IBS, diverticulitis and exocrine pancreatic insufficiency Flashcards

1
Q

epidemiology of IBS

A
  • onset 20-30 - 2x more common in women - 10-20% unreported
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2
Q

IBS aetiology

A

not understood - food intolerances are precursors - no damage present - hypersensitivity and stress

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3
Q

IBS pathophysiology

A
  • functional disorder - no detectable pathology
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4
Q

IBS symptoms

A

cramps diarrhoea/constipation flatulence bloating urgency to defecate acid reflux nausea lethargy may be worsened by eating

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5
Q

diagnosis of IBS

A

pain for 6 months relieved by defecation or stool changes PLUS 2 of…- bloating - altered stool passage - mucus - worsened by eating

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6
Q

ROME IV

A
  • Abdominal pain 1/7 in last 3 months * Symptoms began at least 6 months prior * PLUS two of the following Defecation/frequency/form change
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7
Q

4 types of IBS

A

C- >25% 1/2D- >25% 6/7M- >25% 1/2 AND >25% 6/7U- cannot be categorised

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8
Q

red flags in IBS

A

weight loss rectal bleeding family history of cancer loose stools >6 weeks in 60 y/o + inflammatory markers abdominal/rectal masses

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9
Q

IBS treatment

A

symptom management when not controlled by diet - laxatives/loperamide

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10
Q

treatment for cramping in IBS

A
  1. antispasmodics - mebeverine 2. anti depressants - amitriptyline, SSRI
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11
Q

treatment for uncontrolled constipation in IBS

A

linaclotide

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12
Q

linaclotide pharmacology

A

guanylate cyclase agonist GC-C –> cGMP –> CFTR action –> intestinal chloride+bicarb –> gi transit increased

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13
Q

what is diverticular disease

A

symptomatic presence of diverticula

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14
Q

what is diverticulosis

A

uninflamed, asymptomatic presence of diverticula

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15
Q

what is diverticulitis

A

one or more inflamed/infected diverticula

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16
Q

epidemiology of diverticular disease

A

risk increases with age, rare <40 80-85% symptomatic 15-20% of patients with diverticulitis develop complications requiring surgery - mortality

17
Q

aetiology of diverticular disease

A

genetics - left sided in west, right in Asiandietary - constipationmostly unknown - muscle wall weakening - abnormal motility

18
Q

how are diverticula formed

A

Colonic muscular hypertrophy results in narrowing of lumen and formation of small chamber with high pressure and subsequent diverticula

19
Q

pharmacology of diverticulitis

A
  • faecal matter/undigested food accumulate in diverticula - mucus/bacteria growth distends diverticula - vascular compromise and perforations - intraluminal pressure increases and inflammation
20
Q

diverticulosis symptoms

A

asymptomatic

21
Q

diverticular disease symptoms

A
  • lower left quadrant pain - worsened by eating, relieved by passing wind- flatulence - can overlap with IBS
22
Q

symptoms of diverticulitis

A
  • lower left abdominal pain with feversudden bowel change blood/mucus palpable mass malaise n&v wbc raised
23
Q

how is diverticulosis treated

A
  • good diet - hydration - weight loss/smoking cessation- bulk forming laxatives if required
24
Q

how is diverticular disease treated

A
  • high fibre diet- bulk forming laxatives - anti-spasmodics when colic - avoid NSAIDs- avoid drugs that slow down motility - codeine/loperamide
25
red flags for diverticulitis
>65co-morbidities or immunocompromisedcannot take oral abx dehydratedsigns of acute diverticulitis
26
signs of acute diverticulitis
mass haemorrhage peritonitis stricture (reduce GI motility, constipation, cramping) fistula (faecaluria, pneumaturia, passing faeces through vagina)obstruction sepsis
27
treatment for diverticulitis - acute and systemically unwell
co-amox AND metronidazole 5 days (cefalexin if penicillin allergy) OR trimethoprim and metronidazole
28
causes of pancreatic exocrine insufficiency
pancreatic resection pancreatitis diabetes coeliac disease tumours CF
29
treatment for acute diverticulitis not systemically unwell
avoid nsaids and opioids - analgesia and represent if symptoms worsen
30
pharmacology of pancreatic exocrine insufficiency
lack of pancreatic enzymes being secreted into duodenum (amylase, lipase and protease)
31
symptoms of pancreatic exocrine insufficiency
- maldigestion leading to malnutrition- fatigue- low blood levels of fat soluble vitamins (A, D, E, K)- lack of growth/weight loss - diarrhoea - cramping/bloating- flatulence
32
treatment for pancreatic exocrine insufficiency
pancreatin - creon - dose tailored to meals - higher for main meals lower for snacks - physical symptoms should ease- clinical manifestations should also improve
33
what is a colostomy
stoma surgically inserted within colon/large intestine, inserted into final section in descending portion of colon
34
what is a ileostomy
stoma positioned at the end of small intestine - large intestine removed - more fluid contents
35
what is a urostomy
stoma that removes urine from the body away from the bladder