1
Q

Causes of bloody diarrhoea

A

VASCULAR - ischaemic colitis
INFECTIVE - campylobacter, shigella, salmonella, E. coli, amoeba, pseudomembranous colitis
INFLAMMATORY - UC, Crohn’s
NEOPLASTIC - CRC, polyps

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2
Q

C diff

  • gram stain
  • toxins
  • spore survival time
A
  • Gram -ve spore-forming anaerobe
  • releases enterotoxins A and B
  • Spores can survive for >40 days
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3
Q

risk factors for c diff infection

A
  • Abx especially clindamycin, cefs, augmentin and quinolones
  • increased age
  • increased length of hospital stay
  • PPIs
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4
Q

Pseudomembranous Colitis

A

Complication of c. difficile infection

  • Severe systemic symptoms: fever, dehydration
  • abdo pain, bloody diarrhoea, mucus PR
  • Pseudomembranes (yellow plaques) on flexi sig
  • Complications:
  • -Paralytic ileus
  • -Toxic dilation -> perforation
  • -Multi-organ failure
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5
Q

treatment of c. difficile pseudomembranous colitis

A

GENERAL

  • stop causative abx
  • Avoid antidiarrhoeals and opiates
  • Enteric precautions
1ST LINE
- Metro 400mg TDS PO for 10-14 days
2ND LINE (if failed metro)
- Vanc 125mg QDS PO for 10-14 days
SEVERE
- Vanc 1st line +/- metro IV
- Urgent colectomy may be needed if:
-- toxic megacolon
-- increased LDH
-- deteriorating

RECURRENCE (15-30%)

  • Reinfection or residual spores
  • Repeat metro course for 10-14 days
  • Vanc if further relapse
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6
Q

Causes of constipation

OPENED IT

A
OBSTRUCTION
-Mechanical - adhesions, hernia, Ca, inflammatory strictures, pelvic mass
-Pseudo-obstruction: post-op ileus
PAIN
-anal fissure
-proctalgia fugax (idiopathic anal pain)
ENDOCRINE/ELECTROLYTES
- Endo: hypothyroid
- Elec: low calcium/potassium, uraemia
NEURO
- MS
- Myelopathy
- Cauda equine
ELDERLY
DIET/DEHYDRATION
IBS
TOXINS
- Opioids
- anti-mACh
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7
Q

Definition of IBS

A

Disorders of enhanced visceral perception -> bowel symptoms for which no organic cause can be found

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8
Q

ROME criteria for IBS

A

Abdo discomfort/pain for more than 12 weeks which has two of:

  • Relieved by defecation
  • Change in stool frequency
  • Change in stool form

Plus two of:

  • urgency
  • incomplete evactuation
  • abdo bloating / distension
  • mucus PR
  • worsening symptoms after food

EXCLUSION CRITERIA

  • over 40
  • bloody stool
  • anorexia
  • weight loss
  • diarrhoea at night
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9
Q

Inflammatory causes of dysphagia

A
  • Tonsillitis, pharyngitis
  • Oesophagitis: GORD, candida
  • Oral candidiasis
  • Aphthous ulcers (idiopathic)
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10
Q

Mechanical causes of dysphagia

A
LUMINAL
food bolus
MURAL
web
oesophagitis
trauma
malignancy
pharyngeal pouch
EXTRA MURAL
Lung Ca
rolling hiatus hernia
mediastinal lymph nodes
retrosternal goitre
thoracic aortic aneurism
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11
Q

Motility disorders causing dysphagia

A
LOCAL
achalasia
diffuse oesophageal spasm
nutcracker oesophagus
bulbar/pseudobulbar palsy (CVA, MNA)
SYSTEMIC
systemic sclerosis/ CREST
myasthenia gravis
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12
Q

pathophysiology of achalasia

A

degeneration of myenteric plexus (Auerbach’s) -> decreased peristalsis -> lower oesophageal sphincter fails to relax

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13
Q

Presentation of achalasia

A

Dysphagia: liquids and solids at same time
Regurgitation
Substernal cramps
Weight loss

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14
Q

Treatment of achalasia

A
  • calcium channel blockers, nitrates
  • endoscopic balloon dilatation, botox injection
  • Heller’s cardiomyotomy
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15
Q

Pharyngeal pouch - Zenker’s Diverticulum definition

A

Outpouching of oesophagus between upper border of cricopharyngeus muscle and lower border of inferior constrictor of pharynx

Weak area called Killian’s dehiscence

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16
Q

ALARM symptoms in dyspepsia

A
Anaemia
Loss of weight
Anorexia
Recent onset progressive symptoms
Melaena or haematemesis
Swallowing difficulty