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Year 3 > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

how is bilirubin produced in liver?

A

conjugated

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2
Q

clinical signs of conjugated hyperbilirubinaemia

A

jaundice
dark urine
pale stool
itch

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3
Q

what causes conjugated hyperbilirubinaemia

A

post-hepatic obstruction

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4
Q

causes of obstructive jaundice (5)

A

common: gallstones (biliary colic and cholecystitis/chalngitis), carcinoma of head of pancreas
uncommon: sclerosing cholangitis, cholangiocarcinoma, chronic pancreatitis

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5
Q

causes of hepatocellular jaundice

A

common: alcoholic hepatitis or cirrhosis, viral hepatitis, drug induced, NASH
uncommon: autoimmune liver disease, haemochromatosis, Wilson’s Disease

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6
Q

most likely diagnosis if rise in ALT, AST&raquo_space; rise in alkaline phosphatase (ALP)

A

hepatocelullar damage

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7
Q

most likely diagnosis if rise in ALT, AST &laquo_space;rise in alkaline phosphatase (ALP)

A

obstructive cause

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8
Q

organs of production of AST

A

liver (mitochondrial enzyme), heart, muscle, kidney and brain

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9
Q

ALT:AST ratio in disease

A
  • viral hepatitis: ALT>AST
  • viral hepatitis + cirrhosis: AST>ALT and ratio >1
  • alcoholic liver disease and steastohepatitis: AST>ALT
  • liver disease w/out cirrhosis (alcohol and obesity most common cause): AST>ALT
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10
Q

organs of production of alkaline phosphatase (ALP)

A

hepatic canalicular and sinusoidal membranes
bone
intestine
placenta

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11
Q

serum levels of ALP in intracellular and extracellular cholestatic disease

A

increased

if GGT abnormal, ALP presumed to come from liver

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12
Q

gamma-glumayl transpeptidase activation and serum levels

A

increased activity with drugs (phenytoin, warfarin and rifampicin) and alcohol

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13
Q

levels of alpha- fetoproteins in liver disease

A

raised in hepatocellular carcinoma

increased in pregnancy and regenerative liver tissue with hepatitis, chronic liver disease and teratomas

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14
Q

what is an alcohol unit?

A

10ml or 8g of pure alcohol

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15
Q

acute confusional state from alcohol withdrawal

A

delirium tremens: untreated can result in seizures and death

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16
Q

heme breakdown

A

heme –> (heme oxygenase)
biliverdin –> (biliverdin reductase)
bilirubin

by phagocytosis

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17
Q

what is CAGE

A
  • have you ever attempted to CUT down on drinking
  • do you ever get ANNOYED when people complain about your drinking
  • do you ever feel GUILTY about things you have done while drinking
  • do you ever need a drink to get going in the morning (EYE OPENER)
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18
Q

bilirubin excretion

A

conjugated bilirubin –> (bacteria) urobilinogen (unconjugated and colourless) –> stercobilin (brown) or urobilin (yellow)

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19
Q

increase unconjugated bilirubin cause

A

increase breakdown of RBC, Gilbert’s syndrome, haemolysis

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20
Q

causes of jaundice?

A
  • prehepatic: haemolysis (i.e. sick cell) (unconjugated)
  • hepatic: liver failure
  • post hepatic: obstructive (pale stools, dark nine, itch)
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21
Q

def hepatitis

A

liver inflammation

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22
Q

def cirrhosis

A

fibrosis of the liver

nodule formation

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23
Q

symptoms of acute hepatitis

A

unwell
jaundice
RUQ pain

confusion
coagulopathy (bruising)

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24
Q

symptoms of chronic hepatitis

A

often none
fatigue
low grade fever

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25
Q

def fulminant hepatitis

A

ACUTE hepatitis with liver failure

dvlpt of encephalopathy within 28 days of jaundice

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26
Q

blood test results in acute hepatitis

A

raised ALT/AST (>1000)
high bilirubin

(in severe cases):
coagulopathy
renal impairment

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27
Q

complications of cirrhosis

A

-loss of function:
jaundice (heme breakdown)
coagulopathy (clotting)
decreased drug metabolism (sedatives: benzos and opiates)
decreased hormone metabolism (increased levels of oestrogen)
increased sepsis (decreased immune)

