Case 13: Change in bowel habit Flashcards
VITAMIN CDE causes of diarrhoea
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
what would the presentation of bowel ischaemia be like
severe pain
worse after eating
pain out of proportion to symptoms
what is tenesmus
the feeling of incomplete defecation
could be a sign of cancer
what is mesenteric ischaemia
blood supply to the bowel is disrupted by arterial thrombosis or embolism
risk factors for mesenteric ischaemia
similar to those of CVD
much more common in those with CVD
what is a mechanical bowel obstruction
blockage of the bowel inhibiting movement. adhesions, hernia, tumors, impacted feces, volvus or twisting of the intestines, intussusception
what does mechanical bowel obstruction sound like on auscultation
tinkling bowel sounds
what is a functional bowel obstruction
the intestine muscles cannot move contents thought the bowel
what does a functional bowel obstruction sound like on auscultation
absent bowel sounds
difference between diverticular disease, diverticulosis and diverticulitis
diverticular disease= symptomatic diverticulosis
diverticulosis= multiple diverticula in the colon
diverticulitis= diverticula become inflamed
risk factors for diverticular disease
genetic predisposition
age over 40
diet low in fibre, high in fatty foods and red meat
obesity
sedentary lifestyle
smoking
alcohol
medication- NSAIDs
pathology of diverticular disease
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
complications of diverticulitis
perforation
bowel obstruction
abscess (pocket of infected puss)
fistulae (abnormal connections with adjacent organ/structure)
peritonitis
clinical manifestations of an acute episode of diverticulitis
abdominal pain (LLQ)
fever
nausea
vomiting
change in bowel habits (alternating constipation and diarrhoea)
painless hamatochezia (red/maroon coloured stools)
diagnosis of diverticulosis
colonoscopy
can also be found incidentally on CT
diagnosis of diverticulitis
history + examination
CT abdomen and pelvis
complete blood count- leukocytes, raised inflammatory markers (CRP)
management of diverticular disease
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)
management of diverticular disease where there is severe GI bleeding
coagulation therapy
surgical clips applied to the bleeding artery to seal it
management of severe diverticulitis
hospital admission and CT
IV fluids and antibiotics
surgical intervention for serious complications
can diverticula form in the rectum
no due to the outer longitudinal muscle layer which adds extra support
which areas of the colon are most vulnerable to developing diverticula
areas which do not have teniae coli (the centre has it)
which area of the bowel is most likely to be affected by diverticula
sigmoid colon (but anywhere in the bowel can be affected)
which type of laxatives should be avoided with diverticular disease
stimulant laxatives (these can make matters worse)
VITAMIN CDE for causes of consptiation
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
what may suggest an anal prolapse
constipation
sensation of anal/rectal mass
rectal/anal pain
rectal bleeding/mucus
incontinence
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
which is the area of the colon most often affected by cancer
the recto-sigmoid colon
(caecum is second most affected)
is the left or right side of the colon more commonly affected by cancer
the left
which staging criteria is used for bowel cancer
TNM staging and Dukes criteria
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
what is a bag attached to the colon called
colostomy
what is a bag attached to the small intestine called
ileostomy
what is found on DRE with mechanical bowel obstruction
collapsed rectum (all of the bowel distal to the obstruction will be collapsed)
what is found on DRE with functional bowel obstruction
the entirety of the bowel will be distended and capacious, including the rectum
what could cause functional bowel obstruction
ileus
pseudo-obstruction
causes of RUQ/right hypochondrium pain
acute pancreatitis
duodenal ulcer
gallbladder disease
pneumonia (referred)
cause of epigastric pain
duodenal ulcer
pancreatitis
peptic ulcer
causes of LUQ/hypochondrium pain
pneumonia
spontaneous splenic rupture
causes of umbilical pain
AAA
early appendicitis
mesenteric thrombosis
SBO
causes of left lumbar pain
pyelonephritis
renal colic
causes of RIF pain
acute appendicitis
acute diverticulitis
crohns
ectopic pregnancy
renal colic
ruptures ovarian cyst
salpingitis
causes of hypogastric (suprapubic) pain
ectopic pregnancy
urinary retention
UTI
causes of LIF pain
acute diverticulitis
ectopic pregnancy
ruptured ovarian cyst
salpingitis
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
what is a complication of anastomosing ends of the colon together surgically
anastomotic leak
what is the eligibility for bowel cancer screening in the UK
everyone aged 60-74 every 2 years
which test is used for screening of bowel cancer
FIT test of FOB (fecal occult blood) depending on area of the UK
