CT 2.2 Altered Bowel Habit Flashcards
diarrhoea can be classified into acute, persistent and chronic. what are the time frames for each of these
acute < 2 weeks
persistent 2-6 weeks
chronic > 6 weeks
what are the infective causes of diarrhoea
viruses - norovirus, rotavirus and adenovirus
bacteria - salmonella, shigella, e.coli and campylobacter, c diff
parasites - giardia, Entamoeba histolytica and cryptosporidium
what are food related causes of diarrhoea
gastroenteritis
coeliacs
excessive alcohol and caffeine
what medical conditions can cause diarrhoea
IBS
IBD
hyperthyroid
pancreatic insufficiency or chronic pancreatitis
diverticulitis
what investigations would you do for diarrhoea
rectal exam
stool culture
FBC, CRP + BCP blood chem panel
colonoscopy
small bowel enema
duodenal biopsy
what are some causes of constipation
chronic idiopathic constipation
IBS
diet and lifestyle
drugs eg opioids, anti-cholinergics, antacids, iron supplements + diuretics
mechanical obstruction by cancer, strictures or volvulus
neurological - parkinsons, MS and stroke, autonomic neuropathy
hypothyroid, hypercalcemia
what investigations can be carried out for constipation
FBC - as an initial baseline
thyroid function tests
serum calcium
DRE - rectal masses or faecal impaction
imaging
colonic transit studies
defecating proctogram - look for rectal prolapse
anorectal manometry (evaluates anorectal pressure)
treatments for constipation
Correct underlying metabolic causes
Dietary advice
Laxatives
Biofeedback
Colonic irrigation
Surgery (severe cases only)
what are the extra-intestinal manifestations of crohns
Arthritis
Ankylosing spondylitis
Iritis
Aphthous ulcers
Erythema nodosa
Nephrolithiasis
what criteria is used for constipation
rome II
Straining more than 25% time
Lumpy or hard stool >25% time
Anorectal blockage
Incomplete evacuation
Need for manual manouvres
< than 3 stools per week
How is UC classified on mild, mod and severe
mild <4 times diarrhoea, no anaemia, fever or tachycardia
mod - 4 times or less but small amount of blood in stool
severe - >6, blood, fever, anaemia and tachycardia present
investigations for IBD
Clinical history & examination
FBC/BCP/CRP/stool culture
Rigid sigmoidoscopy (biopsy)
Colonoscopy (biopsy) / Barium enema
Small bowel enema
CT scanning
IBD treatment
5 Aminosalicylic acid
Steroids Prednisolone Budesonide
Azathioprine/ 6 mercaptopurine
Cyclosporine (Ulcerative colitis)
Infliximab (Crohns)
what is IBS
Chronic gastrointestinal symptoms in patients without significant infectious, metabolic or anatomical abnormalities
symptoms of IBS
Fewer than 3 bowel motions per week
More than 3 bowel motions per day
Hard or lumpy stools
Loose or watery stools
Straining during bowel movement
Urgency
Passing mucus
Abdominal bloating and swelling