-portal hypertension:
varices (oesophageal, caput medusa, piles)
ascites
encephalopathy (ammonia)
hepatorenal syndrome
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28
Q

normal venous portal pressure and portal pressure in portal hypertension

A

normal: 5-8 mmHg

in portal hypertension: 10-12 mmHg

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29
Q

symptoms present with decreased hormone metabolism (increased oestrogen)

A 
erythema
spider nevi
gynocomastia
loss of secondary body hair
shrinking external genitalia
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30
Q

causes of cirrhosis

A 
hazardous alcohol
chronic hep B and C 
autoimmune liver disease
haemachromatosis
Wilson's disease
chronic obstruction
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31
Q

why do you get leuconychia with liver disease

A

pale nails due to decreased albumin

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32
Q

alcoholic hepatitis symptoms and signs

A

jaundice
large tender liver
vomitting (feeling ill: not eating or drinking)

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33
Q

what must be the plasma concentration of bilirubin for jaundice to be clinically apparent

A

50 microM/L

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34
Q

how is bile released and how much is released in a day from liver?

A

CCK
vagal
–> response to food

500-1000 ml/day

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35
Q

composition of bile

A
  • 98% water
  • HCO3
  • bilirubin
  • bile salts/acids (derived from cholesterol)
  • metabolites of hormones and drugs
  • heavy metal ions
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36
Q

conjugation of bilirubin

A

in hepatocyte:

  • protein bound and conjugated with glucuronic acid (by glucuronyl transferase enzyme)
  • -> glucuronyl transferase renders it water soluble
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37
Q

causes of haemolytic jaundice (prehepatic)

A
  • RBC abnormality (ie sickle cell)
  • incompatible blood transfusion
  • drug reaction
  • hypersplenism
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38
Q

biochemistry in haemolytic jaundice

A
  • liver function normal
  • glucuronyl transferase saturated
  • increase conjugated bilirubin output
  • increase unconjugated bilirubin in plasma
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39
Q

hepatocellular jaundice causes

A
  • congenital (neonatal)
  • infection (viral hep)
  • cirrhosis (alcohol or NASH (steatohepatitis))
  • damage due to toxins or drugs
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40
Q

biochemistry in hepatocellular jaundice

A
  • increase unconjugated and conjugated bilirubin
  • may be decrease of conjugated bilirubin in gut (due to hepatocellular fibrosis)
  • elevated ALT
  • mild raised ALP
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41
Q

def kernicterus

A

build-up of bilirubin in the brain (especially in neonates): bile pigment deposition in basal ganglia: permanent brain damage

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42
Q

Qs to ask with jaundice for symptoms

A
  • pain
  • duration
  • itching
  • colour of stools and urine
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43
Q

obstructive jaundice causes

A
  • obstruction of bile duct by stone
  • obstruction of bile duct by tumour (i.e. head of the pancreas)
  • intra-hepatic cholestasis
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44
Q

biochemistry of obstructive jaundice

A
  • normal liver function
  • raised plasma bilirubin and conjugated bilirubin
  • raised ALP
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45
Q

Qs to ask in jaundice in social history

A
  • drug and alcohol
  • cigarette use (pancreatic cancer)
  • foreign travel
  • sexual history (hep B)
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46
Q

jaundice and examination

A
  • sclera and skin
  • scratches (pruritus)
  • evidence of weight loss (thenar wasting)
  • troisier’s node (malignancy)
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47
Q

Prognosis of hep A

A

99% recovery

1% Fulminant hepatitis: transplant or death

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48
Q

Epidemiology of hep A

Spread, countries, duration, incubation

A

Faecal-oral spreadable
Dvlping countries
12/52 duration
4-6 weeks incubation

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49
Q

Hep B

spread, endemic, complications

A

Blood, sex, vertical (mother to child)
Africa and Asia
Liver cancer

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50
Q

Factors determining progression of acute hepatitis B to chronic infection

A

-age:
<1yo: 90% chronic
1-5 yo: 30% chronic
>5 yo: 1-% chronic

  • immunosuppression (ie HIV)
  • route of infection
  • genotype
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51
Q

Hep B cirrhosis prognosis

A

Determined by:

  • Rate of fibrosis progression (stage and grade)
  • Viral load
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52
Q

What is Wilson’s disease + symptoms

A

Autosomal recessive condition characterised by toxic accumulation of copper in liver and brain
Symptoms: neurological: tremor, dementia, dyskinesia, dysarthria
Liver: cirrhosis, hepatitis
Kayser-Fleischer rings (eyes)
Renal tubular acidosis
Haemolysis
Blue nails

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53
Q

What is Rovsing’s sign?

