IBD / IBS Flashcards
what is irritable bowel syndrome?
functional bowel disorder - no identifiable disease underlying symptoms
just abnormal functioning
what are the symptoms of IBS
Diarrhoea (may have urgency or incontinence) Constipation Fluctuating bowel habit Abdominal pain Bloating
Worse after eating (exaggerated gastro-colonic reflex)
Improved by opening bowels
Other effects:
Sexual function is interfered with Nausea Thigh and back pain Lethargy Urinary and gynae symptoms (pain on intercourse)
Criteria for Diagnosis (NICE guidelines)
what is the exclusion criteria for diagnosis
exclude other pathology with normal FBC, CRP, ESR, stool culture, FAECAL CALPROTECTIN EXCLUDED
what other diagnostic criteria is needed for IBS?
o Abdominal pain/discomfort:
Relieved on opening bowels
Or associated with a change in bowel habitat
AND 2 of:
Abnormal stool passage
Bloating
Worse symptoms after eating
PR mucus
what is the management of IBS?
reassurance, stress management, altered diet
loperamide for diarrhoea, laxatives for constipation
linaclotide: specialist laxative
anti-spasmodics like buscopine for cramps
what sort of diet should people with IBS be eating?
small meals and regular, reduced processed foods, reduced fatty and rich, limit fruit intake to 3 portions, limit coffee and alcohol
probiotic supplement
what are the red flags when someone presents with abdominal/bowel symptoms
age >60 rectal bleeding anaemia weight loss FH of colorectal cancer mass in abdomen or rectum raised CRP
what is the red flag in a woman >50
persistent bloating = an USS of ovaries and Ca125 for ovarian cancer
what is faecal calprotectin
activated by phagocytes such as monocytes and granulocytes and reflects local ongoing inflammation rather than systemic inflammatory response (like CRP)
what is carnett’s sign
abdo pain, determine whether pain originates from myofasical or abdo wall
= patient should lie down and raise head or leg against gentre resistance from the doctor
• Test is positive if this exacerbates the pain, indicating an abdominal wall, as opposed to visceral, pain origin
what is IBD
ulcerative and crohn’s disease
involve inflammation of walls of GI tract and associated with periods of remission and exacerbation
crohn’s NEST?
o N – no blood or mucus (less common)
o E – entire GI tract
o S – “skip lesions” on endoscopy
o T – terminal ileum most affected and Transmural (full thickness) inflammation
o S – smoking is a risk factor
• Crohn’s disease is also associated with weight loss, strictures and fistulas
• 40% of crohn’s cases involve ileo-caecal area
CLOSE-UP for ulcerative colitis?
o C – continuous inflammation o L – limited to colon and rectum o O – only superficial mucosa affected o S – smoking is protective o E – excrete blood and mucus o U – use aminosalicylates o P – primary sclerosing cholangitis • Main areas: rectal = termed proctitis • However, inflammation can spread from sigmoid area upwards and can even reach transverse colitis = extensive • Spreads distal to proximal colon
what are the signs and symptoms of crohn’s and UC?
- Diarrhoea
- Abdominal
- Passing blood
- Weight loss
- Fever
- Vomiting
- Cramps
- Muscle spasms
what are the complications of UC?
severe bleeding, toxic megacolon, rupture of bowel, colon cancer
complications of CD
stenosis, abscess formation, fistulas, perforation, colon cancer
what investigations would you do for IBD?
bloods for anaemia, infection, thyroid etc
CRP FCP endoscopy: diagnostic imaging for complications histoloogy small bowel enema
how do you manage crohn’s disease?
inducing remission: steroid eg prednisolone or steroids + immunosuppressant eg axathioprine, mercaptopurine
maintaining: azathioprine or mercaptopurine
what is the surgery for crohn’s?
o When disease only affects distal ileum; can surgically resect this area
o Prevents further flares of disease, but crohn’s typically involves the entire GI tract
what is the specific investigations for UC?
enema = loss of haustrations
how do you stage UC?
o Mild < 4 stools/ day, only a small amount of blood
o Moderate: 4-6 stools / day, varying amounts of blood, no systemic upset
o Severe: >6 bloody stools per day and features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)
how do you manage UC?
• Inducing remission:
Mild to moderate disease (and for proctitis)
First line: aminosalicylate (mesazaline oral or rectal)
Second line: corticosteroids (prednisolone)
o Severe disease:
First line: IV corticosteroids (eg hydrocortisone)
Second line: IV ciclosporin
• Maintaining remission:
o Aminosalicylate (eg mesalazine oral or rectal) alone, or with a topical AS daily or intermittent o Azathioprine and Mercaptopurine can be used following a severe relapse or for >2 exacerbations in the past year
what is the surgery for UC?
since typically affects colon and rectum, removal of this = ileostomy or ileo-anal anastomosis permanently
what is c difficile?
Infection of the colon caused by c diff bacteria, characterised by inflammation of the colon
what causes c diff?
recent use of antibiotics
how do patients with c diff present?
diarrhoea, abdo pain and leucocytosis, other common symptoms include fever, abdo tenderness and distension
what investigations do you do for c diff?
fbc, faecal occult, stool pCR, stool immunoassay for glutamate dehydrogenase
how do you treat c diff?
oral vancomycin
