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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
Q

What are the symptoms of UC?

A 
Bloody diarrhoea >6 weeks
Faecal urgency/incontinence
Tenesmus
Pain before defecation, relieved once stool passed
Non specific symptoms
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26
Q

What are the signs of UC?

A

Apthous ulcers
Finger clubbing
Pallor (anaemia)
Abdominal tenderness in LIF

27
Q

What investigations can be done for UC?

A 
P-ANCA positive
FBC 
CRP 
U&Es, LFTs
Coeliac serology 
Stool culture 
Faecal calprotectin
Colonoscopy
28
Q

Why might the following investigations be done for UC:

FBC, CRP, U&Es, LFTs, coeliac serology, stool culture, faecal calprotectin, colonoscopy?

A

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
Q

What is the medical management for UC?

A
  1. Topical then oral amino salicylate
  2. Topical or oral steroid
  3. Immunosuppression
  4. Anti-TNF
30
Q

What medication is used in an acute exacerbation of UC?

A

IV steroids

31
Q

What additional management is used in UC other than medical and surgical?

A 
Lifestyle, support groups
Bone health assessment
Colonic cancer surveillance
Monitor nutrition status
Flu and pneumococcal vaccines
32
Q

What is re-feeding syndrome?

A

A metabolic problem when a malnourished person is reintroduced to food too quickly

33
Q

What is osmotic diarrhoea?

A

Lots of non-digestible substances in the bowel cause water to move into the lumen

34
Q

How is osmotic diarrhoea resolved?

A

Avoidance of the substance that caused it and increasing absorption

35
Q

What are examples of causes of osmotic diarrhoea?

A

Certain purgatives

Malabsorptive conditions

36
Q

What is secretory diarrhoea?

A

The secretion of electrolytes into he lumen in response to a signal, which are followed by water

37
Q

What are causes of secretory diarrhoea?

A

Enterotoxin from E.coli, C.diff and cholera

Hormones

38
Q

How is secretory diarrhoea resolved?

A

Replacing fluids and electrolytes

39
Q

What is inflammatory diarrhoea?

A

Damage to mucosal cells leads to loss of blood and fluid

Decrease in absorptive function causes a build up in malabsorbed substances

40
Q

What is a cause of inflammatory diarrhoea?

A

IBD

41
Q

How is inflammatory diarrhoea resolved?

A

Treat underlying cause and replace fluid and electrolytes

42
Q

What questions are important to ask when taking a history of diarrhoea?

A 
Acute or chronic?
Frequency, urgency, nature of stool?
Blood mucous or pus?
Explosive (cholera)?
Other associated symptoms?
Constipation?
Social history
43
Q

What is the nature of diarrhoea caused by infection?

A

Sudden onset
Crampy abdominal pain
Fever
Can be a trigger

44
Q

What is the nature of diarrhoea caused by IBD?

A

Loose
Blood stained stools
Chronic history
Extra-GI symptoms

45
Q

What is the nature of diarrhoea caused by IBS?

A

No blood
Triggering events
Alternating diarrhoea and constipation

46
Q

What is the nature of diarrhoea caused by pancreatic dysfunction?

A

Steatorrhoea

47
Q

What is the nature of diarrhoea caused by colorectal cancer?

A

Blood

Mass

48
Q

What are causes of constipation?

A

Poor diet and fluid intake
Obstruction (stricture, colorectal cancer, diverticulosis)
IBS
Anorectal disease (stricture, prolapse, diverticulosis)
Functional/idiopathic
Metabolic
Drugs

49
Q

What is necrotising enterocolitis?

A

Condition in premature babies where the GI wall is invaded by bacteria

50
Q

What is the pathogenesis of necrotising enterocolitis?

A

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
Q

What are the symptoms of necrotising enterocolitis?

A

Poor feeding
Abdominal distension
Bile stained vomit
Sepsis

52
Q

What is peritonitis?

A

Inflammation of the peritoneum

53
Q

What are causes of peritonitis?

A 
Underlying GI condition
Perforated organ or ulcer
Peritoneal dialysis
Ascites related to liver disease
TB
54
Q

What are causes of localised peritonitis?

A

Acute inflammation (acute appendicitis, acute cholecystitis)

55
Q

What are the features of localised peritonitis?

A

Pain and localised tenderness with a more gradual onset

56
Q

What are the causes of generalised peritonitis?

A

Inflammation of the peritoneal cavity due to irritation of the peritoneum because of infection or chemical irritation due to leakage of intestinal contents

57
Q

What are the signs and symptoms of peritonitis?

A 
Rigid abdomen
Rebound tenderness
Abdominal pain and tenderness
Distended abdomen if ascites
High temperature
Tachycardia
58
Q

What are the investigations for peritonitis?

A

Erect CXR showing air under the diaphragm if due to perforation
Abdominal paracentesis

59
Q

What is the management for peritonitis?

A

Resuscitation

Surgery - peritoneal lavage

60
Q

What are the complications of peritonitis?

A

Sepsis
Multi-organ failure
Abscess formation

61
Q

What are the features of Peutz-Jegher’s syndrome?

A

Lots of hamartomatous GI polyps and mucocutaneous hyperpigmentation

62
Q

What are associated complications of Peutz-Jegher’s syndrome?

A

Bowel obstruction

Intussusception

63
Q

What management is done in Peutz-Jegher’s syndrome?

A

Active cancer surveillance

Prophylactic polypectomy

Y1 - Gatrointestinal (31 decks)

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