diarrhoea Flashcards
what have you missed out in history of diarrhoea ?
does she have any blood in the stool other than the mucus
any abdominal pain
any obstructive symptoms (vomiting)?
ay family history of gastrointestinal disease
my differential diagnosis of diarrhea
inflammatory bowe disease - such as churns or ulcerative colitis and diverticulitis
i would also keep in mind for celiac disease
anal cancer or gastroinetinstal cancers
gastroenteritis - salmonella , shigella , eccoli , yersnia
IBS
metabolic - hyperthyroidism
pancreatic insufficiency
investigations
bedside - stool culture enteric pcr and c.diff testing
feral calprotectin , decal elastase
vbg - to check lactate
bloods - fbc , ue , LFT , crp, amylase ,
blood culture
radiology - AXR first to r/o any perforation , obstructions nd toxic megaolon
this presentation would warrant for a CT abdomen - however i would discuss this first with my medical registrar
and COLONOSCOPY / FLEXI SIGMOIDOSCOPY if the symptom persists
managment of diarrhoea
I would start them on IV fluids
IV antibiotics ARE ONLY INDICATED IF THERE IS A POSITIVE BLOOD CULTURE
clinical signs of examination which may indicate IBD ?
ulcerative colitis :
blood in the stool
abdominal pain in the left lower quadrant
tensemus
CROhNS disease
mouth ulcers or anal ulcers
weight loss
evidence of renal oxalate stones - giving renal colic
or gall stones
any fistulas or anal fissures
anaemia
low vitamin B12 and vitamin D
for both
erythema nodosum
arthritis
pyoderma gangrenosum
uveitis,
ankylosing spondylitis
radiological features of IBS ?
small bowel enema for chrons
kantor string sign
rose thorn ulcer fistulas
proximal bowel dilation
barium enema - for UC
loss of haustrations
pseudopolyps
superficial ulcerations
severity of IBD (ULCERATIVE COLITIS)
severe >6 bloody stools a day
systemic features - such as pyrexia and tachycardia
albumin less than 30g/L
hb is low
toxic dilation
managment acute flare of UC ?
severe - IV STEROIDS (if contraindicated ciclospoin or no improvement after 72 hours add on ciclopsorin and discuss with surgery!!!
mild - moderate
just proctitis
topical rectal mesalazine
add oral no remission in 4 weeks
if no remission add topical or oral corticosteroids
proctosigmoiditis
topical rectal mesalazine
no remission - high dose oral mesalazine
no remission - stop topical treatment - go for oral steroid and oral mesalazine
extensive disease
topical and oral mesalazine
if no remission in 4 weeks - stop topical
oral steroid and aminosaliclate
chrons disease managmnet
induce remission with glucocrtciouds 0 through oral or IV
second line - mesalazine
azathioprine and mercapturine can be used as adjective therapy not stand alone and used for remission
inflixab in refectory and fistulating churns
STOP SMOKING
what signs on sigmoidoscopy /colonscopy diffnetaite UC from chrons ?
UC
no inflammation beyond the submucosa
widespread ulceration - and preservation of adjacent mucosa seen as pseudo polyps
predominantly affects the large colon and rectum no spread beyond the ileocecal valve
chrons
dep ulcers
skin lesion , cobble stone appearance
can affect the whole gastrointestinal tract - rectum frequently sparest
=== histology will confirm
UC
depletion of goblet cells
grandma infrequent
no inflammation beyond submucosa
crypt abcess
chrons
increased goblet cells and granulomas
inflammation in all layers from mucosa to serosa
does surgery have a role in IBD ?
UC
surgery - is curative
30 percent of UC will require a colectomy
Colonic perforation, uncontrollable bleeding, toxic megacolon and fulminating disease require urgent proctocolectomy.
colostomy bag
Surgery in Crohn’s disease
stricturing terminal ileal disease → ileocaecal resection
segmental small bowel resections
stricturoplasty
is not curative and is only indicated for perforation, obstruction, abscess formation and fistulae.
