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G.I. > IBS & Perianal Disorders > Flashcards

IBS & Perianal Disorders Flashcards

1
Q

IBS-D

A

IBS Diarrhoea

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2
Q

IBS-C

A

IBS constipation

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3
Q

IBS-M

A

IBS mixed

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4
Q

IBS common presentation

A

Change in bowel habit

Abdo pain

Bloating

Chronic, relapsing condition

Urgency

Sensation of incomplete emptying

Mucous PR

Aggravated by stress

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5
Q

What are the criteria for IBS?

A

Pain/discomfort for at least 3 days per month for 3 months

Improvement with defecation

Change of stool habit with onset

Change of stool form

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6
Q

What is IBS associated with (diseases)

A

Fibroyalgia
Chronic fatigue syndrome
TMJ dysfunction
Chronic pelvic pain

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7
Q

IBS - psychology

A

Many are depressed/anxious/hypochondriacs

Many have anxiety

Stressed –> more IBS –> MORE stress –> IBS and so on.

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8
Q

IBS history

A

Bowel habit change

What do they eat? - something may be triggering it

Bloating

Nocturia

Changed your diet?

Triggers?

Opiate use?

Psychological - stress, anxiety

Underlying fears

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9
Q

Alarm features

A

Age > 50

Short duration of symptoms / sudden onset

Woken from sleep by altered bowel habit

Rectal bleeding

Weight loss

Anaemia

FHx of colorectal cancer

Recent Abx

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10
Q

Investigations for IBS

A 
FBC
ESR
CRP
TTG (coeliac)
Lower GI tests if aged > 50 
Endoscopy (if alarm symptoms)
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11
Q

Management of IBS

A

Diet
Regular meal times
Fibre
FODMAP/GFD (gluten free diet)

Eat more vegetables

Stop opiate analgesia (reliance)

Antidiarrhoeal

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12
Q

What drug do you NOT use?

A

Lactulose

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13
Q

Anti-diarrhoeal - loperamide 1ST LINE

A

Opiate analogue

Inhibits peristalsis, gut secretions

Benefits diarrhoea

Works quickly

No dependency

PRN use

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14
Q

IBS - antidepressants

A

Amitryptyline

Reduce diarrhoea
Reduce afferent signals from gut
Help restore sleep pattern

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15
Q

IBS psychological treatment

A

Severe anxiety/depression

Relaxation therapy
Hypnosis

Probiotic yoghurts

If it helps, it’s worth doing.

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16
Q

Amitryptyline

A

Anti-depressant

Good therapy for IBS

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17
Q

What kind of stool consistency are you aiming for?

A

Soft well formed (bristol type 4)

18
Q

Below the dentate line =

A

PAINFUL

19
Q

Perianal conditions - key questiosn

A

How long have you had symptoms for?

First episode?

Bleeding - fresh? Dark? mixed with stool? dripping in the toilet or just on the paper?

Pain - sharp, dull, how long

Anything protruding?

Any discharge

20
Q

Haemorrhoids

what are they

A

Enlarged vascular cushions in the lower rectum and anal canal

21
Q

Haemorrhoids - presentaiton

A

Painless bleeding

Fresh, bright red blood, not mixed with stool

Usually on the paper

Perianal itchiness

No change in bowel habit, no weight loss or other associated symptoms

22
Q

Haemorrhoids - clincial

A

Obvious haemorrhoids if 3rd degree piles are present

Maceration of peri-anal skin

Must use proctoscope to properly see

Unless they are very large they are difficult to see.

23
Q

Classic positions of haemorrhoids?

A

3, 7 and 11 o’clock

in lithotomy position

24
Q

Investigations - haemorrhoids

A

PR exam
Rigid sigmoidoscopy
Proctoscopy

Flexible sigmoidoscopy in patients above the age of 50 (cancer)

25
Q

Management - Haemorrhoids

A

Symptomatic

Sclerosation therapy

Rubber band ligation

Open haemorrhoidectomy

Stapled haemorrhoidectomy

HALO/THD procedure (haemorrhoids artery ligation)

26
Q

Above dentate line?

A

Painless

27
Q

Rectal prolapse

  • partial
  • complete
A

Partial (anterior mucosal prolapse) - more common

Complete (full thickness)

28
Q

Rectal Prolapse - presentation

A

Protruding mass from anus (esp during defectation)

May reduce spontaneously

Bleeding and passing mucous PR

Poor anal tone

29
Q

COMPLETE prolapse - management

A

Many patients are too frail

Bulking agent and education on manual reduction

Surgery

Biological mesh (pig skin) used

30
Q

Partial prolapse - management

Children
Adults

A

Children - dietary advice & treatments for constipation

Adults - treatment similar to haemorrhoids (suturing and pushing back)

31
Q

Anal Fissure

A

Tear in anal margin due to passage of constipated stool

Usually in midline, posteriorly but may anterior

Multiple fissures - Crohn’s?

Below dentate line so are painful

32
Q

Anal fissure - presentation

A

Acute onset of severe anal pain

Following constipation

“Passing glass”

pain lasts after defecation

33
Q

Vicious cycle of anal fissures?

A

They hold on to their poo because they are afraid of the pain

Become more constipated

When they finally go it is very painful

34
Q

What could multiple anal fissures indicate?

A

Crohn’s disease

35
Q

Anal fissure - treatment

A

Dietary advice

Stool softeners

Lateral sphyncterotomy

Botox injection

36
Q

Why would a paralytic drug be good for anal fissures?

A

The blood vessels are spasming because the muscle is spasming (due to pain)

tissue will not heal properly

If you relax the sphincters blood can get to it and allow it to heal

37
Q

Fistula in ano

A

Abnormal comm between two epithelial surfaces

internal opening in anal canal and one or more external openings on the peri-anal skin

crohn’s, TB, carcinoma

38
Q

Fistula in ano - presentation

A

Majority arise from delay in treatment

Crohn’s
TB

39
Q

Multiple fistulae could be due to?

A

Crohn’s

40
Q

Fistula in ano - Ix

A

EUA of anorectum (exam under anaesthetic)

Rigid sigmoidoscopy

Proctoscopy

Flexible sigmoidoscopy

MRI

41
Q

Fistula - management

A

Laying open

Insertion of seton (draining, cutting)

LIFT procedure

Glue/permacol

Let it heal

42
Q

Fistula - complications

A 
Pain
Bleeding
Incontinence of flatus/stool
Recurrence
Further surgery

G.I. (20 decks)

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