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TCD Gastrointestinal > Per Rectum Bleeding > Flashcards

Per Rectum Bleeding Flashcards

1
Q

What test should always be offered to any patient requiring admission to hospital with severe infectious bloody diarrhoea?

A

A test for HIV, as immunocompromise should be suspected.

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2
Q

What causes anaemia in Coeliac Disease?

A

Poor absorption of iron in the inflamed small bowel (rather than direct blood loss).

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3
Q

What is Giardia infection, and what are the symptoms? (5)

A

A parasitic infection of the bowel, causing:
-Foul smelling diarrhoea
-Bloating
-Cramping abdominal pain
-Weight loss
-Fatigue
[Symptoms can last for many weeks.]

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4
Q

What is the first line treatment for Giardia infection?

A

Metronidazole

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5
Q

Why does pancreatic exocrine insufficiency cause diarrhoea?

A

Reduced secretion of pancreatic digestive enzymes means food cannot be broken down and absorbed.

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6
Q

What is bile acid diarrhoea?

A

Failure to reabsorb bile acids in the terminal ileum, which can cause symptoms very similar to irritable bowel syndrome with diarrhoea predominance.

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7
Q

What conditions can cause diarrhoea, with the potential for visible blood loss? (7)

A

-Colorectal cancer
-Inflammatory bowel disease
-Ischaemic colitis
-Diverticulitis
-Shigella infection
-Shiga toxin producing E.coli infection
-Clostridium difficile (C. diff) infection

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8
Q

Which patients with Shigella infection should be treated with antibiotics?

A

Those with severe symptoms and immunocompromised patients.

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9
Q

Which antibiotic is currently first line in the UK for treating Shigella infection?

A

Azithromycin

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10
Q

Why is Shiga toxin producing E.coli infection NOT treated with antibiotics?

A

This increases the risk of a potentially fatal complication, haemolytic uraemic syndrome.

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11
Q

What complications can occur in severe cases of Clostridium difficile (C. diff) infection?

A

Dilation of the bowel, resulting in toxic megacolon and perforation.

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12
Q

What is pseudomembranous colitis?

A

A characteristic appearance of raised whitish yellow plaques on endoscopy, resulting from an exudate of inflammatory cells and mucus seen most commonly in Clostridium difficile infection.

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13
Q

How should Clostridium difficile infection be treated?

A

Vancomycin; oral route is preferred if possible.

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14
Q

What is an anal fissure?

A

A small tear in the lining of the anal canal.

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15
Q

What symptoms are associated with an anal fissure? (2)

A

Sharp pain on defecation
Bright red blood on stool or on wiping

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16
Q

What are haemorrhoidal cushions?

A

Normal vascular rich connective tissue cushions in the anal canal; can become haemorrhoids if they become swollen or inflamed, causing pain and bleeding.

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17
Q

What is loperamide?

A

An antimotility drug used to treat diarrhoea, but contraindicated in IBD as can increase risk of bowel dilation and toxic megacolon.

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18
Q

How does chronic inflammation affect albumin?

A

Chronic inflammation causes increased degradation of albumin, leading to lower serum albumin.

19
Q

Give five causes of hypokalaemia.

A

-Profuse diarrhoea
-Vomiting
-Loop/thiazide diuretics
-Mineralocorticoid excess
-Disorders causing excess renal loss of potassium

20
Q

What are the next steps on discovering hypokalaemia on a blood test? (3)

A

Perform an ECG
Check levels of other electrolytes (magnesium, phosphates and calcium)
Provide adequate replacement therapy

21
Q

What are the four main causes of hypoalbuminaemia?

A

-Inflammation (acute or severe) causing increased albumin degradation
-Primary liver disorder affecting synthesis of albumin
-Malabsorption in bowel or kidneys
-Abnormally high losses from bowel or kidneys

22
Q

What is recommended as part of a fluid challenge?

A

Giving 500mL of 0.9% sodium chloride over less than 15 minutes, reevaluating the response in blood pressure after and giving another 500mL if needed.

23
Q

What should never be infused as a rapid bolus?

A

Potassium containing fluid - it can precipitate ventricular arrhythmias and death.

