Gastroenterology Flashcards
List two predisposing factors for IBS
History of GI infection
Genetic
Adverse childhood events or psych factors
female
What are the red flags for change in bowel habit?
> 50
rectal bleeding
weight loss
family history bowel/ovarian cancer
change in bowel habit
What is the three step process for diagnosing IBS?
- Suspect diagnosis- symptoms abdo pain, bloating, change in bowel habit for over 6 months
- Exclude other conditions
- Positive diagnostic criteria for IBS
List three investigations for change in bowel habit
FBC, coeliac, CRP
Faecal calprotectin
FIT- for those WITHOUT rectal bleeding
CA125
List two positive diagnostic criteria for IBS
- Abdo pain relieved by defaecation
- Change in stool frequency
- Altered stool passage- straining, urgency…
- Abdo bloating, distension, hardness
- Symptoms worsened by eating
- Passage of mucus
List the three types of IBS
IBS-D= diarrhoea predominant
IBS- C= constipation
IBS-mixed
List three options for the management of IBS
Lifestyle- diet and exercise
Antispasmodics for pain
Laxatives for constipation
Loperamide for diarrhoea
TCAs
SSRIs
Define dyspepsia
Describes range of symptoms= indigestion
Discomfort or pain in upper abdomen after eating or drinking
What does univestigated dyspepsia mean?
dyspepsia that has not been investigated with endocscopy
List three differentials for dyspepsia
Functional dyspepsia
OEsophagitis
Oesophageal ulcers
Benign oesophageal strictures
Gastric or duodenal ulcers
Oesophageal or gastric cancers
Patient who is on NSAIDs and omeprazole requires endocoscopy. How long before the endoscopy should they stop taking these medications for?
2 weeks before endoscope
List the red flags for urgent endoscopy investigation to rule out cancer
Upper abdo mass (Stomach cancer)
Dysphagia
>55 with weight loss and upper abdo pain/reflux/dyspepsia
Haematemesis
Patient has experienced significant weight loss but upper GI endoscopy is normal. Which diagnosis should you consider?
Pancreatic cancer- urgent CT if weight loss, >60, and diarrhoea, nausea/vomiting, abdo pain, back pain, new onset diabetes!!!!
List three options for management of uninvestigated dyspepsia
NSAIDs
Corticosteroids
Nitrates
Theophyllines
Bisphosphonates
Lifestyle
State three lifestyle changes to manage univestigated dyspepsia
weight loss
smoking cessation
reduce alcohol, chocolate, coffee
avoid fatty foods
have evening meal well before bed
raised the head of the bed
Patient with dyspepsia has tried lifestyle modifications and NSAIDs but dyspepsia is still present. What should you do now?
Trial PPI for 1 month
There is no response to PPI treatment. What do you do now?
Test for H.pylori
List two methods for investigating H.pylori
Carbon-13 urea breath test
Stool antigen test
What is the H.pylori eradication regimen if person has not previously had antibiotics?
Clari or Met
Amox
Twice daily PPI
Patient has to stop using PPI for 2 weeks prior to H. pylori testing. What can you offer them as an alternative?
H2 receptor blocker
List two modifiable risk factors for bowel cancer
red meat and processed meat
obesity
alcohol
smoking
List two non-modifiable risk factors for colon cancer
male
older age
family history
IBD
diabetes
List one hereditary cancer that predisposes to bowel cancer
familial adenomatou polyposis FAP
hereditary non-polyposis colorectal cancer HNPCC
List two contraindications/disadvantages of colonoscopy
Bowel prep may decomponsate certain groups of patients e.g. heart failure, renal failure
May cause decreased absoroption of antiepileptics
Bowel prep may need to be done in hospital