A

Pushing the colon in a anti peristalsis direction in the left iliac fossa to illicit pain in the right iliac fossa
Sign of appendicitis

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54
Q

Diagnosis of Wilson’s disease

A

Reduced serum caeruloplasmin
Reduced serum copper
Increased 24h urinary copper excretion

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55
Q

What is Wernicke-Korsakoff syndrome( cause and symptoms)

A

Wernicke’s encephalopathy: triad of mental confusion, ataxia and ophthalmoplegia
Korsakoff’s syndrome: late manifestation when Wernicke’s encephalopathy has not been treated

Thiamine deficiency (alcohol, chronic subdural haematoma, hype remedies gravidarium, thyrotoxiscosis, spread of cancers, log term dialysis, congestive heart failure

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56
Q

Def ophthalmoplegia

A

Paralysis/weakness of one or more occulomotor muscles

Could be myotonic or neuropathic

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57
Q

Def hyperemesis gravidarium

A

Pregnancy complication: severe nausea, vomiting, fatigue, dehydration, weight loss
Goes beyond the 12th week of regnant (up to he 20th week)

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58
Q

def odynophagia

A

pain on swallowing

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59
Q

def halitosis

A

bad breath

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60
Q

what is delirium tremens

A

acute confusional state which results when sudden alcohol withdrawal in chronic alcohol intake
untreated: seizures and death

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61
Q

management of acute alcohol withdrawal

A
  • benzodiazepine or carbamazepine
  • clomethiazole (alternative to benzodiazepine or carbamazepine)
  • info about local alcohol support services

-for delirium tremens: oral lorazepam (or parenteral lorazepam or haloperidol)

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62
Q

difference between acute and chronic hepatitis

A

inflammation persisting > 6 months

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63
Q

natural history of acute hepatitis

A

3 possibilities:

  • recovery
  • fulminant hepatitis (death or liver transplant)
  • chronic hepatits –> increase fibrosis –> cirrhosis
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64
Q

def of steatohepatitis

A

inflammation in the liver in association with fatty infiltration

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65
Q

signs of decompensated liver disease

A 
jaundice 
ascites
encephalopathy 
vatical bleeding
small liver
easily bruising
spontaneous bacterial peritonitis
collateral veins in the abdomen
\+stigmata of liver disease
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66
Q

management of alcohol related liver disease

A
  • liver transplant (if decompensated liver disease after best management and 3 months abstinence from alcohol)
  • corticosteroids
  • nutritional support
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67
Q

main causes of cirrhosis

A

alcohol abuse
hep B and C
NAFLD and NASH

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68
Q

types of neonatal jaundice

A
  • unconjugated hyperbilirubinaemia: potentially toxic (penetration through blood brain barrier), may be pathological or physiological (glucuronyl transferase not at optimal level)
  • conjugated hyperbilirubinaemia: non toxic, always pathological
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69
Q

treatment of neonatal jaundice

A
  • unconjugated hyperbilirubinaemia: phototherapy or exchange transfusion
  • conjugated: treat underlying obstructive condition
70
Q

investigations in jaundice

A
  • trans-abdominal US: duct dilation or normal ducts?

