IBS and Gastroenteritis Flashcards
What is irritable bowel syndrome? RF?
Disorder of intestinal motility and enhanced visceral perception causing abnormal sensation of intra-abdominal events. Symptoms are exacerbated by stress, food, gastroenteritis, characterised by abnormal and forceful contractions of the bowel.
RF: FH, also common in adults.
Clinical presentation of IBS?
1) Abdominal pain often before/relieved by defecation.
2) Explosive, loose/mucousy stools
3) Bloating
4) Constipation (alternating with loose/normal stools)
5) Feeling of incomplete emptying
Ddx of IBS?
1) IBD
2) Coeliac
Diagnosis of IBS?
1) Clinical
2) Exclusion:
- Ig TTG (tissue transglutaminase antibody) - raised in coeliac.
- Faecal calprotectin (raised in IBD)
Treatment of IBS?
1) Education, reassurance and dietary changes - regular small meals and plenty of fluids.
2) Antispasmodics for bloating and pain - Buscopan
3) Laxatives for constipation - Movicol
Epidemiology, aetiology and RF of Gastroenteritis (VIRAL)?
- Remains a major cause of child mortality in developing countries.
- Rotavirus infection (most common cause in developed countries, accounting for 60% under 2 years - mostly in winter and early spring, VACCINATION in immunisation programme).
- Other causes include norovirus and adenovirus - may cause outbreaks.
RF: Recent contact with a person with D+V or recent travel abroad.
Aetiology of Gastroenteritis (BACTERIAL)?
- Bacterial causes are less common in developed countries.
- Suggested by blood in stools, campylobacter jejuni results in severe abdominal pain.
- Shigella and Salmonella - dysenteric infection with blood + pus in stool, pain and high fever
- Cholera and E. coli - profuse, rapidly dehydrating diarrhoea.
Clinical presentation of Gastroenteritis?
1) Sudden change to loose/watery stools (diarrhoea) often accompanied by vomiting.
2) Abdominal pain
3) Fever (not always)
4) Dehydration - appears unwell, altered responsiveness (irritable and lethargic), sunken eyes, decreased urine output, reduced skin turgor, tachypnoea, tachycardia.
Who is at increased risk of dehydration (from gastroenteritis)?
1) Infants < 6 months OR low-birthweight
2) Passed > 6 diarrhoea stools in 24 hours
3) Vomited > 3 times in 24 hours
4) Intolerant to fluids
5) Malnourished
Presentation of shock (from gastroenteritis)?
1) Decreased consciousness
2) Pale/mottled skin
3) Cold extremities
4) Dry mucous membranes
5) Tachypnoea and tachycardia
6) Prolonged cap refill time (>2 seconds)
What is isonatraemic dehydration?
When losses of water and sodium are proportional and plasma Na+ remains normal.
What is hyponatraemic dehydration? How does it present?
When loss of Na+ is greater compared to water - e.g. child with diarrhoea drinks a lot of water resulting in overall greater loss of Na+, thereby there is a fall in plasma Na+. Shift of water from extra to intracellular compartments - increase in brain volume that can cause convulsions.
What is hypernatraemic dehydration? How does it present?
Water loss exceeds that of Na+ = plasma Na+ increases which results in a shift of water from intracellular to extracellular compartment- causing depression of fontanelle, reduced tissue elasticity and sunken eyes. Water drawn out of brain - results in seizures or multiple small cerebral haemorrhage due to brain shrinkage.
Caused by highly insensible water loss - high fever or hot, dry environment.
Differential diagnosis of Gastroenteritis?
1) Intussusception
2) Acute appendicitis
3) Coeliac
Diagnosis of gastroenteritis?
1) Stool cultures if: septic, mucous/blood in stool, or if child is immunocompromised
2) Blood culture if antibiotics given
