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CSI 16 Flashcards

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1
Q

In inflammatory diarrhoea what is found in the stool?

A

Faecal leukocytes

Occult blood

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2
Q

In non inflammatory diarrhoea what does the stool look like?

A

Watery and large in volume

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3
Q

How frequent is stool in non inflammatory diarrhoea?

A

Over 10-20 times a day

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4
Q

What is not found in stool in non inflammatory dairrhoea?

A

No tenesmus, blood in the stool, fever or faecal leukocytes

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5
Q

What size is the stool in secretory diarrhoea?

A

Larger

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6
Q

What size is the stool in osmotic diarrhoea?

A

Smaller

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7
Q

How does fasting affect secretory diarrhoea?

A

Doesn’t improve it

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8
Q

How does fasting affect osmotic diarrhoea?

A

Improves it

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9
Q

What are the 2 types of inflammatory diarrhoea?

A

Non infectious and infectious

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10
Q

What are the 2 types of non inflammatory diarrhoea?

A

Secretory and osmotic

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11
Q

What are the 2 types of osmotic diarrhoea?

A

Maldigestion and malabsorption

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12
Q

What are the main symptoms of inflammatory dairrhoea?

A

Mucoid and blood stool
Tenesmus
Fever

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13
Q

What is tenesmus?

A

Cramping rectal pain

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14
Q

What are the 3 classes of diarrhoea and what time periods distinguish them?

A

Acute (<14 days)
Persistent (>14 days)
Chronic (> 4 weeks)

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15
Q

What type of cause is IBS for diarrhoea? What does this mean?

A

Its a functional cause meaning symptoms are present but there is no structural change causing them

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16
Q

What is the cause of diarrhoea called if its a result of a structural change?

A

Organic cause

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17
Q

How much fluid enters the body everyday? From where?

A

1-2L from diet

6-7L from body secretions

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18
Q

How much fluid is excreted everyday?

A

0.1L

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19
Q

How much fluid is reabsorbed everyday?

A

Up to almost 9L (99% of what enters the body)

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20
Q

What are the 2 cells types involved in diarrhoea and how do they contribute to its cause?

A

Enterocytes- these absorb solutes etc so lack of this can cause diarrhoea as lack of solute absorption means osmolarity in enterocytes is low so water doesnt enter
Lumen cells- there can be fluid retention here if osmolarity is high due to high levels of solute

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21
Q

Whats the pathophysiology behind inflammatory diarrhoea?

A

The epithelium is destroyed due to inflammation that arises after infection so absorption is not possible via enterocytes

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22
Q

Whats the pathophysiology behind secretory diarrhoea?

A

There is altered ion transport across the mucosa, solutes remain in the lumen increasing osmolarity so water is not reabsorbed

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23
Q

Whats the pathophysiology behind malabsorption causing diarrhoea?

A

Food is digested but it contains components that cannot be absorbed, solutes and water are therefore held in the lumen

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24
Q

Whats the pathophysiology behind maldigestion causing diarrhoea?

A

Food is undigested due to things such as enzyme deficiency, nutrients therefore cannot be absorbed if they aren’t broken down and so solutes and water are held in the lumen