- CT

71
Q

obstructive jaundice clinical picture

A

jaundice
dark urine
pale stools

72
Q

pre hepatic jaundice clinical picture

A

jaundice
no dark urine
no pale stools (may have dark stools)

73
Q

infective causes of liver disease

A

hepatitis A, B or C
cytomegalovirus
Epstein Barr virus

74
Q

lifestyle cause of liver disease

A

DM
obesity
alcohol excess

75
Q

drug causes of liver disease

A 
paracetamol overdose
anti epileptics 
rifampicin 
flucloxacillin 
methotrexate
76
Q

obstructive causes of liver disease

A

carcinoma of the pancreas

gallstone

77
Q

autoimmune causes of liver disease

A

autoimmune hepatits
primary billiard cholangitis
primary sclerosing cholangitis

78
Q

hereditary causes of liver disease

A

hereditary haemochromatosis
Wilson’s disease
alpa-1-antitrypsin deficiency

79
Q

biliary tree path from liver to duodenum

A
  • left and right hepatic ducts
  • common hepatic duct
  • cystic duct
  • common bile duct
  • ampulla of Vater/Sphincter of Oddi/ Major duodenal papillary
80
Q

causes of acute pancreatitis

A 
Idiopathic
Gallstones, genetic (CF)
Ethanol 
Trauma
Steroids
Mumps
Autoimmune
Scorpion venom
Hyperlipidemia/hypercholesteremia
ERCP
Drugs
81
Q

management of acute pancreatitis

A
  • IV fluids, O2 and pain relief
  • antibiotics if associated infection
  • early nutritional support
  • lipase and amylase levels
  • CT, MRI or ultrasound
  • ERCP/cholecystectomy if caused by gallstones
82
Q

what might precipitate decompensation of a previous stable liver cirrhosis

A
  • infection
  • alcohol binge
  • GI bleed
  • hypoglycaemia
83
Q

causes of fresh blood in the stools

A 
haemorrhoids
acute anal fissure
colorectal neoplasms
acute proctitis
IBD
84
Q

def hemicolectomy

A

removal of half the colon

85
Q

def ileostomy

A

stoma of SI

86
Q

def colostomy

A

stoma of colon

87
Q

def anterior resection

A

removal of part of the rectum (leaving rectal sphincter intact)

88
Q

def abdomino-perineal resection

A

excision of lower rectum and anus with removal of the anal sphincter and placement of colostomy

89
Q

what is the 2 week wait guideline for colorectal cancer

A
  • > 40 w/ unexplained weight loss and abdominal pain
  • > 50 w/ unexplained rectal bleeding
  • > 60 w/ iron deficiency anaemia OR changes in bowel habit >6weeks
  • tests that show occult blood in their faeces
90
Q

what is the screening for colorectal cancer?

A

from 50; every 2 years

  • faecal immunochemical test
  • faecal occult blood
  • flexible sigmoidoscopy
91
Q

what should you advise to reduce risk of bowel cancer?

A
  • bowel screening
  • healthy weight
  • diet high in starchy veg, pulses and whole grains
  • reduce consumption of red and processed meat
  • avoid alcohol and smoking
  • regular physical activity
92
Q

most frequent sights for CRC

A

left side of colon, in sigmoid
caecum
rectum

93
Q

risk factors for CRC

A
  • age
  • animal fat and red meat
  • sugar consumption
  • colorectal polyps
  • FH
  • chronic IBD
  • obesity
  • smoking
  • acromegaly
  • abdo radiotherapy
  • uretosigmoidoscopy
94
Q

what reduces the risk of CRC

A
  • vegetables, garlic, milk, Ca consumption
  • exercise
  • aspin and NSAIDs
95
Q

what are the different types of CRC

A
  • adenocarcinomas (from polyps)

- carcinoid tumours (from neuroendocrine cells)

96
Q

CRC TNM staging

A

T1: tumour in inner layer of bowel
T2: tumour in muscle layer
T3: tumour grown into outer lining go bowel wall
T4: tumour has grown through outer layer of muscle wall

N0: no lymph nodes
N1: cancer cells in up to 3 nearby lymph nodes
N2: cancer cells in 4+ nearby lymph nodes

M0
M1: metastests (liver, lungs)

97
Q

CRC number staging

A
  • Stage 1: T1/T2, N0, M0 (cancer hasn’t spread outside the bowel wall)
  • Stage 2: T3/T4, N0, M0 (cancer has grown into or through the outer layer of the bowel wall)
  • Stage 3: any T, N1/N2, M0 (the cancer has spread to nearby lymph nodes)
  • Stage 4: Any T, Any N, M1 (the cancer has spread to other parts of the body)
98
Q

CRC Dukes’ staging

A

Dukes’ A: TNM stage 1
Dukes’ B: TNM stage 2
Dukes’ C: TNM stage 3
Dukes’ D: TNM stage 4

99
Q

what is Lynch syndrome?

