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Gastrointestinal > irritable bowel syndrome & bowel ischaemia > Flashcards

irritable bowel syndrome & bowel ischaemia Flashcards

1
Q

what is irritable bowel syndrome

A

’ functional bowel disorder’

mixed group of abdo symptoms with no organic cause

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2
Q

epidemiology of IBS

A

Age of onset under 40yrs
more common in femalles
1 in 5 in the western world

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3
Q

risk factors for IBS

A

Previous gastroenteritis
Previous severe long-term diarrhoea
Anxiety and depression
Psychological stress, trauma, abuse

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4
Q

What are the three types of IBS

A

IBS-C – with constipation
IBS-D – with diarrhoea
IBS-M – mixed, with alternating constipation & diarrhoea

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5
Q

clinical presentation of IBS

A

Abdo pain
Bloating
Change in bowel habit

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6
Q

diagnosable criteria of irritable bowel syndrome

A

Abdominal pain/discomfort associated with 2+ of:
Relieved by defecation
Altered stool form
Altered bowel frequency

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7
Q

what other symptoms may a patient complain of

A

Urgency
Incomplete evacuation
Abdo bloating/distension
Mucus in rectum & stool
Worsening of symptoms after food
Abdo tenderness

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8
Q

symptoms are exacerbated by

A

stress
menstruation
gastroenteritis
food

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9
Q

red flag symptoms for colon cancer

A
  • Unexplained weight loss
  • Bleeding on defecation/wiping
  • Abdo/rectal mass
  • Raised inflammatory markers
  • Anaemia
  • Aged over 50
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10
Q

what investigations would you do for ibs

A

blood test
faecal calprotectin
colonoscopy

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11
Q

management for mild IBS

A

-Education and reassurance
- dietary modification
- keep a food diary - to identify triggers

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12
Q

management for IBS-C

A
  • stool softeners
    -oral laxatives
  • avoid alcohol
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13
Q

management for IBS-D

A

AVOID insoluble fiber
Makes diarrhoea
Cereals, whole-wheat bread, lentils, apples, avocados

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14
Q

medication for bloating

A

antispasmodics
buscopan

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15
Q

medication for diarrhoea

A

loperamide

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16
Q

medication for constipation

A

laxatives- macrogol

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17
Q

What is the mesentery

A

Mesenteries are double layers of peritoneum in the abdominal cavity and are continuations of the visceral and parietal peritoneum

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18
Q

What is chronic mesenteric ischaemia

A

narrowing of GI blood vessels causing decreased supply to bowel. same as angina in heart

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19
Q

Risk factors for chronic mesenteric ischaemia

A

same as cardiac

20
Q

classic triad of signs and symptoms of chronic mesenteric ischaemia

A
  • central colicky abdominal pain after food
  • weight loss
  • abdominal bruit
21
Q

investigations for CMI

A

CT contrast angiography

22
Q

Define acute mesenteric ischaemia

A

blockage of mesenteric arteries/ veins – leading to small bowel ischaemia
Affects superior mesenteric artery

23
Q

Mesenteric ischaemia epidemiology

A

Age: >40
F>M

24
Q

Aetiology of mesenteric ischaemia

A

Arterial - thrombosis, embolism
Venous - Thrombosis
Non- occlusive - Hypoperfusion

25
Q

RFs for mesenteric ischaemia

A

Age
AF
Atherosclerosis
MI
Vasculitis
IE

26
Q

Physiology of SI blood circulation

A
  • SI need high oxygen for digestion > susceptible to tissue injury from ischaemia
  • Reduce risk: mesenteric arteries branch and reconnect at points froming collateral circulation - blood flow reduced one way blood received from another pathway
27
Q

S + S of mesenteric ischaemia

A

Rectal bleeding
DIARRHOEA
N/V
Fever
Weight loss

28
Q

Small Bowel infarction (mesenteric ischaemia)

A
  • SBI - decrease in BF to SI
  • ISchaemic injury leads to production of ROS > damage DNA,RNA and protein in cell leading to cell death
  • BF returns to tissue called reperfusion causes reperfusion injury
  • ROS triggers inflammatory response - neutrophils remove dead cells + release cytokines TNFa
  • Blood vessels become more permeable to fluid + immune cells > bowel oedema
29
Q

examples of mesenteric vessels

A

superior + inferior mesenteric artery
SMV
IMV
right and middle colic artery

30
Q

What does acute mesenteric ischaemia cause

A

Bowel infarction + perforation
Short bowel syndrome
Strictures

31
Q

Most commonly affected vessel

A

SMA

32
Q

Causes of acute mesenteric ischaemia

A
  • embolus
  • low perfusion
  • thrombus
33
Q

classic triad of signs and symptoms for acute mesenteric ischaemia

A

-severe colicky abdominal pain
- abdominal bruit
- rapid hypovolaemia

34
Q

How does chronic mesenteric ischaemia present

A
  • abdo pain after eating
  • fear of eating
  • weight loss
35
Q

investigations for AMI

A
  • History and diagnosis
    1st line- CT contrast/ angiography
    GOLD- colonoscopy
36
Q

treatment for ami

A

Supportive
- IV fluids
- Catheter
- o2
- analgesia

37
Q

What is ischaemic colitis

A

Bowel ischaemia which affects the large bowel. This is mainly due to pathology in the inferior mesenteric artery territory and can range from mild ischaemia to gangrenous colitis.

38
Q

Causes of ischaemic colitis (intestinal ischaemia when intestines small and large dont get sufficient blood)

A

Non occlusive: HF, Renal impairment, Cocaine use
Arterial: Thrombus, embolism
Venous: Embolism

39
Q

RFs for Ischaemic colitis

A

Older age
Peripheral vascular disease
AF
Atherosclerosis
MI
Cocaine

40
Q

what is the most common ischaemic bowel disease

A

ischaemic collitis

41
Q

S+ S of IC

A

Abdom tenderness
Pyrexia
Tachycardia
Diarrhoea
Fever
Haematochezia

42
Q

what is most commonly affected in ischamic collitis

A

splenic flexure despite dual blood supply of sma and ima

43
Q

Investigations for IC

A

FBC, U&Es, VBG
GI endoscopy - GS
CT

44
Q

signs and symptoms of ischaemic colitis

A
  • severe colicky abdominal pain
  • abdominal bruit
  • rapid hypovolaemia
45
Q

Management of IC

A

NBM
IV Fluid
Broad spectrum ANTIBIOTICS

Gastrointestinal (13 decks)

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