Change In Bowel Habit Flashcards
Name the main arterial blood supply associated with each embryological region of the GI tract. (3)
Foregut - coeliac trunk
Midgut - superior mesenteric artery
Hindgut - inferior mesenteric artery
What are the primary functions of the large intestine? (3)
Absorbing water and electrolytes
Producing and absorbing vitamins
Forming and propelling faeces toward the rectum
Where does the large majority of food digestion and absorption take place?
The small intestine
What is the main function of the small intestine? (1)
Absorption of nutrients and minerals from food.
Give one autoimmune cause of diarrhoea.
Coeliac disease
What are two neoplastic causes of diarrhoea?
Bowel cancer
Ovarian cancer
Give one endocrine cause of diarrhoea.
Thyrotoxicosis
What are some of the main early warning signs in colorectal cancer? (6)
-Rectal bleeding, either bright/dark red in colour
- Tenesmus (feeling that you have to empty your bowel but nothing passes)
- Anaemia caused by iron deficiency
- Persistent abdominal pain/distension
- Unexplained weight loss
- Unexplained appetite changes
What are diverticulae?
Small outpouches of the mucosa of the colon, through its muscular wall.
What is the difference between diverticulosis, diverticular disease and diverticulitis?
Diverticulosis —> asymptomatic presence of diverticulae
Diverticular disease —> patients with diverticulosis who become symptomatic (most commonly with abdominal pain)
Diverticulitis —> complication of diverticulosis where inflammation and/or infection occur.
What symptoms effectively rule out Inflammatory Bowel Syndrome (IBS)? (2)
Weight loss
Rectal bleeding
What population demographic are most commonly affected by Irritable Bowel Syndrome (IBS)?
Females between 20 and 30 years old.
What tests should be undertaken to exclude other diagnoses in people who meet the NICE Inflammatory Bowel Disease (IBD) Diagnostic Criteria? (4)
-Full blood count
-Erythrocyte sedimentation rate (ESR) or plasma viscosity
-C-reactive protein (CRP)
-Antibody testing for coeliac disease (EMA or TTG testing)
What pharmacological therapies are available for Irritable Bowel Syndrome (IBS)? (6)
-Antispasmodic agents taken as required
-Laxatives for constipation (NOT lactulose)
-Linaclotide if previous laxatives haven’t worked
-Loperamide (antimotility agent for diarrhoea)
-Tricyclic antidepressants (second line if none of above have helped)
-Selective serotonin reuptake inhibitors (if TCAs ineffective)
What is the first line investigation for suspected colorectal cancer in adults, used to guide subsequent referral?
Quantitative Faecal Immunochemical Testing (FIT)
What Faecal Immunochemical Testing (FIT) result would trigger referral of an individual using the 2 week wait suspected colorectal cancer pathway?
FIT Test result of at least 10 micrograms of haemoglobin per gram of faeces.
What is mesenteric ischaemia?
An acute or chronic problem where blood supply to the bowel is disturbed by arterial thrombosis or embolism.
Describe the nature of the pain seen in mesenteric ischaemia.
Severe pain, out of proportion with any physical examination findings, and associated with eating.
How can you differentiate between mechanical and functional bowel obstruction on auscultation?
Mechanical bowel obstruction —> bowel sounds become high pitched or ‘tinkling’
Functional bowel obstruction —> bowel sounds are absent
What are the NICE criteria for offering FIT tests to investigate bowel cancer? (3)
EITHER
-adult without rectal bleeding, aged >=50 with unexplained abdominal pain or weight loss
-adult aged <60 with changes in bowel habit or iron deficiency anaemia
-adult aged >=60 with anaemia without iron deficiency
In which half of the colon are more tumours diagnosed?
More tumours are diagnosed in the left half of the colon than in the right side.
Where is the most frequent site for colon tumours to be found?
The recto-sigmoid colon.
Which types of staging criteria are used for bowel cancer? (2)
TNM Staging and Dukes’ Criteria
What is the Dukes’ Staging System? (4)
Four groups of cancer features used to categorise the stage of bowel cancer an individual has, where A is an early stage and D is advanced:
A - cancer only in innermost bowel lining or slightly growing into muscle layer
B - cancer has grown through muscle layer of bowel
C - cancer has spread to at least one lymph node in area close to the bowel
D - cancer has spread to somewhere else in the body (such as liver or lungs)
What is synchronous metastatic disease?
Metastatic disease found at the time of diagnosis of the primary tumour.
How can a DRE exam discern between mechanical (physical) bowel obstruction and functional obstruction (where there is no bowel peristalsis)?
Mechanical obstruction - collapsed rectum on DRE (all bowel distal to obstruction will be collapsed)
Functional obstruction - entirety of bowel will be distended and capacious, including the rectum
What type of bowel obstruction may acute pancreatitis cause?
Functional bowel obstruction (ileus)
What are the main three potential causes of bowel obstruction?
Adhesions (small bowel)
Hernias (small bowel)
Malignancy (large bowel)
What is the initial management of bowel obstruction? (3)
‘Drip and suck’:
-Nil by mouth
-IV fluids to hydrate and correct electrolyte imbalances (‘drip’)
-NG tube with free drainage to allow stomach contents to freely drain and reduce risk of vomiting and aspiration (‘suck’)
What is the screening eligibility criteria for bowel cancer in the UK?
Everyone aged 60-74 years, every 2 years.
Which tests are used for screening as part of the national bowel screening programme?
FIT or faecal occult blood (FOB) test (depending on region of UK)
What are the two main types of Inflammatory Bowel Disease (IBD)?
Ulcerative colitis
Crohn’s disease
What are the general presenting features of Inflammatory Bowel Disease (IBD)? (5)
Diarrhoea
Abdominal pain
Rectal bleeding
Fatigue
Weight loss
What features differentiate Crohn’s Disease from Ulcerative Colitis? (5)
NESTS:
-No blood or mucus (PR bleeding less common)
-Entire GI tract affected
-‘Skip lesions’ on endoscopy
-Terminal ileum most affected and Transmural (full thickness) inflammation
-Smoking (as a risk factor)
