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Y1 - Gatrointestinal > Large bowel and other lower GI conditions > Flashcards

Large bowel and other lower GI conditions Flashcards

1
Q

What is IBS?

A

Functional bowel syndrome in which abdominal pain is associated with a change in bowel habit in the absence of structural pathology

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2
Q

Which sex is IBS more common in?

A

Females

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3
Q

What is important when taking a history of suspected IBS?

A

Detailed questions on nature of stools
Impact on daily activities
Diet, exercise, mental-wellbeing

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4
Q

What examinations should be done in suspected IBS?

A

BMI - for unexplained weight loss
Abdo exam for tenderness or masses
PR exam for rectal pathology

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5
Q

What must be ruled out before a diagnosis of IBS can be made?

A

IBD
Coeliac
Malignancy

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6
Q

What investigations should be done before a diagnosis of IBS?

A

FBC
CRP/ESR
Coeliac serology
If inflammation markers are raised, further investigation would be done

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7
Q

How is IBS managed?

A 
Identify and avoid dietary or mental triggers
Dietary advice (try low FODMAP diet)
Recommend probiotics
Medication can help with severe diarrhoea, constipation and abdominal pain
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8
Q

What are the main IBD GI manifestations?

A

Increased risk of colon cancer
Toxic megacolon (UC)
Bowel obstruction
Sclerosing cholangitis

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9
Q

Which part of the GI tract is most commonly affected by CD?

A

Terminal ileus

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10
Q

What are the characteristic features of CD?

A

Transmural inflammation

Cobble-stoning on endscopy

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11
Q

What are the investigations done when CD is suspected, and in what order?

A
  1. Examination
  2. Bloods
  3. Endoscopy
  4. Biopsy for diagnosis
  5. Imaging
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12
Q

What can be seen on examination in CD?

A

Weight loss
RIF mass
Peri-anal signs

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13
Q

What may be seen from taking bloods in CD?

A

Raised CRP/ESR, ferritin and vitamin B12 deficiency

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14
Q

What can be seen on endoscopy in CD?

A

Cobble-stoning

Skip lesions

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15
Q

What are the histological features of CD?

A

Granulomas

Loss of villi

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16
Q

What imaging is done for CD and what is it done for?

A

MRI
CT
Barium follow-through
Done to look for strictures, fistula and to give an indication of severity

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17
Q

What is the treatment for CD?

A

Lifestyle

  1. Steroids
  2. Immunosuppressants
  3. Anti-TNF
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18
Q

What are some side effects of steroids?

A

Weight gain
Osteoporosis
Thinning of skin
Hypertension

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19
Q

When is surgery done in CD?

A

If a flare up is particularly bad to cut out the bit causing problems

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20
Q

What are the risks of surgery in CD?

A

Short gut syndrome

Parenteral nutrition

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21
Q

What are the complications of CD?

A 
Strictures
Fistula
Obstruction
Malnutrition
Short gut syndrome 
Colon cancer
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22
Q

What are the macroscopic features of UC on endoscopy?

A

Red, inflamed and friable mucosa
Pseudo-polyps
Thin wall

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23
Q

What are the microscopic features of UC?

A

Inflammation limited to mucosa (superficial)
Loss of goblet cells
Crypt abscesses

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24
Q

What are the symptoms of CD?

