Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gastrointestinal System > Lecture 7.2: Other Disorders of the Bowel > Flashcards

Lecture 7.2: Other Disorders of the Bowel Flashcards

1
Q

What is Constipation?

A
  • Difficulty with defecation
  • Infrequent and/or hard to pass stool
  • Rome IV criteria: <3x a week
  • Sensation of incomplete evacuation or anorectal
    blockage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is Chronic Constipation?

A

Constipation for >3months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is Faecal Loading/Impaction?

A

Retention of faeces to the extent that spontaneous evacuation is unlikely (might require manual disimpaction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is Functional (primary or idiopathic) Constipation?

A

Chronic constipation without a known cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is Secondary Constipation?

A

Cause by medication or an underlying condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How much higher is constipation in women than in men?

A

2-3 times

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Risk Factors for Constipation: Social (7)

A
  • Low Fibre/Calorie Diet
  • Access to Toilet
  • Reduce Exercise
  • Privacy when Toileting
  • Low Educational Levels
  • Socio-Economic Deprivation
  • Family History
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Risk Factors for Constipation: Psychological (4)

A
  • Anxiety
  • Depression
  • Eating Disorders
  • Abuse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Risk Factors for Constipation: Physical (6)

A
  • Female Sex
  • Older Age
  • Pyrexia
  • Poor Fluid Intake
  • Immobility
  • Sitting Position on Toilet Seat
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the 2 categories of Secondary Causes of Constipation?

A
  • Organic Causes
  • Medication Related
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Secondary Causes of Constipation: Medications (7)

A
  • Opiates
  • Tryciclics
  • NSAIDs
  • Antihistamines
  • Iron Supplements
  • Beta-Blockers
  • Calcium Channel Blockers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are Organic Causes of Secondary Causes of Constipation (5)

A
  • Endocrine
  • Myopathic Conditions
  • Neurological Conditions
  • Structural Abnormalities
  • Other
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Secondary Causes of Constipation: Endocrine (2)

A
  • Hypothyroidism
  • Hypercalciaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Secondary Causes of Constipation: Myopathic Conditions (3)

A
  • Scleroderma
  • Amyloidosis
  • Myotonic Dystrophy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Secondary Causes of Constipation: Neurological Conditions (3)

A
  • Multiple Sclerosis
  • Parkinson’s Disease
  • Spinal Cord Injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Secondary Causes of Constipation: Structural Abnormalities (3)

A
  • Anal Fissures
  • Structuring IBD
  • Obstructive Mass
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Secondary Causes of Constipation: Other (3)

A
  • CVD
  • IBS
  • Coeliac Disease
  • Hirschprungs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is Hirschprungs?

A
  • Congenital
  • Developmental failure of Auberbach and Meissner
    plexuses
  • Absent from anorectal junction
  • Gut aperistaltic and spastic
  • Causes constipation and gut dilatation
  • Megacolon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is Stool Impaction?

A

A faecal impaction is a large, hard mass of stool that gets stuck so badly in your colon or rectum that you can’t push it out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When should the diagnosis of Impaction be considered? (4)

A
  • Hard, lumpy stool which may be large and infrequent
  • Small and relatively frequent - ’rabbit droppings’ * Need manual methods to extract faeces
  • Overflow incontinence/loose stool
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is a Colonic Transit Study?

A
  • A test that shows how quickly food passes through the
    digestive system
  • It starts when you give your child some pellets to
    swallow on three consecutive days
  • On the fourth day, they will need to come into hospital
    for an x-ray
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Red Flags in Bowel Issues (5)

A
  • PR bleed
  • Unintentional Weight Loss
  • Recent Change in Bowel Habit
  • New Abdominal Pain
  • Iron Deficiency/Anaemia
23
Q

How to treat Constipation? (6)

A
  • Dietetic Referral
  • Lifestyle Adjustments
  • Rectal Suppositories
  • Laxatives
  • Disimpaction
  • Obstructive defecation – refer for balloon expulsion
    test/anorectal manometry and biofeedback sessions
24
Q

What is Irritable Bowel Syndrome (IBS)

A

It is a chronic, relapsing, and often lifelong disorder of the lower gastrointestinal tract, with no discernible structural or biochemical cause

25
Q

Symptoms of IBS

A
  • Stomach Pain/Cramps
  • Bloating
  • Diarrhoea
  • Constipation
26
Q

When can IBS be diagnosed?

A

Abdominal pain/discomfort, in association with altered bowel habit, for at least 6 months, in the absence of alarm symptoms or signs

27
Q

What are possible mechanisms of IBS? (6)

A
  • Visceral hypersensitivity
  • Abnormal gastrointestinal immune function
  • Changes in colonic microbiota
  • Abnormal autonomic activity
  • Abnormal central pain processing of afferent gut
    signals (altered ‘brain-gut interactions’)
  • Abnormal gastrointestinal motility
28
Q

Possible Risk Factors of IBS? (6)

A
  • Genetic
  • Enteric infection (e.g. following gastroenteritis)
  • Gastrointestinal inflammation (e.g. secondary to
    inflammatory bowel disease)
  • Dietary factors (alcohol, caffeine, spicy and fatty
    foods)
  • Drugs (antibiotics)
  • Psychosocial (stress, anxiety and/or depression)
29
Q

What demographic is IBS most common in?

