Small Intestine Disorders Flashcards
what are diverticula
diverticula are sac-like protrusions of mucosa through the muscular wall of the colon
define diverticular disease and diverticulitis
a condition where diverticula cause symptoms that can progress to diverticulitis - inflammation and infection of diverticula
causes of diverticular disease
believed to be caused as a result of deficiency of dietary fibre
risk factors of diverticular disease/diverticulitis
low fibre diet >50yrs smoking obesity use of NSAIDs, opioids and corticosteroids
clinical features of diverticular disease
intermittent abdominal pain in LLQ and tenderness
constipation or diarrhoea
bloating
rectal bleeding + passage of mucous
clinical features of diverticulitis
constant abdominal pain from hypogastrium to LLQ pyrexia bowel changes rectal bleeding anorexia vomiting + nausea
differentials of diverticular disease/diverticulitis
IBS appendicitis crohns disease colorectal cancer ruptured ovarian cyst ectopic pregnancy UTI
investigations for symptomatic diverticular disease
colonoscopy
bloods - ⬆️ WCC, platelets and ⬇️ Hb
investigations for diverticulitis
barium enema (if no complications) abdominal US sigmoidoscopy bloods - FBC, U+E, ESR + CRP
management of diverticular disease
advise high fibre diet with adequate fluid intake
consider prescription of bulk-forming laxatives
recommend paracetamol for pain
management of diverticulitis (at home)
oral antibiotics (if systemically unwell) paracetamol for pain clear liquids only for 48-72hrs with gradual solids reintroduction
management of diverticulitis (hospital)
IV antibiotics
Harmann’s procedure (resect sigmoid colon)
common complications of diverticular disease/diverticular disease
fibrosis
perforations
ruptured abscess
obstruction
define coeliac disease
a chronic immune-mediated systemic disorder that is triggered by exposure to dietary gluten
describe genetics of coeliacs disease
multigenetic disorder associated with HLA types HLA-DQ2 or HLA-DQ8
risk factors of coeliac disease
familial history
genetics (HLA allele)
diabetes (type 1)
autoimmune thyroid disease
clinical features of coeliacs disease
persistent, unexplained GI symptoms faltering growth dermatitis herpetiformis prolonged fatigue/lethargy 1st degree relative with disease
differentials of coeliacs disease
infective gastroenteritis non-coeliac gluten sensitivity food allergy IBS crohns disease
investigations of coeliacs disease
clinical examination (height, weight, abdominal pain/distension)
coeliac serology testing (IgA, tTGA)
bloods - FBC, LFTs
gold standard investigation for coeliacs disease and indication
if serology and blood indicate coeliac, refer for distal duodenal biopsy
histological appearance of coeliacs disease
subtotal vilous atrophy and crypt hypertrophy
management of coeliacs disease
lifelong strict guten free diet
provide education, advice and support
refer to specialised dietician if patient concerned
reassess patient after time on diet to assess if symptoms persist
common complications of coeliacs disease
nutritional deficiency increased cancer risk reduced QoL mental health issues anaemia
define irritable bowel syndrome
a chronic, relapsing disorder of the lower GI tract with no discernible structural or biochemical cause
classifications of IBS
based on predominant stool type (according to Rome IV)
- diarrhoea (IBS-D)
- constipation (IBS-C)
- mixed (IBS-M)
causes of IBS
exact is unknown but thought to be multi-factoral mix of environment and genetics
- colonic microbiota change
- visceral hypersensitivity
- abnormal GI immune function
clinical features of IBS
presenting for >6mnths with:
- abdominal pain/discomfort that relieves with defecation
- bloating
- bowel habit changes
- excessive mucus passage
differentials of IBS
GI infection coeliacs disease IBD hyperthyroidism underlying malignancy
investigations of IBS
extensive history
rectal examination
bloods - FBC, ESR, CRP and coeliac serology
faecal calprotectin
conservative management of IBS
provide education and reassurance
provide healthy diet and exercise advice (FODMAP, smaller meals and less processed foods)
medical management of IBS
anti-spasmodics for abdominal pain
antidepressants for severe pain (TCA for IBS-D and SSRIs for IBS-C)
probiotics for bloating
laxatives or anti-motility for constipation
common complications of IBS
mood disorders
reduced QoL
define intestinal obstruction
impairment of the normal flow of intestinal contents
types of intestinal obstruction
dynamic = peristalsis works AGAINST obstructing agent atypical = peristalsis ceases to cause absence of propulsive waves
what is meant by simple vs. strangulating bowel obstruction
simple means obstruction does not cause interference with blood supply whilst strangulating means there is interference with blood supply
causes of small bowel obstruction
adhesions
strangulated hernia
malignancy
volvulus
clinical features of small bowel obstruction
colicky abdominal pain palpation of dilated bowel loops nausea and vomiting abdominal distension} absolute constipation
investigations of small bowel obstruction
plain AXR
bloods - FBC, U+E, amylase and raised CRP
management of small bowel obstruction
fluid IV resuscitation to correct fluid and electrolytes
NG-tube for content aspiration
nil by mouth
indications for surgery in small bowel obstruction
severe abdominal pain, raised WCC or serum lactate - indicates strangulation
complications of small bowel obstruction
perforation and ischaemia leading to peritonitis and specticaemia
define appendicits
an acute inflammation of the appendix due to obstruction
causes of appendix obstruction in appendicitis
fibrous tissue
foreign bodies
faecolith (hard mass of faecal matter)
risk factors of appendicitis
younger age
poor fibre diet
clinical features of appendicitis
abdominal pain - starts peri-umbilical/generalised and moves to RLQ in right iliac fossa
signs of infection (e.g. fever and tachycardia)
nausea and vomiting
signs of appendicitis
tenderness/pain in right iliac fossa (McBurney’s Point)
pain in RLQ on palpation of LLQ - Rovigs sign
differentials of appendicitis
ovarian cyst/torsion
ectopic pregnancy
gastroenteritis
biliary colic/choleric disease
investigations of appendicitis (bedside)
urine dip
urine HCG - exclude pregnancy
VBG
investigations of appendicitis (labs and imaging)
bloods - FBC, U+E, CRP, LFTs, serum amylase, clotting and cross-match
US in RIF
management of appendicitis
prophylactic antibiotics
IV fluids
appendectomy (open or laproscopic)
what are signs of an appendicular abscess?
swinging pyrexia
worsening symptoms of appendicitis
failure of conservative management
