Diarrhoea Flashcards

Question

Investigations in suspected coeliac

Answer 1

-Upper GI endoscopy and biopsy

Answer 2

-MRI enterography or capsule endoscopy -CT if MRI or VCE not possible

Answer 3

-Weight loss -Significant progressive change in bowel habit -Urgency nocturnal -Persistent PR bleeding

Answer 4

-ROME IV criteria: Recurrent abdominal pain, on average, at least 1 day per week in the last 3 months (with symptom onset at least 6 months prior to diagnosis) which is associated with two or more or the following: =Related to defaecation; =Change in frequency of stool; =Change in stool form. -Patients are sub-grouped according to predominant Bristol stool type to help direct treatment: =IBS with diarrhoea (IBS-D). =IBS with constipation (IBS-C). =IBS with mixed bowel habits (IBS-M). =IBS unclassified (IBS-U) where symptoms meet the criteria for IBS but do not fall into one of the three subgroups above according to Bristol stool type.

Answer 5

For at least 6 months: -Abdominal pain, and/or -Bloating, and/or -Change in bowel habit A positive diagnosis of IBS should be made if the patient has abdominal pain relieved by defecation or associated with altered bowel frequency stool form, in addition to 2 of the following 4 symptoms: =altered stool passage (straining, urgency, incomplete evacuation) =abdominal bloating (more common in women than men), distension, tension or hardness =symptoms made worse by eating =passage of mucus Features such as lethargy, nausea, backache and bladder symptoms may also support the diagnosis =Red flag features should be enquired about: =rectal bleeding =unexplained/unintentional weight loss =Positive FIT, raised faecal calprotectin, IDA =family history of bowel or ovarian cancer =bowel habit change onset after 60 years of age, persistent or frequent bloating in females Suggested primary care investigations are: -full blood count -ESR/CRP -coeliac disease screen (tissue transglutaminase antibodies) -Assess for bowel cancer, ovarian cancer, IBD

Answer 6

-Full blood count (FBC) — to assess for anaemia, and a raised platelet count. -Inflammatory markers such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) — may be raised if there is active inflammation or infection. -Coeliac serology — to exclude coeliac disease, particularly if there is diarrhoea-predominant IBS or mixed symptoms. -Faecal calprotectin — in particular if the person has diarrhoea and is aged 45 years or younger to exclude inflammatory bowel disease. -Local and national referral guidelines for suspected colorectal or ovarian cancer should be followed, where indicated.

Answer 7

NICE/BDS IBS advice sheet Food diary Trial of GFD (bloating) Symptom guided approach FODMAP exclusion diet Transit studies Pro-kinetics (linaclotide/prucalpride) First-line pharmacological treatment - according to predominant symptom =pain: antispasmodic agents =constipation: laxatives but avoid lactulose =diarrhoea: loperamide is first-line -For patients with constipation who are not responding to conventional laxatives linaclotide may be considered, if: =optimal or maximum tolerated doses of previous laxatives from different classes have not helped and =they have had constipation for at least 12 months -Second-line pharmacological treatment =low-dose tricyclic antidepressants (e.g. amitriptyline 5-10 mg) are used in preference to selective serotonin reuptake inhibitors -Other management options =psychological interventions - if symptoms do not respond to pharmacological treatments after 12 months and who develop a continuing symptom profile (refractory IBS), consider referring for cognitive behavioural therapy, hypnotherapy or psychological therapy =complementary and alternative medicines: 'do not encourage use of acupuncture or reflexology for the treatment of IBS' -General dietary advice =have regular meals and take time to eat =avoid missing meals or leaving long gaps between eating =drink at least 8 cups of fluid per day, especially water or other non-caffeinated drinks such as herbal teas =restrict tea and coffee to 3 cups per day =reduce intake of alcohol and fizzy drinks =consider limiting intake of high-fibre food (for example, wholemeal or high-fibre flour and breads, cereals high in bran, and whole grains such as brown rice) =reduce intake of 'resistant starch' often found in processed foods =limit fresh fruit to 3 portions per day =for diarrhoea, avoid sorbitol =for wind and bloating consider increasing intake of oats (for example, oat-based breakfast cereal or porridge) and linseeds (up to one tablespoon per day).

Answer 8

-Malignancy -Functional or drug-induced constipation -Hypothyroidism -IBD -Coeliac -GI infection and secondary lactose intolerance -Antibiotic associated diarrhoea -Microscopic colitis -Bile acid malabsorption -Hyperthyroidism -Laxative misuse -Diverticular disease

Answer 9

-Context of the gut-brain axis and explain that IBS is a chronic condition with recurrent fluctuating symptoms which can be triggered by stress, intercurrent illnesses, medications and eating. -Reassure the person that IBS is not associated with an increased risk of cancer or mortality. -Explain that the aim of management is to improve symptoms (it may not relieve them completely) and quality of life — treatments are likely to be needed long term.

Answer 10

OGD D1 and D2 biopsies DEXA scan if significant weight loss GFD (gluten free diet) Dietician review GI review if ongoing/refractory symptoms

Answer 11

Colonoscopy (+OGD if <17yo) SBMRI Biologic screening Polymeric diet (CD) 5’ASA (UC) (steroids) Immunomodulators -AZA, 6-MP -methotrexate Biologic drugs -anti-TNF (infliximab, adalimumab) -anti-α4β7 (vedolizumab) -anti-IL-12/23p40 (ustekinumab) -tofacitinib (JAK inhibitor)

Answer 12

-Trial of antibiotics (e.g. rifaximin)

Answer 13

-Creon -DM control

Answer 14

-Vascular MDT

Diarrhoea Flashcards

(39 cards)