Case 15 - Lower GI

Question 1

Nutrients absorbed in duodenum

Answer 1

Vitamin A, D, E, and K
Iron
Calcium
Magnesium

Question 2

Nutrients absorbed in jejunum

Answer 2

Glucose (other sugars too)
Vitamin C
Riboflaven

Question 3

Nutrients absorbed in ileum

Answer 3

Vitamin B12
Bile salts
Fat
Cholesterol

Question 4

Nutrients absorbed in the colon

Answer 4

Vitamin K
Sodium
Water

Question 5

GI investigations

Answer 5

Flexible Sigmoidoscopy

Stool Sample (microbiology, calprotectin and elastase) - IBD

Colonoscopy

PR exam

LFTs, FBCs, U+Es

FIT Testing (fecal immunochemical test): screening test for colon cancer

Question 6

What is ulcerative colitis

Answer 6

a long-term condition that results in inflammation and ulcers of the colon and rectum. The primary symptoms of active disease are abdominal pain and diarrhoea mixed with blood. Weight loss, fever, and anaemia may also occur. Often, symptoms come on slowly and can range from mild to severe. It is typically diagnosed with a colonoscopy and biopsies.

Question 7

What is IBS

Answer 7

a group of symptoms—including abdominal pain and changes in the pattern of bowel movements without any evidence of underlying damage. It has been classified into four main types depending on whether diarrhoea is common, constipation is common, both are common, or neither occurs very often. Cause is unknown but believed to be largely psychologically related. It is largely managed through diet, mental health support, and painkillers/antispasmodics.

Question 8

What is Crohn’s

Answer 8

Crohn’s disease is a type of inflammatory bowel disease (IBD) that may affect any segment of the gastrointestinal tract from the mouth to the anus. While the causes of Crohn’s disease are unknown, it is believed to be due to a combination of environmental, immune, and bacterial factors in genetically susceptible individuals. Smokers are 2x more likely to get Crohn’s. There are no medications or surgeries to treat it but sufferers must be monitored for bowel cancer

Question 9

What is diverticular disease

Answer 9

Diverticula are small bulges or pockets that can develop in the lining of the intestine as you get older. If the diverticula become inflamed or infected, causing more severe symptoms, it’s called diverticulitis. Symptoms of diverticular disease include:
tummy pain, usually in your lower left side, that tends to come and go and gets worse during or shortly after eating (emptying your bowels or passing wind eases it)
constipation, diarrhoea, or both
occasionally, blood in your poo

Question 10

Causes of slimy stools

Answer 10

Excess mucus in the stool might be a sign of a gastrointestinal (GI) problem. Dehydration and constipation may also produce excess mucus, or at least give the appearance of increased mucus

Question 11

Causes of loose stools

Answer 11

Diarrhoea happens when the large colon is unable to absorb all of the water from the waste passing through it. In people with some types of IBD the colon often becomes ulcerated and inflamed during a ‘flare’, making it difficult for water to be absorbed. Because the stools are very watery they move more quickly through the colon - causing the urgency and frequency associated with diarrhoea.

Question 12

Smoking impact on gut health

Answer 12

Smoking increases the risk for Crohn’s disease and gallstones. It also increases the risk of more damage in liver disease. Smoking can also make pancreatitis worse

Question 13

Impact of fibre on gut health

Answer 13

Without adequate dietary fibre, you increase your risk of constipation. You may experience straining, lack of bowel movement and difficulty eliminating hard, dry stools. You may also feel bloated. Fibre helps move the stool along the digestive tract.

Question 14

Impact of stress on gut health

Answer 14

When a person becomes stressed enough to trigger the fight-or-flight response, for example, digestion slows or even stops so that the body can divert all its internal energy to facing a perceived threat. In response to less severe stress, such as public speaking, the digestive process may slow or be temporarily disrupted, causing abdominal pain and other symptoms of functional gastrointestinal disorders. Of course, it can work the other way as well: persistent gastrointestinal problems can heighten anxiety and stress

Question 15

Medications for IBD

Answer 15

Loperamide – relieves diarrhoea
Immunosupressants – reduce immune response
Biologics – reduce immune response specifically
Antibiotics – reduces infection
Aminosalicylates – anti-inflammatory agents
Steroids – anti-inflammatory agents

Question 16

What is familial adenomatous polyposis

Answer 16

leads to the growth of hundreds to thousands of non-cancerous (benign) polyps in the colon and rectum. Overtime, the polyps can become cancerous (malignant), leading to colorectal cancer at an average age of 39 years. Symptoms of FAP may include dental abnormalities, tumors of the connective tissue (desmoid tumors), and benign and malignant tumors of the duodenum (a section of the small intestine), liver, bones, skin, and other tissues. Attenuated familial adenomatous polyposis (AFAP) is a milder form of FAP which includes fewer colon polyps (an average of 30). People with AFAP have an increased risk of developing colon cancer at a later age than classic FAP. FAP is due to genetic variants in the APC gene and is inherited in an autosomal dominant pattern.

Question 17

What is lynch syndrome

Answer 17

a genetic disorder that causes an increased risk of developing certain types of cancer such as colon and rectal cancer, as well as cancers of the stomach, small intestine, liver, gallbladder ducts, upper urinary tract, brain, skin, and prostate. Women with Lynch syndrome also have a high risk of developing uterine cancer (also called endometrial cancer) and ovarian cancer. Even though the disorder was originally described as not involving noncancerous (benign) growths (polyps) in the colon, people with Lynch syndrome may occasionally have colon polyps.

Question 18

Symptoms of colorectal cancer

Answer 18

The 3 main symptoms of bowel cancer are:
• persistent blood in your poo – that happens for no obvious reason or is associated with a change in bowel habit
• a persistent change in your bowel habit – which is usually having to poo more and your poo may also become more runny
• persistent lower abdominal (tummy) pain, bloating or discomfort – that’s always caused by eating and may be associated with loss of appetite or significant unintentional weight loss

Question 19

Risk factors for bowel cancer

Answer 19

• age – almost 9 in 10 people with bowel cancer are aged 60 or over
• diet – a diet high in red or processed meats and low in fibre can increase your risk
• weight – bowel cancer is more common in overweight or obese people
• exercise – being inactive increases your risk of getting bowel cancer
• alcohol – drinking alcohol might increase your risk of getting bowel cancer
• smoking– smoking may increase your chances of getting bowel cancer
• family history – having a close relative (mother or father, brother or sister) who developed bowel cancer under the age of 50 puts you at a greater lifetime risk of developing the condition; screening is offered to people in this situation, and you should discuss this with a GP

Question 20

Treatments for bowel cancer

Answer 20

• surgery – the cancerous section of bowel is removed; it’s the most effective way of curing bowel cancer and in many cases is all you need
• chemotherapy – where medicine is used to kill cancer cells
• radiotherapy – where radiation is used to kill cancer cells
• targeted therapies – a newer group of medicines that increases the effectiveness of chemotherapy and prevents the cancer spreading