A
  • 20-30 years
  • Women > men
30
Q

Consider the diagnosis of IBS in a person who has
had any of the following symptoms for at least 6 months: ABC

A

Abdominal Pain
Bloating
Change in bowel habit

31
Q

Make a diagnosis of IBS if a person has
abdominal pain which is associated with either..? (8)

A
  • Related to defecation
  • Associated with altered stool frequency
  • Associated with altered stool form or appearance
  • Altered stool passage
  • Abdominal bloating
  • Symptoms worsened by eating
  • Passage of rectal mucus
  • Alternative conditions with similar symptoms have.
    been excluded
32
Q

Investigations for IBS- most;y to rule out other conditions (6)

A
  • Full blood count (FBC)
  • Erythrocyte sedimentation rate (ESR)
  • C-reactive protein (CRP)
  • Antibody testing for coeliac disease
  • Fecal calprotectin to r/o IBD
  • Consider FIT testing in 50+ population
33
Q

Treatment of IBS: Lifestyle Changes (6)

A
  • Encourage addressing psychological causes
  • Increase water intake
  • Reduce insoluble fibre (wholemeal)
  • Reduce food that exacerbate (caffeine, alcohol,
    carbonated drinks, gas-producing food)
  • Fibre supplements
  • Encourage 30mins exercise 5x a week
34
Q

Treatment of IBS: Pharmacological (5)

A
  • Antispasmodics (mebeverine, peppermint oil capsules)
  • Laxatives (avoid lactulose)
  • Loperamide (for antimotility)
  • TCA second line (Amitriptyline/Nortryptilline): for IBS-D
  • SSRI second line (Citalopram): for IBS-C
35
Q

When should Linaclotide be considered for treating IBS? (3)

A
  • Optimal or maximum tolerated doses of previous
    laxatives from different classes have not helped
  • Constipated 12months +
  • Need follow up after 3months
36
Q

What causes Bile Acid Malabsorption?

A

An over-production of bile acids (BA) due to defective feedback inhibition of hepatic bile acid synthesis

37
Q

Small Intestinal Bacterial Overgrowth (SIBO)

A

Excessive amount of bacteria (dysbiosis) populates the small intestines

38
Q

Symptoms of SIBO (7)

A
  • Bloatiness
  • Abdominal Pain
  • Diarrhoea
  • Loss of appetite
  • Nausea/Vomiting
  • Unintentional Weight Loss
  • Malnutrition
39
Q

Conditions associated with SIBO (4)

A
  • Gut Dysmotility
  • Anatomical Changes
  • Altered GI Secretions
  • Impaired Gut Immunity
40
Q

Investigations to diagnose SIBO (2)

A
  • Gold standard dg: quantitative culture of jj aspirates
    (invasive, non-practical)
  • Real life dg tests: glucose and lactulose breath tests
41
Q

Treatment of SIBO (5)

A
  • Avoid Sugar
  • Smoking Cessation
  • Avoid NSAIDs
  • Low FODMAP Diet
  • Antibiotics: Rifaximin 550mg bd for 7-14/7,
    Ciprofloxacin 500mg bd, Metronidazole 500mg tds
42
Q

What is Coeliac Disease?

A

Chronic immune-mediated systemic disorder in
genetically predisposed people, triggered by exposure to dietary gluten

43
Q

What is Potential Coeliac Disease?

A

Symptomatic patients or those who are asymptomatic with +ve antibodies but no villous atrophy on biopsy

44
Q

What is Non-Responsive Coeliac Disease?

A

Persistent symptoms and enteropathy that do not response after 6-12 months of treatment

45
Q

What is Refractory Coeliac Disease?

A

Persistent or recurrence of otherwise unexplained symptoms and villous atrophy despite 12+ adherence to treatment

46
Q

What is Coeliac Disease characterised by? (3)

A
  • Inflammatory small bowel enteropathy
  • GIT and /or systemic symptoms
  • Presence of coeliac-specific autoantibodies
47
Q

Predisposing Factors of Coeliac Disease (4)

A
  • Genetic : strong association with HLA-DQ2/-DQ8
  • Immune-mediate disorder driven by immune
    response to gluten
  • Link with other auto-immune diseases (diabetes,
    thyroid disease)
  • Gluten exposure
48
Q

What signs indicate that Coeliac Disease should be suspected? (8)

A
  • Persistent, unexplained GI symptoms
  • IBS
  • Faltering growth/delayed development
  • Prolonged fatigue/lethargy
  • Unexplained Fe, B12 or folate deficiency/anaemia not
    responding to treatment
  • At diagnosis of auto-immune disease
  • Selective IgA deficiency
  • First degree relative with condition
49
Q

Consider a diagnosis of Coeliac Disease in a person with what conditions? (8)

A
  • Osteomalacia/-penia/-porosis or fragility fracture
  • Unexplained anxiety/depression
  • Unexplained Peripheral neuropathy
  • Unexplained Recurrent miscarriage or subfertility
  • Unexplained Persistently raised LFTs
  • Dental enamel defects
  • Hyosplenism
  • Downs/Turners/Williams syndrome
50
Q

What is Dermatitis Herpetiformis?

A

A chronic, intensely itchy, blistering skin manifestation of gluten-sensitive enteropathy, commonly known as celiac disease

51
Q

Treatment of Coeliac Disease

A

Gluten Free Diet

52
Q

Complications of uncontrolled/undiagnosed Coeliac Disease (9)

A
  • Reduced quality of life
  • Mental health disorders
  • Faltering growth and delayed puberty in children
  • Nutritional deficiencies
  • Anaemia
  • Reduced bone density
  • Hyposplenism
  • Malignancy/risk of lymphoma
  • Refractory coeliac disease
53
Q

What is the Valsalva Maneuver?

A

It is the performance of forced expiration against a closed glottis

Gastrointestinal System (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions