Intestinal Flashcards
what 3 things can define constipation
<3 times a week // difficulty passing // incomplete emptying
what are common complications of constipation (3)
overflow diarrhoea // AUR // haemorrhoids
what defines diarrhoea
> 3 loose stools in a day
what is acute vs chronic diarrhoea
acute <14 // chronic > 14 days
what are common causes of acute diarrhoea (4)
infection // diverticulitis // abx // overflow constipation
what can cause chronic diarrhoea (5)
IBS // UC // chrohns // colorectal cancer // coeliac
what symptoms must be present for IBS and how long (3)
6 months: abdo pain +/- bloating +/- change in bowels
what red flags need to be ruled out in IBS
rectal bleeding // weight loss // FH ovarian cancer // 60+
what invx should be done in IBS
FBC // CRP // coeliac TTG antibodes
1st line mx IBS (3)
pain = antispaspodic eg hyoscine (buscopan) // consitpation = laxitive // diarrhoea = loperamide
what laxative should be avoided in IBS
lactulose
what laxitve can be given in special cases of IBS
linaclotide
2nd line mx IBS
TCAs low dose eg amitrip 5-10mg
when is CBT offered in IBS
after 12 months
what is diverticular disease
herniation of colonic mucosa through muscilar wall
where does diverticular disease usually occur in colon + what area is usually spared
between teania coli // rectum spared
difference between diverticular disease and diverticulosis
diverticulosis is no symptoms
symptoms diverticular disease (3)
change bowel habits // PR bleed // abdo pain
complications diverticular disease (6)
diverticulitis // bleed // fistula // perforation // peritonitis // abscess
invx diverticular diseae
CT 1st –> colonscopy // barium enema
how is severity determined in diverticular disease (4)
Hinchey: paracolonic abscess –> pelvic –> purulent peritnotis –> faecal peritonitis
what are risk factors for diverticuloss
age and low fibre diet, obese
what is diverticulitis
infected diverticulas
symptoms of diverticulitis
LLQ pain // N+V // consipation or diarrhoea // urinary symptoms // PR bleed // signs of infection
what is a serious complication of diverticulitis (5)
abcess // peritonitis // obstruction // perforation // colovesical or colovaginal fistula
what X rays should be done in diverticulitis and what do they show
erect CXR - pneumoperitoneum // AXR - dilation
what invx should be avoided in diverticulitis
colonscopy –> perforation
how is mild –> severe diverticulitis managed
oral abx – > IV ceftriaxone + IV metro
how is severe diverticulitis with faecal peritonitis managed
resection + stoma // less severe = washout
what are the 3 main ischaemias to the lower GI tract
acute mesenteric // chronic mesenteric // ischaemic colitis
risk factors for bowel schaemia (5)
age // A fib // thromboemboli eg endocarditis, cancer // CVS eg smoking, HPT, DM // cocaine
symptoms bowel ischaemia
abdo pain (sevre and sudden) // PR bleed // diarhhoea // fever // raised WCC and lactate
invx bowel ischaemia
CT
what causes mesenteric ischamia
embolus usually AF
artery block in acute mesenteric ischaemia
mesenteric artery
mx acute mesenteric ischaemia
urgent surgery
what is ischaemic colitis
acute and transient block in blood flow –> inflam, ulcer, haemorrhage
where does ischamic colitis usually occur + initial invx
splenic flexure // AXR shows thumbprinting
what are the 2 most common causes of SBO
adehsions then hernias
most common causes large BO
tumour // volvulus // diverticular
key features SBO (5)
abdo pain // bilious vomiting // constipation // distension // tinkling bowel sounds
1st line invx for small and large BO
AXR
diagnostic invx small and large BO
CT
mx for small and large BO (4)
NBM + IV fluid + NG tube // maybe surgery
when would bowel obstruction commonly require surgery
perforation
what is the most common type f volvulus
sigmoid (80%)
what associations are there with sigmoid volvulus (5)
older // chronic constipation // Chagas disease // neruological conditions // psychiatric eg schizo
what associations are there with caecal volvulus (3)
all ages // adhesions // pregnancy
how is voluvulus diagnosed
AXR: sigmoid = LBO + coffeebean // caecal = SBO
mx sigmoid volvulus
rigid sigmoidoscopy + rectal tube
mx caecal
right hemicolectomy
what is maximum normal diameter for small bowel when obstruction suspected
35mm
what is maximum normal diameter for large bowel when obstruction suspected
55mm
what type of tumour characterises Zollinger Ellison syndrome
gastrin secreting from dudodenum or pancreas
what gene is Zollinger Ellison syndrome assoc with
MEN1
symtoms zollinger ellison (3)
multiple gastroduodenal ulcers // diarrhoea // malabsorption
