble out through weak spots

can mean blood vessels rupture causing GI bleeding

bacteria and undigested food can get stuck into these protrusions and cause infection- diverticulitis

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12
Q

complications of diverticulitis

A

perforation

bowel obstruction

abscess (pocket of infected puss)

fistulae (abnormal connections with adjacent organ/structure)

peritonitis

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13
Q

clinical manifestations of an acute episode of diverticulitis

A

abdominal pain (LLQ)
fever
nausea
vomiting
change in bowel habits (alternating constipation and diarrhoea)
painless hamatochezia (red/maroon coloured stools)

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14
Q

diagnosis of diverticulosis

A

colonoscopy

can also be found incidentally on CT

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15
Q

diagnosis of diverticulitis

A

history + examination

CT abdomen and pelvis

complete blood count- leukocytes, raised inflammatory markers (CRP)

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16
Q

management of diverticular disease

A

high fibre diet

drinking 2 litres of clear fluid per day (avoid solids with diverticulitis)

simple analgesia- paracetamol (avoid NSAIDs)

bulk-forming laxatives for constipation (ispaghula husk)

oral antibiotics (co-amoxiclav)

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17
Q

management of diverticular disease where there is severe GI bleeding

A

coagulation therapy

surgical clips applied to the bleeding artery to seal it

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18
Q

management of severe diverticulitis

A

hospital admission and CT

IV fluids and antibiotics

surgical intervention for serious complications

19
Q

can diverticula form in the rectum

A

no due to the outer longitudinal muscle layer which adds extra support

20
Q

which areas of the colon are most vulnerable to developing diverticula

A

areas which do not have teniae coli (the centre has it)

21
Q

which area of the bowel is most likely to be affected by diverticula

A

sigmoid colon (but anywhere in the bowel can be affected)

22
Q

which type of laxatives should be avoided with diverticular disease

A

stimulant laxatives (these can make matters worse)

23
Q

VITAMIN CDE for causes of consptiation

A

Vasular= haemorrhoids

Infectious/inflammatory= N/A

Traumatic/toxic= N/A

Autoimmune= coealiac

Metabolic= N/A

Iatrogenic= diet/lifestyle, medications (opiates, antihistamines, antispasmodics, diuretics)

Neoplastic= bowel cancer

Congenital= any congenital neurological illness (Duchennes muscular dystrophy)

Degenerative= Parkinsons, IBS

Endocrine= hypothyroidism

24
what may suggest an anal prolapse
constipation sensation of anal/rectal mass rectal/anal pain rectal bleeding/mucus incontinence
25
anal fissure typical presentation
constipation fresh blood in stools extreme pain during defecation (often worsens constipation as patients fear passing stool) may be history of trauma examination will reveal fissure
26
which is the area of the colon most often affected by cancer
the recto-sigmoid colon (caecum is second most affected)
27
is the left or right side of the colon more commonly affected by cancer
the left
28
which staging criteria is used for bowel cancer
TNM staging and Dukes criteria
29
what does dukes criteria for bowel cancer look at
looks at the stage of cancer- how far it has spread and chances of 5 year survival due to this staged A-D A= 90% chance of survival at 5 years D= less than 10 chance of survival at 5 years
30
what is a bag attached to the colon called
colostomy
31
what is a bag attached to the small intestine called
ileostomy
32
what is found on DRE with mechanical bowel obstruction
collapsed rectum (all of the bowel distal to the obstruction will be collapsed)
33
what is found on DRE with functional bowel obstruction
the entirety of the bowel will be distended and capacious, including the rectum
34
what could cause functional bowel obstruction
ileus pseudo-obstruction
35
causes of RUQ/right hypochondrium pain
acute pancreatitis duodenal ulcer gallbladder disease pneumonia (referred)
36
cause of epigastric pain
duodenal ulcer pancreatitis peptic ulcer
37
causes of LUQ/hypochondrium pain
pneumonia spontaneous splenic rupture
38
causes of umbilical pain
AAA early appendicitis mesenteric thrombosis SBO
39
causes of left lumbar pain
pyelonephritis renal colic
40
causes of RIF pain
acute appendicitis acute diverticulitis crohns ectopic pregnancy renal colic ruptures ovarian cyst salpingitis
41
causes of hypogastric (suprapubic) pain
ectopic pregnancy urinary retention UTI
42
causes of LIF pain
acute diverticulitis ectopic pregnancy ruptured ovarian cyst salpingitis
43
management of large bowel obstruction secondary to bowel tumour
NBM IV fluids and correct electrolyte disturbance NG tube to decompress bowel and suck to prevent aspiration urinary catheter for fluid balance analgesia antiemetics VTE prophylaxis (there is a higher risk of DVT with the cancer) antibiotics
44
what is a complication of anastomosing ends of the colon together surgically
anastomotic leak
45
what is the eligibility for bowel cancer screening in the UK
everyone aged 60-74 every 2 years
46
which test is used for screening of bowel cancer
FIT test of FOB (fecal occult blood) depending on area of the UK