  • mutation
  • inheritance
  • cancers
  • diagnosis
A

HNPCC: mismatch repair gene mutation (microsatelite instability)

inheritance: autosomal dominance
- cancer: colon, stomach, SI, bladder, skin, brain, hepatobiliary system, endometrial/ovarian
- diagnosis: Amsterdam criteria, Bethesda guidelines

100
Q

diagnostic methods of CRC

A

barium enema
colonoscopy
CT/MR

101
Q

what are the different mutations in CRC

A

apc (FAP)
Kras
P53
MLH1/MSH2 (HNPCC°

102
Q

what is the Amsterdam criteria?

A
  • > 3 relatives, spanning 2 generations (1 must be first degree relative)
  • age of onset <50 in at least 1 relative
  • FAP excluded
103
Q

treatment of CRC

A

surgery

chemo

104
Q

what is diverticular disease

A

out pouching of colonic mucosa and submucosa through inherent weakness in outer muscle layers

105
Q

where is the commonest site for diverticular disease?

A

sigmoid colon (due to chronic constipation and/or accumulation of faecal matter)

106
Q

risk factors of diverticular disease

A

age
high meat and red meat intake
FH
chronic constipation

107
Q

complications of diverticular disease

A
  • infection (diverticulitis)
  • bleeding (occult/overt)
  • perforation
  • abscess formation
  • fistula formation (with bladder or vagina)
  • obstruction
108
Q

clinical features of diverticular disease

A
  • asymptomatic
  • intermittent LIF pain/discomfort
  • erratic bowel habit
  • severe pain and constipation (if narrowing)
109
Q

presentation of acute diverticulitis

A

sever pain in LIF
fever
constipation

110
Q

presentation of acute appendicitis?

A
  • T° (37.7-38.3)
  • loss of appetite
  • nausea and vomiting (+Diarroea)
  • dull pain in umbilical region that becomes sharp when moving towards RIF
  • abdominal tenderness RIF
111
Q

what is acute abdomen?

A

condition of severe abode pain, requiring emergency surgery, caused by acute disease of or injury to the internal organs

112
Q

how do you know if it is acute abdomen?

A

if someone previously well and abode pain > 6h, w/ no symptoms of diarrhoea

113
Q

causes of bowel obstruction

A 
adhesions
hernia
stricture
cancer
gallstones ileus
114
Q

acute abdomen: causes of RUQ pain

A
  • Gallbaldder disease (cholecstitis, cholangitis etc)
    • Duodenal ulcers
    • Pancreatitis
    • Medical disorders (ie referred pain from pneumonia)
    • Hernias
115
Q

acute abdomen: causes of LUQ pain

A
  • Acute pancreatitis
    • Spontaneous splenic rupture
    • Medical disorders (ie pneumonia)
      Hernias
116
Q

acute abdomen: causes of RIF pain

A
  • Acute appendicitis
    • Perforated duodenal ulcer
    • Crohn’s disease
    • Diverticulitis
    • Constipation
    • Renal colic
      Obs and gynae (ectopic pregnancy, ruptured ovarian cyst, salphingitis)
117
Q

acute abdomen: causes of LIF pain

A
  • Diverticulitis
    • Constipation
      Obs and gynae (ectopic pregnancy, ruptured ovarian cyst, salphingitis)
118
Q

acute abdomen: causes of epigastric pain

A
  • peptic or duodenal ulcers

- acute pancreatitis

119
Q

acute abdomen: causes of central pain

A
  • Early appendicitis
    • Small bowel obstruction
    • Acute pancreatits
      Mesenteric thrombosis
120
Q

acute abdomen: causes of suprapubic pain

A
  • acute urinary retention
    • UTI
      Ectopic pregnancy
121
Q

classic signs of acute abdomen?

A
  • Fever (low grade)
    • Tenderness
    • Rigidity and guarding
    • Rebound tenderness
    • Bowel sounds (absent in peritinitis and increased in small bowel obstruction)
      Abdominal distention (6Fs)
122
Q

where is the deep inguinal ring located?

