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Gastro YR3 > Diarrhoea Gastro Tutorial (2) > Flashcards

Diarrhoea Gastro Tutorial (2) Flashcards

1
Q

Commenest cause of gastroenteritis in UK

A

Campylobacter - common cause of bloody diarrhoea

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2
Q

Origin of Campylobacter bacteria

A
  • Chicken guts
  • Spread
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3
Q

Abx for severe Campylobacter infection

A

Clarithromycin - only if very unwell, if not conservative management

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4
Q

Treatment and investigation for suspected UC

A
  • Colonoscopy
  • Corticosteroids in flare up - prednisolone
  • 80% of people feel 80% better after 2 weeks of steroids
  • If no improvement - complication can be toxic megacolon
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5
Q

Toxic megacolon management

A
  • Fluids - 6L probably for 24hrs (3x saline and 3x dextrose, 20mmol of K+ added to each bag so 120 total due to high K+ losses)
  • Biologics - Anti-TNF alpha eg Infliximab to try and save colon
  • If no improvement in 24-48hrs –> colectomy
  • But doing CRP and abdo x-ray regularly to see improvement
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6
Q

What is a Crohn’s mass and how to manage ?

A
  • Inflamed loops of small bowel stick together + omentum = hard
  • If perforates can cause abscess - assess this using CT scan
  • If just Crohns - steroids
  • If abscess - surgery needed
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7
Q

Differentials for mass felt in RIF with diarrhoea and abdo pain

A
  • Crohns
  • GI cancer
  • Constipation - check if caecum is indentable?
  • Chronic appendicitis?
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8
Q

Test to differentiate IBS and IBD

A
  • Faecal calprotectin - if negative likely to not be IBD as VERY sensitive test
  • BUT cannot tell between acute infection and chronic inflammation so careful as someone with IBS may just have gastroenteritis so test comes back +ve
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9
Q

Test to rule out coeliac disease

A
  • Anti tissue transglutaminase antibody blood test
  • Need to do total IgA alongside this - otherwise useless if low
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10
Q

Definitive test for coeliac disease and findings

A
  • Endoscopy of 2nd part of duodenum
  • Increased lymphocytes
  • Flattened villi
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11
Q

How to assess whether diarrhoea is overflow diarrhoea or IBS?

A
  • Take bloating history
  • If bloating not present in morning but then worsens throughout day = IBS
  • If bloating present overnight until morning = constipation overflow diarrhoea. Bloating will not subside until stool is passed
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12
Q

Causes of constipation

A
  • Avoiding poo reflex too often - this then stops happening as often and feel need to go less and less –> constipation
  • Diet - lack fibre
  • Lack exercise
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13
Q

Cause of long term steatorrhoea and weight loss after visit to foreign country

A
  • Giardia lamblia - parasite infection
  • Causes malabsorption (hence steatorrhoea due to lipid in faeces) from presence of Giardia
  • From contaminated water sources
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14
Q

Treatment for Giardia infection

A

Metronidazole

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15
Q

How to know when diarrhoea is caused by toxin

A

Effects are immediate - very fast
Usually contaminated by Staphylococcus on skin - produces toxins with are heat stable
Everytime reheat and cool food = multiplies, more and more toxin
Eg esp with kebabs

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16
Q

How to test for C.diff?

A

C difficile toxin A and B test on stool sample via PCR or enzyme immunoassay
C.difficile antigen (specifically glutamate dehydrogenase)

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17
Q

Treatment for C.diff

A

Oral vancomycin or metronidazole
2nd line -Fidaxomicin

18
Q

Fluids for C.diff

A
  • only large bowel affected
  • Not too dehydrated
  • 2-3L should be enough of half saline half dextrose with 40K+ added
19
Q

Likelihood of second c.diff infection after treatment

A

High - spores are resistant to abx, they germinate a lot when gut is treated with antibiotics as no flora to compete with

20
Q

Management of second C.diff infection

A
  • Do nothing if mild - let GI tract regain flora
  • If likely to be severe - treat with prophylactic vancomycin for 2 weeks following infection treatment
21
Q

Other cause of diarrhoea post abx apart from C.diff

A

The antibiotics themselves - can cause diarrhoea

22
Q

How can a low MCV be caused by GI issue?

A

Malabsorption - causes iron deficiency
= iron deficiency anaemia

23
Q

Main causes of malabsorption in UK

A
  • Crohns
  • Coeliac disease
  • Pacreatitis - eg from alcohol or gall stones
24
Q

`

Test for pancreatitis

A

Faecal elastase

25
Q

Test for coealic disease

A

Coeliac serology - anti-TTG
Then gastroscopy with duodenal biopsy to see if flattened villi

26
Q

Cause of triad of facial flushing, wheezy breathlessness and diarrhoea

A

Carcinoid syndrome - from neuroendocrine tumour in GI tract releasing serotonin hormones

27
Q

Where do neuroendocrine tumours causing carcinoid syndrome often begin

A
  • Start small/large bowel or appendix
  • Spread to liver via portal vein = nodular, hard enlarged liver
28
Q

At what point do neuroendocrine tumours cause carcinoid syndrome

A
  • After spread to liver
  • When just in GI tract, hormones go via portal vein and are broken down in liver so no effects
  • When in liver, travel via hepatic vein systemically = carcinoid syndrome
29
Q

Treatment for carcinoid syndrome

A

Somatostatin analogue - off switch for endocrine system eg Lanreotide (Somatuline) injection every 3 weeks

30
Q

Causes of hepatomegaly in exams

A
  • Carcinoid syndrome
  • Polycystic liver - often have PCKD too
  • Myelofibrosis - large liver and spleen
31
Q

How to reassure someone they are experiencing overflow diarrhoea with proof?

A

Abdominal X-ray - will show bowel filled with faeces

32
Q

First line laxatives for overflow diarrhoea

A

Example bisacodyl
Give at night to stimulate bowel to work in morning
Then glycerine suppositoreis into rectum in morning

33
Q

How do glycerine suppositories work?

A
  • Dissolve in rectum
  • Draw water into rrectum
  • Distends rectum
  • Poo reflex initated
34
Q

What is obstructive defaecation syndrome?

A

When someones anal sphincter does not relax or even contracts when they push out faeces
Often due to previous sexual abuse

35
Q

Cause of bronw pigmentation if seen on colonoscopy

A
  • Called melanosis coli
  • Caused by excessive senna based laxative use
  • Can do laxative screen on urine if suspect this
36
Q

What happens following cholecystectomy sometimes to faeces?

A
  • get diarrhoea
  • Usually bile acids reabsorbed at terminal ileum
  • For some reason they are not sometimes after this operation
  • Large bowel secretes water into lumen in response to bile acids being there
  • = diarrhoea
37
Q

Treatment for bile acid malabsorption

A

Questran - Cholestyramine - bile acid sequestrants, bind them and make them inert

38
Q

Dose of questran importance

A

Too much - do not absorb lipids properly = steatorrhoea
Too little - still get diarrhoea

39
Q

Treatment options for UC flare up

A
  • Oral steroids or mesalazine enemas
  • If no better try a biologic
    OR
  • If get better but then relapse try Azathioprine
  • LAST option - colectomy

Do stool sample culture at presentation in case of infection

40
Q
A

Gastro YR3 (10 decks)

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