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25
What is the general treatment for inflammatory diarrhoea?
Anti inflammatories Antibiotics/virals for infections Oral rehydration
26
What is the general treatment for secretory diarrhoea?
Block channels that allow movement from enterocyte to lumen | Activate channels that allow movement from lumen to enterocyte
27
What is the general treatment for malabsorption causing diarrhoea?
Depends on the nature of malabsorption but options include Avoid foods you cant absorb Increase absorption via channels Steroids
28
What is the general treatment for maladigestion causing diarrhoea?
Enzyme replacement
29
Why is oral rehydration therapy so important?
The main reason diarrhoea kills is because of dehydration and massive solute loss, rehydration therapy helps with this
30
How does oral rehydration therapy work?
Giving one part sodium to 2 parts water allows sodium to move into enterocytes so water potential falls and reabsorption into enterocytes can begin again
31
What is the main difference between IBD and IBS?
IBD is an organic disorder IBS is a functional disorder (cause is identifiable as a structural change vs not)
32
What symptoms are specific to IBS?
Alternating constipation and diarrhoea Mucus in stool Bloating
33
What symptoms are specific to IBD?
Weight loss Fever Blood in stool Anaemia
34
What symptoms occur in both IBD and IBS?
Abdominal pain Fatigue Faecal urgency
35
What are gastrology investigations one can do when trying to diagnose someone?
``` FBC Urea and electrolytes CRP Liver function tests Colonoscopy Barium contrast ESR Stool sample Faecal occult blood test Antibody assay ```
36
What is FBC useful for in relation to gastro?
To look for anaemia and inflammation
37
What is a urea/electrolyte test useful for in relation to gastro?
To check renal function and electrolyte status
38
What is CRP useful for in relation to gastro?
Marker of infection or inflammation
39
What is colonoscopy useful for in relation to gastro?
Checking for cancer or coeliac disease
40
What is a stool sample useful for in relation to gastro?
Check for bacteria and infection
41
What is a faecal occult blood best useful for in relation to gastro?
For checking if there is non visible blood present in the stool
42
When is faecal occult blood test used in gastro?
If there is no blood visible present, in older patients, when IBD or colorectal cancer may be suspected
43
What is antibody assay useful in relation to gastro?
When screening for coeliac disease
44
When is faecal calproctectin raised?
In IBD, coeliac or colon cancer
45
Is faecal calproctectin specific or non specific?
Non specific, it doesn't tell you the exact cause
46
What is faecal calproctectin?
A surrogate marker of inflammation in the bowel
47
What pathophysiology underlies raised faecal calproctectin?
Neutrophils moving into the bowel
48
How is Crohn's disease characteristically described?
Non continuous, granulomatous, deep inflammation
49
What are granulomas?
Aggregations of neutrophils
50
Where in the GI tract is affected by Crohn's?
Anywhere from the mouth to the anus
51
Where in the GI tract is affected by UC?
Starts at the rectum and extends upwards continuously but doesn't extend past the large bowel (may rarely invade ileum)
52
What happens to the no of goblet cells in Crohn's?
Increases
53
When doe Crohn's present?
Often in children but can also present in teenage years and as an adult without any childhood history too
54
How is appearance of the tract commonly described in Crohn's?
Cobblestone appearance
55
How is appearance of the tract commonly described in UC?
Pseudo polyps
56
What causes pseudo polyps to arise in UC?
Cycle of inflammation and scarring
57
What is seen in histology in Crohn's?
Granulomas
58
What is seen in histology in UC?
Crypts abcesses
59
What layers of the gut does UC affect? Whats the clinical significance of this?
Confined to mucosa and submucosa, this increases risk of colorectal cancer
60
What layers of the gut does Crohn's affect? Whats the clinical significance of this?
Transmural- it can affect all layers of the bowel (mucosa, submucosa, muscularis and serosa), this means fistulas can form
61
What are fistulas?
Abnormal connections from a hollow tube to somewhere else
62
What does the conservatory management of Crohn's involve?
Stop smoking Dietary advice Psychological help eg support groups
63
How is an acute flare up of Crohn's treated?
Corticosteroids but only short term to induce remission
64
How is Crohn's treated medically long term?
Azothiopine and biologics
65
Why may surgery be needed in Crohn's?
Due to risk of strictures or fistulas but they should be left as late as possible as chance of needing more surgery will only increase
66
What pharmacological medicines can make Crohn's worse?
Anti inflammatories like ibuprofen | Medicines to relieve stomach cramps or diarrhoea eg loperamide
67
What vaccinations are recommended for those with Crohn's and why?
The flu jab every year and the once off pneumococcal vaccine
68
What vaccinations are not recommended for those with Crohn's and why?
Live vaccines eg MMR as they could make you more ill
69
How is pregnancy affected by Crohn's?
It isn't much but women should tell their GP if they are planning to get pregnant or if they get accidentally get pregnant as some Crohn's medications can harm the baby
70
How is female fertility affected by Crohn's?
It shouldn't be much but it might be harder to get pregnant during a flare up
71
How is male fertility affected by Crohn's?
Some medications can temporarily reduce fertility in men
72
How is contraception affected by Crohn's?
Some types might not work as well eg the pill
73
Why might malnutrition arise in Crohn's?
There is difficulty absorbing nutrients from food and people might be put off food because of diarrhoea and other symptoms, this can lead to osteoporosis and iron deficiency anaemia
74
What is the relationship between bowel cancer and Crohn's? How is this managed
Risk increases in those with Crohn's Risk is low at first and increases the longer you have the condition This is managed by screening for cancer regularly if the patient has had Crohn's for more than 10 years via colonoscopies

CSI Y2 (3 decks)

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