Investigations + management Flashcards
FBC?
coeliac disease, Crohns and UC can all cause anaemia from malabsorption of iron, folate or B12.
ESR?
Crohns and UC are systemic inflammatory diseases that elevate ESR.
CRP?
infectious diarrhoea, Crohns, UC
TTG and IgA levels?
positive result has 90% sensitivity to coeliac.
TFTs?
low TSH and high T3/T4 suggest hyperthyroidism
U&Es?
may be dehydrated with electrolyte imbalances.
Albumin?
low in patients with chronic diarrhoea and malabsorption.
Capillary glucose?
tells if patient is diabetic.
Faeces tests Faeces microscopy and culture?
exclude infection, and can indicate IBD.
Faeces tests C. difficile toxin?
if patient has had recent antibiotic use
Faeces tests Faecal occult blood test (FOBT)
point towards infection or UC and away from hyperthyroidism
Crohns disease symptoms?
bloody diarrhoea and abdo pain often starting on lower right quadrant, can suffer weight loss and failure to thrive between attacks. The symptoms are due to chronic activation of the immune system in various tissues and its squelae
UC symptoms?
pain is diffuse with bloody diarrhoea but patients are fine inbetween attacks
AXR for UC?
essential for UC as rule out toxic megacolon, this can be detected as large bowel loop >6cm.
What will colonoscopy see in IBD?
visualise interrupted lesions of Crohns or diffuse erythematous inflammation of UC and allows biopsies.
Treatment for infectious diarrhoea?
oral rehydration, stay away from work until 48 hrs after diarrhoea.
IBS diagnosis?
at least 3 months of recurrent abdo pain or discomfort associated with 2 or more of the following; improvement with defecation, onset associated with change in frequency of stool, onset associated with change in form of stool.
IBS management?
Reassurance, antispasmodic (decrease bowel smooth muscle activity), antidepressants (slow colonic transit time) diet remedies (avoid certain food, increase fibre).
C.difficile is common in
Elderly patients who are immunosuppressed
C.difficile management?
ABC, faeces analysis, isolation, meticulous hygiene, antibiotic treatment (metronidazole 14 days).
UC overview?
systemic inflammatory disease, GI affected distal to proximal, shows gross uniform inflammation with clear cut off, patients present with painless, bloody diarrhoea. Can also have; arthritis, sacroiliitis, uveitis, scleritis, episcleritis , erythema nodosum, anaemia of chronic disease. UC has a much stronger association with: colorectal adenocarcinoma, cholangiocarcinoma (CBD cancer), primary sclerosing cholangitis (obstructive jaundice and liver failure).
UC management?
anti-inflammatories, disease monitoring due to high colonic adenocarcinoma rates and surgical therapy (remove affected bowel, potentially curative but results in lifelong end ileostomy bag).
Hyperthyroidism symptoms and investigations?
increased frequency softer stools, heat intolerance, weight loss, resting tremor, lid lag, tachycardic. Check TSH and T3/T4. Most common aetiology is Graves, investigated by looking at the antithyroid perioxidase and a raised ESR.
IBD complications outside the bowel?
Clubbing, eyes (inflammation leading to iritis, episcleritis, scleritis), skin (erythema nodusum or pyoderma anaemias), joints (enteric arthritis), blood (iron deficiency anaemia), biliary system (PSC, cholesterol gallstones), kidneys (stones), bones (lack of Ca2+ can lead to osteomalacia).
