L6: Gastroenterology - A Symptoms Based Approach Flashcards
According to the bristol stool chart, which types are considered to be “normal”?
Type 3 or 4
What is the definition of diarrhea?
increased frequency and liquidity of faecal evacuation (frequency > 3 a day)
What is considered acute diarrhea?
less than 7 days
What is considered persistent diarrhea?
occurs for between 14 to 21 days
What is considered chronic diarrhea?
occurs for more than 1 month
List some of the characteristics of small bowel diarrhea
- watery
- large volume
- cramping, bloating, gas
- weight loss
- no blood
- rarely fever
List some of the characteristics of large bowel diarrhea
- frequent
- small volume
- blood present
- mucus
- fever common
- rarely weight loss
How many stools/day would be considered a trait of severe diarrhea?
6 stools/24 hours
What is steatorrhea? Why does it occur? How does it appear?
fat in the stool; due to fat malaborption
- appears as pale stools
What is tenesmus? What may be some causes of this?
Tenesmus: sensation that rectum is full; need to go to the washroom
may result from proctitis or a rectal issue
- can also be a tumour!
Why may tenesmus be concerning? (i.e. why should it be investigated?)
There may be a tumour present near/around the rectum that is causing the feeling of fullness and need to go to the washroom
PPIs may increase the risk for what type of diarrhea?
C. difficile - associated diarrhea
What are the effects of opioids in the GIT and what can it cause?
- opioids inhibit gastric emptying and inhibit peristalsis in the GIT
- leads to hardening of stool and constipation
opioids a/w with OVERFLOW DIARRHEA
Which bacteria cause bloody diarrhea?
campylobacteria, shigella, salmonella
Which bacteria cause non-bloody diarrhea?
norovirus, c. difficile, cholera
If stool is described as yellow, loose and difficult to wash away - what is this describing?
Steatorrhea (fat in the stool)
What is a medication that may cause diarrhea? (hint: PPI and what else?)
Metformin
What is malabsorption? (definition)
impaired absorption of digested food caused by alterations of the intestinal mucosa
What are the 4 categories of malabsorption?
- Intestinal
- Pancreatic
- Biliary
- Other
Malabsorption is characterized by what 3 things?
- Diarrhea
- Steatorrhea
- Weight Loss
What are some examples of intestinal malabsorption (or intestinal causes of malabsorption)?
coeliac disease
crohn’s disease
giardiasis
whipple’s disease
What are some examples pancreatic malabsorption (or pancreatic causes of malabsorption)?
Main One = chronic pancreatitis
cystic fibrosis
pancreatic cancer
What are some examples of biliary malabsorption (or biliary causes of malabsorption)?
biliary obstruction
primary biliary cirrhosis
What can hypercalcaemia cause?
constipation
What are haemorrhoids?
they are swollen and inflamed veins in the rectum or anus
What are anal fissures?
small tears in the anus
List the complications of constipation
- haemorrhoids
- anal fissures
- rectal prolapse
- fecal impaction
What is the connection between the brain-gut axis and constipation?
patients become constipated due to ignoring the urge to have a bowel movement/for psychological reasons
- treated w/ biofeedback
Laxatives are used to treat what condition?
constipation
What are some non-medicinal treatments for constipation?
- changes in diet/nutrition
- exercise and lifestyle changes
- biofeedback
What are some medicinal treatments for constipation?
- Bulk Forming Agents
- Osmotic Laxatives
- Stimulant/Irritant Laxatives
- Stool Softeners
- Cholinergic Agonists
What are the 5 F’s of abdominal distension and bloating? (5 possible causes)
Fluid Faeces Flatus Foetus Fat
List some of the symptoms of oesophageal disease
heartburn regurgitation chest pain dysphagia odynophagia globus sensation water brash
What is odynophagia?
painful swallowing
What symptoms of oesophageal disease should raise a red flag?
dysphagia
odynophagia
What is globus sensation/globus pharyngeus?
tightness in the throat/sensation of a constant lump in throat without any difficulty of swallowing
- mainly psychological
What are the “mechanical” causes of dysphagia?
oesophageal cancer
peptic stricture
achalasia
inflammatory (oesophagitis)
What are the clinical features/symptoms of achalasia?
dysphagia, regurgitation and CHEST PAIN*
What is achalasia? What imaging is used and how does it appear?
narrowing of the LES
barium swallow used - Bird Beak appearance
What is a possible treatment of achalasia?
botox injection
What is a possible complication of oesophagitis?
narrowing of eosophagus causing a stricture
What is a possible complication of diverticulae in the eosophagus?
food may get stuck in the pouches
What is the Schatski ring? How would it present?
thin, web like constriction located @ squamocolumnar mucosal junction or near border of LES
dysphagia to solids is the only symptom
What is eosinophilic oesophagitis? What is the treatment for it?
huge amount of eosinophils in oesophagus; can get dysphagia
a/w asthma and eczema
treated w/ PPI
What is eosinophilic oesophagitis associated with?
asthma and eczema
Clubbing of the fingers is associated with which conditions?
IBD, cirrhosis, coeliac disease
Leuconychia is associated with what condition?
hypoalbuminaemia
What is koilonychia associated with?
iron deficiency anaemia
What is dupytren’s contracture associated with?
excess alcohol
What is palmar crease pallor associated with?
anaemia
What is angular stomatitis? What is it associated with?
causes swelling around sides of mouth; a/w iron or b12 deficiency
Aphthous ulcers are associated with what?
Crohn’s or Coeliac disease
What is Felty’s Syndrome? What triad is it a/w?
- a rare subtype of rheumatoid arthritis
- characterized by arthritis, splenomegaly*, and neutropenia
What gastrointestinal condition can NSAIDs cause?
colitis
A Schatski Ring may only present with 1 symptom which is…
dysphagia to solids
What is a hepatic flap a/w?
hepatic encephalopathy or uraemia
What is conjunctival pallor a/w?
anaemia
What is scleral icetrus a/w?
liver disease/jaundice
What is xanthelasma a/w?
hyperlipidaemia + PBC