A

between the pubis tubercle and ASIS (midpoint of the inguinal ligament

123
Q

where is the superficial inguinal ring located?

A

above and medial to pubis tubercle

124
Q

predisposing factors to hernias

A
  • weakness of abdominal wall/increase in abode pressure
  • coughing
  • straining
  • obesity
  • abdominal distension
  • pregnancy
  • heavy lifting
  • age
  • congenital
125
Q

what are the different types of hernias?

A 
epigastric
umbilical
incisional
direct inguinal
indirect inguinal
femoral
126
Q

what is the difference between a direct and indirect inguinal hernia

A

indirect: pass through deep inguinal ring (IN the canal)
direct: weakness in the posterior wall of the abode canal

127
Q

what can cause dysphagia

A
  • muscular (muscular dystrophy, myasthenia gravis)
  • neuro (stroke, PD, MS)
  • weakened muscle or impaired coordination
  • narrowing of the throat/oesophagus (throat/oesophageal cancer, GORD, sacs/rings in oesophagus)
  • achalasia
128
Q

what are the complications of dysphagia

A

choking
pulmonary aspiration
lack of nutrition

129
Q

def odynophagia

A

dysphagia with pain

130
Q

causes of odynophagia

A

ulcers
tumours
fungal infections

131
Q

what must you ask when taking a UGIT disease history

A
  • weight loss
  • vomit and blood
  • meleana? change in bowel habit
  • pain
  • symptoms of anaemia
  • any previous investigations (i.e. endoscopy)
  • meds linked i.e. omeprazole, NSAIDs
  • any previous abode surgery
  • relevant FH
  • lifestyle
132
Q

what cellular changes happens in Barretts oesophagus

A

epithelium change from squamous to columnar (metaplasia to dysplasia)

133
Q

2 week referral for oesophageal cancer?

A

-dysphagia OR
->55 with weight loss AND 1 of following:
upper abdo pain
reflex
dyspepsia

134
Q

risk factors for oesophageal cancer

A
  • smoking
  • alcohol
  • diet lacking in veg/fruit/dairy/folate/vit A
  • pickle consumption
  • high BMI
  • GORD
135
Q

what investigations if oesophageal cancer?

A 
OGD, bloods, ECG/Pulmonary Function Test/CXR
CT thorax/abd/pelvis
EUS
PET
laparoscopy
CPx (cardio pulmonary exercise test)
136
Q

treatment of oesophageal cancer

A

surgery
chemo
radiotherapy

137
Q

cause of peptic ulcer disese

A

H pylori

NSAIDs

138
Q

risk factors for peptic ulcer disease

A

-smoking
-alcohol
-FH of PUD
-physical stress
-hypersecretory syndromes (Zollinger Ellison syndrome)
medications

139
Q

drugs that are linked to formation of peptic ulcers or GI bleeds

A 
anticoags
corticosteroids
K+ channel activator
SSRIs
antiplatelets
NSAIDs
140
Q

symptoms of peptic ulcer disease

A 
epigastric pain 
dyspepsia
appetite loss
vomiting/nausea
GORD
feeling full after a meal
(w/ duodenal ulcers, pain can get better w/eating)
141
Q

treatment of H pylori?

A

7 day, twice daily course of

  • PPI
  • amoxicillin
  • either clarithromyocin or metronidazole

(if allergic to penicillin: clarithromyocin and metronidazole)

142
Q

treatment of peptic ulcer disease due to NSAIDs

A

stop NSAIDs

4-8 week course of full dose PPI

143
Q

complications of peptic ulcer disease

A
  • internal bleeding (anaemia, haematesis, meleana)
  • perforation
  • gastric outlet obstruction
  • stomach cancer
144
Q

what is the Glasgow blatchford score used for

A

stratifies upper GI bleeding patients who are at low risk and candidates for outpatient management

145
Q

what is the Rockall score used for?

