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Z Year3 Clinical Presentations > Diarrhoea 2 > Flashcards

Diarrhoea 2 Flashcards

1
Q

What signs do you look for on examination with diarrhoea?

A
  1. Clubbing
  2. Iritis? Episcleritis? Scleritis
  3. Mouth ulcers
  4. Eryhema nodusm
  5. Dermatitis herpetiformis
  6. Virchow’s lympahdenopathy
  7. Abdominal Msas
  8. Anal ulcers or fistulae
  9. DRE
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2
Q

What would clubbing and diarrhoea suggest?

A
  1. Crohn’s disease
  2. UC
  3. hyperthryoidism
  4. coeliac disease (unlikely)
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3
Q

What would Iritis (anterior uveitis), Episcleritis, Scleritis with diarrhoea suggest?

A

UC and Crohn’s

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4
Q

What would mouth ulcers and diarrhoea suggest?

A

Crohn’s produces ulcers anywhere GI tract mouth to anus

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5
Q

What would erythema nodusum and diarrhoea suggest?

A
  1. Crohn’s and UC

2. COCP can also cause this in young women

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6
Q

What would dermatitis herpetiformis and diarrhoea suggest?

A

scalp and on extensor surfaces of limbs very itchy signs of coeliac disease

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7
Q

What would Virchow’s lymphaednopathy suggest with diarrhoea?

A

bowel malignancy that has spread

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8
Q

What would mass in RLQ with diarrhoea suggest?

A

Crohn’s (due to inflammation of terminal ileum)

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9
Q

What would mass elsewhere esp LLQ with diarrhoea suggest?

A

malignancy

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10
Q

What would anal ulcers and fistulae with diarrhoea suggest?

A

Crohn’s (patient may be unaware of these so inspect)

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11
Q

Why do you peform a DRE with diarrhoea?

A
  1. causes of obstruction for overflow diarrhoea esp malignant recta carcinoma
  2. check if feaces is mucoid or bloody
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12
Q

What blood tests should you do for diarrhoea?

A
  1. FBC
  2. ESR
  3. CRP
  4. TTG and IgA levels
  5. TFTs
  6. U+Es
  7. Albumin
  8. Capillary glucose
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13
Q

What would anaemia on FBC with diarrhoea suggest?

A
  1. coeliac disease
  2. UC
  3. Crohn’s
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14
Q

When is ESR elevated?

A

UC and Crohn’s

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15
Q

When is CRP elevated?

A

UC, Crohn’s, infectious diarrhoea

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16
Q

Why do you carry out a TTG?

A

positive result has sensitivity and specificity of over 90% for coeliac disease

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17
Q

Why do you measure IgA?

A
  1. IgA can cause false negative for TTG if deficient

2. Antigliadin antibodies can also be used instead of TTG but they are less specific and sensitive

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18
Q

What TFTs would suggest hyperthyroidism?

A

ow TSH but high T3/T4

19
Q

Why do you measure U+Es?

A

may be suffering electrolyte loss and be dehydrated

20
Q

When is albumin low?

A

patients with chronic diarrhoea and malabsoprtion e.g. IBD

21
Q

Why do you measure capillary glucose?

A

easy, quick and checks if patient diabetic

22
Q

What feaces tests do you carry out for diarrhoea?

A
  1. Feaces microscopy and culture
  2. C.diff toxin test
  3. FOBT
23
Q

Why do you carry out feaces microscopy and culture?

A
  1. exclude infection (can be false neg in Giardia)

2. pus cells visible can indicated inflammation in IBD

24
Q

When do you carry out a c.diff toxin test?

A

if recent antibiotic use

25
Q

What does it mean if FOBT comes back positive?

A
  1. Infection or UC

2. Less likely to be hyperthyroidsm, coeliac disease and IBS

26
Q

When can you request a FOBT?

A

after stopping drugs that cause bleeding (e.g. aspirin and warfarin as can give false positive)

27
Q

What is key difference between Crohn’s and UC?

A
  1. UC: bloody diarrhoea and pain diffuse
  2. Crohn’s: abdominal pain starts in RLQ and no bloody diarrhoea - more likely to have weight loss and failure to thrive between attacks
28
Q

What are second line investigations to confirm or exclude Crohn’s disease?

A
  1. ABX
  2. Colonscopy
  3. Double contrast barium enema
29
Q

What could a ABX show?

A
  • bowel inflammation

- check if UC toxic megacolon

30
Q

What can a colonoscopy visualise in crohn’s?

A

discrete interuppted lesions of Crohn’s disease (or diffuse, erythematous inflammation of UC)

31
Q

What action does colonscopy allow you to take?

A

biopsies to be taken in search of non-caesating granulomas in bowel mucosa (hallmark of Crohn’s)

32
Q

When do you do a DCBE?

A

when colonoscopy not possible

33
Q

What could a DCBE show in crohn’s?

A

discrete lesions and strictures in colon suggestive of crohn’s

34
Q

What are the symptoms of Crohn’s due to?

A

chronic activation of immune system in various tissues (e.g. bowel wall)

35
Q

What is the sequelae of Crohn’s?

A
  1. abcesses
  2. fistulae
  3. strictures
  4. adhesions
  5. perforation
36
Q

What type of medicine is used to treat Crohn’s?

A

immunosuppressants

37
Q

What steroid-sparing immunosuppressants are used to treat Crohn’s LT?

A
  1. methotrexate (folate antagonist)
  2. azathioprine (purine synthesis inhibitors
  3. Anti-TNF alpha monoclonal antibodies (infliximab)
38
Q

Why are steroid-sparing immunosuppressants used?

A
  1. avoid steroid complications (diabetes, osteoperosis, cataracts)
  2. steroids don’t modify disease or induce sustained mucosal healing
39
Q

Do patients with Crohn’s need surgery?

A
  1. ultimately need to surgery to resect most affected portion of bowel
  2. BUTit is temporary
  3. so medical management better and more important
40
Q

What is the cause of Crohn’s?

A

mutations in genes responsible for cleaning up phagocytosed bacteria

41
Q

What happens to this bacteria in Crohn’s?

A
  1. inability of macrophages to correctly clear bacteria they ingest leads to them secreting cytokines
  2. that make the immune system try to wall off the aberrant situation forming a granuloma
42
Q

What does a granuloma lead to?

A

chronic inflammation

43
Q

What does are the local effects of this?

A
  1. diarrhoea
  2. ulcers
  3. strictures of bowel
  4. fistulae between bowel and other compartments
44
Q

What are the systemic complications of Crohn’s?

A
  1. inflammation of eyes (iritis, episcleritis, scleritis)
  2. the joins (arthritis)
  3. skin (erythema nodosum)
  4. anaemia (either from malabsorption or chronic inflammation)
  5. weight loss
  6. fatigue

Z Year3 Clinical Presentations (37 decks)

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