A 
Abdominal pain
Diarrhoea
Weight loss
Fatigue
Malaise
Fever
Mouth ulcers
Angular stomatitis
Peri-anal disease
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25
What are the symptoms of UC?
``` Bloody diarrhoea >6 weeks Faecal urgency/incontinence Tenesmus Pain before defecation, relieved once stool passed Non specific symptoms ```
26
What are the signs of UC?
Apthous ulcers Finger clubbing Pallor (anaemia) Abdominal tenderness in LIF
27
What investigations can be done for UC?
``` P-ANCA positive FBC CRP U&Es, LFTs Coeliac serology Stool culture Faecal calprotectin Colonoscopy ```
28
Why might the following investigations be done for UC: | FBC, CRP, U&Es, LFTs, coeliac serology, stool culture, faecal calprotectin, colonoscopy?
FBC - check for anaemia and high platelets CRP - raised U&Es, LFTs - may be deranged Coeliac serology - exclude coeliac Stool culture - Exclude infection Faecal calprotectin - raised suggests active inflammation Colonoscopy - diagnosis
29
What is the medical management for UC?
1. Topical then oral amino salicylate 2. Topical or oral steroid 3. Immunosuppression 4. Anti-TNF
30
What medication is used in an acute exacerbation of UC?
IV steroids
31
What additional management is used in UC other than medical and surgical?
``` Lifestyle, support groups Bone health assessment Colonic cancer surveillance Monitor nutrition status Flu and pneumococcal vaccines ```
32
What is re-feeding syndrome?
A metabolic problem when a malnourished person is reintroduced to food too quickly
33
What is osmotic diarrhoea?
Lots of non-digestible substances in the bowel cause water to move into the lumen
34
How is osmotic diarrhoea resolved?
Avoidance of the substance that caused it and increasing absorption
35
What are examples of causes of osmotic diarrhoea?
Certain purgatives | Malabsorptive conditions
36
What is secretory diarrhoea?
The secretion of electrolytes into he lumen in response to a signal, which are followed by water
37
What are causes of secretory diarrhoea?
Enterotoxin from E.coli, C.diff and cholera | Hormones
38
How is secretory diarrhoea resolved?
Replacing fluids and electrolytes
39
What is inflammatory diarrhoea?
Damage to mucosal cells leads to loss of blood and fluid | Decrease in absorptive function causes a build up in malabsorbed substances
40
What is a cause of inflammatory diarrhoea?
IBD
41
How is inflammatory diarrhoea resolved?
Treat underlying cause and replace fluid and electrolytes
42
What questions are important to ask when taking a history of diarrhoea?
``` Acute or chronic? Frequency, urgency, nature of stool? Blood mucous or pus? Explosive (cholera)? Other associated symptoms? Constipation? Social history ```
43
What is the nature of diarrhoea caused by infection?
Sudden onset Crampy abdominal pain Fever Can be a trigger
44
What is the nature of diarrhoea caused by IBD?
Loose Blood stained stools Chronic history Extra-GI symptoms
45
What is the nature of diarrhoea caused by IBS?
No blood Triggering events Alternating diarrhoea and constipation
46
What is the nature of diarrhoea caused by pancreatic dysfunction?
Steatorrhoea
47
What is the nature of diarrhoea caused by colorectal cancer?
Blood | Mass
48
What are causes of constipation?
Poor diet and fluid intake Obstruction (stricture, colorectal cancer, diverticulosis) IBS Anorectal disease (stricture, prolapse, diverticulosis) Functional/idiopathic Metabolic Drugs
49
What is necrotising enterocolitis?
Condition in premature babies where the GI wall is invaded by bacteria
50
What is the pathogenesis of necrotising enterocolitis?
GI wall is invaded by bacteria Bowel becomes inflamed and leads to necrosis of tissue Bowel contents leak into peritoneal cavity and cause peritonitis
51
What are the symptoms of necrotising enterocolitis?
Poor feeding Abdominal distension Bile stained vomit Sepsis
52
What is peritonitis?
Inflammation of the peritoneum
53
What are causes of peritonitis?
``` Underlying GI condition Perforated organ or ulcer Peritoneal dialysis Ascites related to liver disease TB ```
54
What are causes of localised peritonitis?
Acute inflammation (acute appendicitis, acute cholecystitis)
55
What are the features of localised peritonitis?
Pain and localised tenderness with a more gradual onset
56
What are the causes of generalised peritonitis?
Inflammation of the peritoneal cavity due to irritation of the peritoneum because of infection or chemical irritation due to leakage of intestinal contents
57
What are the signs and symptoms of peritonitis?
``` Rigid abdomen Rebound tenderness Abdominal pain and tenderness Distended abdomen if ascites High temperature Tachycardia ```
58
What are the investigations for peritonitis?
Erect CXR showing air under the diaphragm if due to perforation Abdominal paracentesis
59
What is the management for peritonitis?
Resuscitation | Surgery - peritoneal lavage
60
What are the complications of peritonitis?
Sepsis Multi-organ failure Abscess formation
61
What are the features of Peutz-Jegher's syndrome?
Lots of hamartomatous GI polyps and mucocutaneous hyperpigmentation
62
What are associated complications of Peutz-Jegher's syndrome?
Bowel obstruction | Intussusception
63
What management is done in Peutz-Jegher's syndrome?
Active cancer surveillance | Prophylactic polypectomy

Y1 - Gatrointestinal (31 decks)

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