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S2 Case 2 - Diarrhoea > Lower GI Disease > Flashcards

Lower GI Disease Flashcards

1
Q

How does UC present?

A

Mucosa of rectum + colon inflamed

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2
Q

What are the causes of UC?

A

Environmental + immunological
Most likely autoimmune condition triggered by colonic bacteria

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3
Q

What are the risk factors of UC?

A

Family history, oral contraceptives + non-smoking

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4
Q

How does CD present?

A

Inflammation of mucosa any where from mouth to anus

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5
Q

What are causes of CD?

A

Immune-mediated caused by environmental trigger in genetically susceptible people

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6
Q

What are the risk factors of CD?

A

Family history, smoking, drugs

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7
Q

What are UC + CD?

A

IBD

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8
Q

What is the first test that can be done for IBD?
FBC

A

FBC = first blood count
= anaemia due to blood loss, malabsorption, malnutrition
= increased platelet count
= suggest active inflammation

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9
Q

What is the 2nd test that can be done for IBD?
Inflammatory markers

A

CRP + ESR raised in active inflammation

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10
Q

What is the 3rd test that can be done for IBD?
U&Es

A

Assess electrolyte disturbance or dehydration

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11
Q

What is the 4th test that can be done for IBD?
LFT

A

May indicate protein-losing enteropathy = lead to malnutrition

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12
Q

What is the 5th test that can be done for IBD?
Vitamin B12 + Vitamin D

A

Nutritional deficiences

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13
Q

How do you control symptoms of diarrhoea?

A

Diet
Antibiotic colitis
Do NOT give anti-diarrhoeal = stops motility

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14
Q

How do you control symptoms of constipation?

A

Check for bowel obstruction
Obstruction unlikely = tackle diet, fibre + fluids
Bulk-forming laxative - eg. ispaghula

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15
Q

How do you control symptoms of abdominal pain?

A

Now obstruction = hospital
Paracetamol for relief

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16
Q

Why are opiates + NSAIDs NOT recommended for abdominal pain?

A

Opiates = constipating effect
NSAIDs = gastric problems

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17
Q

What are the clinical features of acute flare of UC?

A

5 stools a day plus
Temp increases
Tachycardia >90bpm
Anaemia
Blood in stool

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18
Q

What are the other clinical features of UC?

A

Bloody diarrhoea > 6 weeks
Rectal bleeding
Nocturnal defecation
Faecal urgency
Abdominal pain (left quadrant)
Pre-defecation pain

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19
Q

What are the treatment options for UC?

A

5-aminosalicylates
Steroids
Immunosuppressants
Ciclosporin
Biologics
Surgery

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20
Q

Describe 5-ASA use for UC

A

Short term = induce remission
Long term = maintenance
Oral or rectal

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21
Q

When is oral 5-ASA for UC used?

A

Higher up GI tract

22
Q

When is rectal 5-ASA for UC used?

A

Low in GI tract
= local + systemic action

23
Q

What side effect of 5-ASA?

A

Discolours tears or urine
Sensitivity to light

24
Q

What is sometimes required for 5-ASA?

A

Require prescribing by brand
= narrow therapeutic window
= need to be kept on same brand
eg. mesalazine

25
Q

Describe steroids use for UC

A

Short term = induce remission
Used with or instead of 5-ASA
Oral or rectal
With food
In morning

26
Q

What is required for use of steroids if long term use?

A

Tapering

27
Q

Why are steroids NOT used long term?

A

Osteoporosis
Diabetes
Hypertension

28
Q

What are the side effects of steroids?

A

Ance
Weight gain
Increase appetite

29
Q

Describe immunosuppressant use for UC

A

Relieve symptoms if steroids can’t
Tablet once a day BUT sometimes given as injections

30
Q

Why are steroids taken in the morning?

A

Reduce disturbance to sleep

31
Q

Why are immunosuppressants given as injections?

A

1x every few months
= improves adherence

32
Q

What are the side effects of immunosuppressants?

A

Feeling + being sick
Increased risk of infection + liver problems

33
Q

What are examples of immunosuppressants?

A

Azathioprine + mercaptopurine

34
Q

What is ciclosporin?

A

More powerful immunosuppressant

35
Q

Describe use of biologics for UC

A

Reduce inflammation
Moderate to severe UC
Given for 12 months
Infusions

36
Q

What are side effects of UC?

A

Increased risk of infection
Vertigo

37
Q

Describe use of surgery for UC

A

Removes colon

38
Q

What is an ileostomy?

A

Small intestine diverted out of hole in abdomen

39
Q

What is ileo-anal pouch?

A

Part of small intestine used to create internal pouch then connected to anus

40
Q

What is problem with oral contraceptives with women who have IBD?

A

Less reliable
= malabsorption
= vomiting

41
Q

Why can’t barrier methods (condoms) just be suitable alone for women?

A

Teratogenic drugs
eg. mercaptopurine

42
Q

Does IBD affect fertility?

A

NO
BUT some drugs can
eg. teratogenic drugs stopped 3 months before trying to conceive

43
Q

What are the clinical features of CD?

A

Unexplained persistent diarrhoea (4-6 weeks)
Abdominal pain
Weight loss
Mouth ulcers
Clubbing
Perianal pain

44
Q

What are the treatments for CD?

A

NO cure
Steroids = episodic
Liquid diet
Immunosuppressants
Biological medicines
Sugery

45
Q

Describe use of steroids for CD

A

May need couple of months
Long term effects

46
Q

Describe liquid diet for CD

A

Drinks contain nutrients
Avoids risk of slower growth

47
Q

What are side effects of liquid diet?

A

Nausea
Diarrhoea
Constipation

48
Q

Describe use of surgery for CD

A

Relieve symptoms + help stop them coming back
BUT is it really viable if can happen throughout GI?

49
Q

What does the main operations for CD involve?

A

Small cuts in abdomen = keyhole surgery
Removing small, inflamed sections of bowel
Stitching healthy parts together

50
Q

What is the routine review for IBD?

A

Under care of consultant gastroenterologist
Check mental health
Compliance with meds
Contraceptive advice
Make aware need for colonscopic surveillance of colorectal cancer

S2 Case 2 - Diarrhoea (12 decks)

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