24
Q

What is the maximum concentration of potassium containing fluid that can be given via peripheral infusion?

A

40mmol/L (higher concentrations can cause phlebitis)

25
Q

When should you always give IV steroids to an acutely unwell patient, regardless of whether they have an infection? (2)

A

-If you suspect an acute adrenal crisis
-If the patient is on long term steroids and now cannot take them orally (to avoid missing doses which may precipitate an acute adrenal crisis)

26
Q

What are three potential complications of ulcerative colitis?

A

Colorectal cancer
Primary sclerosing cholangitis (progressive inflammation and fibrosis of the bile ducts)
Iron deficiency anaemia

27
Q

What cardiovascular drug can cause rectal ulceration?

A

Anti-anginal drug nicorandil.

28
Q

What is a perianal haematoma?

A

A painful, pea sized lump caused by blood from a ruptured vein collecting under the mucosa around the anus.

29
Q

What is the Truelove and Witts’ Severity Index?

A

An index used to classify the severity of ulcerative colitis in adults into either mild, moderate or severe. Looks at bowel movement frequency, blood in stools, pyrexia, tachycardia, anaemia and ESR.

30
Q

According to the Truelove and Witts’ Severity Index, what clinical features of systemic upset are present only in severe ulcerative colitis? (4)

A

Pyrexia (temp>37.8)
Pulse > 90
Anaemia
ESR > 30mm/hour

31
Q

What is the Mayo Score/Disease Activity Index (DAI)?

A

A scoring system used to assess disease activity in established ulcerative colitis (scored out of 12) - particularly used when considering changing, adding or stopping medication. Looks at stool frequency, rectal bleeding, mucosal appearance on endoscopy and physician rating of disease activity.

32
Q

What are the four potential eventual outcomes of acute inflammation?

A

Complete resolution
Fibrosis and formation of scar tissue
Chronic inflammation
Formation of an abscess

33
Q

What is an abscess?

A

A localised collection of pus walled off by granulation tissue.

34
Q

What is the definitive management for an abscess?

A

Incision and drainage (opening the abscess cavity and draining the pus inside. Antibiotics need to be taken concurrently and potentially afterwards.

35
Q

What is the most common bacteria to be found in abscesses, especially in the skin?

A

Staphylococcus aureus

36
Q

What are the key clinical features of necrotising fasciitis? (3)

A

Skin necrosis
Septic shock
Skin crepitus (crackling sound on touching the skin)

37
Q

What is necrotising fasciitis?

A

A rare but life threatening condition caused by rapid infection of subcutaneous tissues and fascia, that results in sepsis and a high mortality rate (up to 20%).

38
Q

What is the difference between internal and external haemorrhoids?

A

Internal haemorrhoids = within the anal canal and above the dentate line.
External haemorrhoids = originate below the dentate line, prolapse outward and are palpable by the patient.

39
Q

What is involved in the medical treatment of grade 1-2 internal haemorrhoids? (2)

A

Lifestyle modifications (high fibre diet, laxatives)
Rubber band ligation of internal haemorrhoids using a proctoscope or endoscope

40
Q

What are the options for surgical treatment of grade 2-3 internal haemorrhoids? (2)

A

The Rafaelo Procedure - radiofrequency ablation of haemorrhoids under local anaesthetic
Haemorrhoidal Artery Ligation Operation (HALO) - ultrasound probe identifies feeding haemorrhoidal artery, which is then ligated with a suture.

41
Q

What is involved in the surgical treatment of grade 4 internal or external haemorrhoids?

A

Excisional haemorrhoidectomy to physically excise the haemorrhoid, either with an energy device or a stapler.

42
Q

What medications can be given to treat an anal fissure? (3)

A

Glyceryl trinitrate (GTN) ointment (0.4%)
Stool softeners/laxatives
Botox to anal sphincter to help relax it and reduce spasm

43
Q

What surgical treatment is used for anal fissures when medical and conservative treatments fail?

A

Lateral sphincterotomy - internal sphincter is divided to reduce sphincter spasm.

TCD Gastrointestinal (6 decks)

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