A

determines severity of upper GI bleeding (needs to have an endoscopy done)

146
Q

what does coffee group blood suggest in emesis

A

bleeding has slowed or stopped

147
Q

what is Mallory Weiss oesophageal tear

A

due to alcohol or bullimia (vomiting/retching)

due to prolonged vomiting

148
Q

what is the trauma lethal triad

A

hypothermia
coagulopathy
metabolic acidosis

149
Q

what are abdominal red flag symptoms

A 
rectal bleeding
anaemia
weight loss
FH of colorectal cancer
abdo/rectal mass
raised CRP/ESR or faecal calprotectin 
for woman > 50 with persistent bloating: can be ovarian cancer
150
Q

what are the 2 types of IBS

A

diarrhoea

constipation

151
Q

symptoms of IBS

A

colicky pain
bloating
altered bowel habit

(extra-intestinal manifestations: nausea, thigh pain, backache, lethargy, urinary symptoms, gynae symptoms)

152
Q

diagnostic criteria of IBS

A

-abdominal pain/discomfort that is relieved by defecation OR associated with altered bowel frequency or stool form

+ at least 2 of the following

  • altered stool passage
  • abdominal bloating, distention, tension orr hardness
  • symptoms made worse by eating
  • passage of mucus
153
Q

treatment of IBS

A
  • diet
  • exercise
  • laxatives or loperamide, tricyclic antidepressants
  • psychological help
  • acupuncture
  • probiotics?
  • hypnotherapy?
154
Q

what is Carnett’s sign

A

abdo pain s unchanged or increased when muscles of abode wall are tensed

155
Q

def diarrhoea

A

production of more that 2 unformed stools per day

156
Q

difference between acute and chronic diarrhoea

A

acute: less than 4 weeks
chronic: more than 4 weeks

157
Q

def dysentery

A

diarrhoea with visible blood in the stools

158
Q

def tenesmus

A

ineffective and painful straining on stool or urination

159
Q

social history of patient with diarrhoea?

A 
travel
employment (food-handler, caregiver)
consumption of unsafe foods
swimming/drinking untreated fresh surface water
animal contact
receptive anal intercourse
contact with other ill persons
160
Q

causes of diarrhoea

A 
gastroenteritis
diverticulitis
antibiotic therapy 
IBS
IBD
colorectal cancer
coeliac disease
appendicitis
161
Q

causes of constipation

A 
rectocele
IBS
drug induced 
dysinergic defecation 
enterocoele
slow transit
162
Q

risk factors for IBD

A
  • genetics
  • smoking
  • NSAIDs
  • hygiene (decrease in it decreases risk for CD)
  • stress/depression
  • appendectomy (is protective)
163
Q

histological difference between crohn’s disease and ulcerative colitis

A
  • inflammation: CD: deep (transmural), patchy/ UC: mucosal, continuous
  • granulomas: CD: ++/ UC: rare
  • goblet cells: CD: present/ UC: depleted
  • crypt abscesses: CD: +/ UC: ++
164
Q

clinical features of Crohn’s disease

A 
diarrhoea (sometimes w/ blood)
abdo pain 
weight loss
malaise
lethargy 
anorexia
nausea/vomiting
low grade fever
mouth ulcers
joint pain/back pain
uveitis/conjunctivitis
165
Q

investigations in Crohn’s disease

A
  • bloods: CRP, FBC, etc
  • faecal calprotectin
  • stool sample for infective agent
  • endoscopy
166
Q

management of Crohn’s disease

A
  • glucocorticoid
  • azathioprine or mercaptopurine
  • infliximab and adalimumab (TNF-A inhibitors)

-surgery

167
Q

clinical features of Ulcerative Colitis

A
  • diarrhoea with blood and mucus
  • lower abode discomfort
  • malaise, lethargy, weight loss, anorexia
  • aphthous ulcerations in the mouth may be seen
168
Q

def proctitis

A

inflammation of the lining of the rectum

169
Q

investigations of ulcerative colitis?

A
  • bloods: CRP, FBC, etc
  • faecal calprotectin
  • stool sample for infective agent
  • endoscopy
170
Q

treatment of ulcerative colitis

A
  • topical (or oral) aminosalicylate
  • topical or oral corticosteroids
  • tofacinib, vedolizumab

-surgery

171
Q

causes of hypoalbuminia

A

reduced synthesis
loss (renal or bowel)

NOT MALNUTRITION

172
Q

what is the MUST score

A

5 step screening tool to identify adults who are malnourished or at risk

Year 3 (7 decks)

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