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gastrointestinal system > Small Intestine Disorders > Flashcards

Small Intestine Disorders Flashcards

1
Q

what are diverticula

A

diverticula are sac-like protrusions of mucosa through the muscular wall of the colon

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2
Q

define diverticular disease and diverticulitis

A

a condition where diverticula cause symptoms that can progress to diverticulitis - inflammation and infection of diverticula

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3
Q

causes of diverticular disease

A

believed to be caused as a result of deficiency of dietary fibre

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4
Q

risk factors of diverticular disease/diverticulitis

A 
low fibre diet 
>50yrs 
smoking 
obesity 
use of NSAIDs, opioids and corticosteroids
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5
Q

clinical features of diverticular disease

A

intermittent abdominal pain in LLQ and tenderness
constipation or diarrhoea
bloating
rectal bleeding + passage of mucous

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6
Q

clinical features of diverticulitis

A 
constant abdominal pain from hypogastrium to LLQ
pyrexia 
bowel changes 
rectal bleeding 
anorexia
vomiting + nausea
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7
Q

differentials of diverticular disease/diverticulitis

A 
IBS 
appendicitis 
crohns disease 
colorectal cancer 
ruptured ovarian cyst
ectopic pregnancy
UTI
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8
Q

investigations for symptomatic diverticular disease

A

colonoscopy

bloods - ⬆️ WCC, platelets and ⬇️ Hb

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9
Q

investigations for diverticulitis

A 
barium enema (if no complications)
abdominal US 
sigmoidoscopy
bloods - FBC, U+E, ESR + CRP
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10
Q

management of diverticular disease

A

advise high fibre diet with adequate fluid intake
consider prescription of bulk-forming laxatives
recommend paracetamol for pain

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11
Q

management of diverticulitis (at home)

A 
oral antibiotics (if systemically unwell) 
paracetamol for pain 
clear liquids only for 48-72hrs with gradual solids reintroduction
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12
Q

management of diverticulitis (hospital)

A

IV antibiotics

Harmann’s procedure (resect sigmoid colon)

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13
Q

common complications of diverticular disease/diverticular disease

A

fibrosis
perforations
ruptured abscess
obstruction

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14
Q

define coeliac disease

A

a chronic immune-mediated systemic disorder that is triggered by exposure to dietary gluten

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15
Q

describe genetics of coeliacs disease

A

multigenetic disorder associated with HLA types HLA-DQ2 or HLA-DQ8

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16
Q

risk factors of coeliac disease

A

familial history
genetics (HLA allele)
diabetes (type 1)
autoimmune thyroid disease

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17
Q

clinical features of coeliacs disease

A 
persistent, unexplained GI symptoms 
faltering growth
dermatitis herpetiformis 
prolonged fatigue/lethargy
1st degree relative with disease
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18
Q

differentials of coeliacs disease

A 
infective gastroenteritis 
non-coeliac gluten sensitivity 
food allergy 
IBS
crohns disease
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19
Q

investigations of coeliacs disease

A

clinical examination (height, weight, abdominal pain/distension)
coeliac serology testing (IgA, tTGA)
bloods - FBC, LFTs

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20
Q

gold standard investigation for coeliacs disease and indication

A

if serology and blood indicate coeliac, refer for distal duodenal biopsy

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21
Q

histological appearance of coeliacs disease

A

subtotal vilous atrophy and crypt hypertrophy

22
Q

management of coeliacs disease

A

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

23
Q

common complications of coeliacs disease

A 
nutritional deficiency
increased cancer risk
reduced QoL 
mental health issues 
anaemia
24
Q

define irritable bowel syndrome

A

a chronic, relapsing disorder of the lower GI tract with no discernible structural or biochemical cause

25
Q

classifications of IBS

A

based on predominant stool type (according to Rome IV)

  • diarrhoea (IBS-D)
  • constipation (IBS-C)
  • mixed (IBS-M)
26
Q

causes of IBS

A

exact is unknown but thought to be multi-factoral mix of environment and genetics

  • colonic microbiota change
  • visceral hypersensitivity
  • abnormal GI immune function
27
Q

clinical features of IBS

A

presenting for >6mnths with:

  • abdominal pain/discomfort that relieves with defecation
  • bloating
  • bowel habit changes
  • excessive mucus passage
28
Q

differentials of IBS

A 
GI infection
coeliacs disease
IBD
hyperthyroidism 
underlying malignancy
29
Q

investigations of IBS

A

extensive history
rectal examination
bloods - FBC, ESR, CRP and coeliac serology
faecal calprotectin

30
Q

conservative management of IBS

A

provide education and reassurance

provide healthy diet and exercise advice (FODMAP, smaller meals and less processed foods)

31
Q

medical management of IBS

A

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

32
Q

common complications of IBS

A

mood disorders

reduced QoL

33
Q

define intestinal obstruction

A

impairment of the normal flow of intestinal contents

34
Q

types of intestinal obstruction

A 
dynamic = peristalsis works AGAINST obstructing agent 
atypical = peristalsis ceases to cause absence of propulsive waves
35
Q

what is meant by simple vs. strangulating bowel obstruction

A

simple means obstruction does not cause interference with blood supply whilst strangulating means there is interference with blood supply

36
Q

causes of small bowel obstruction

A

adhesions
strangulated hernia
malignancy
volvulus

37
Q

clinical features of small bowel obstruction

A 
colicky abdominal pain 
palpation of dilated bowel loops 
nausea and vomiting 
abdominal distension}
absolute constipation
38
Q

investigations of small bowel obstruction

A

plain AXR

bloods - FBC, U+E, amylase and raised CRP

39
Q

management of small bowel obstruction

A

fluid IV resuscitation to correct fluid and electrolytes
NG-tube for content aspiration
nil by mouth

40
Q

indications for surgery in small bowel obstruction

A

severe abdominal pain, raised WCC or serum lactate - indicates strangulation

41
Q

complications of small bowel obstruction

A

perforation and ischaemia leading to peritonitis and specticaemia

42
Q

define appendicits

A

an acute inflammation of the appendix due to obstruction

43
Q

causes of appendix obstruction in appendicitis

A

fibrous tissue
foreign bodies
faecolith (hard mass of faecal matter)

44
Q

risk factors of appendicitis

A

younger age

poor fibre diet

45
Q

clinical features of appendicitis

A

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

46
Q

signs of appendicitis

A

tenderness/pain in right iliac fossa (McBurney’s Point)

pain in RLQ on palpation of LLQ - Rovigs sign

47
Q

differentials of appendicitis

A

ovarian cyst/torsion
ectopic pregnancy
gastroenteritis
biliary colic/choleric disease

48
Q

investigations of appendicitis (bedside)

A

urine dip
urine HCG - exclude pregnancy
VBG

49
Q

investigations of appendicitis (labs and imaging)

A

bloods - FBC, U+E, CRP, LFTs, serum amylase, clotting and cross-match
US in RIF

50
Q

management of appendicitis

A

prophylactic antibiotics
IV fluids
appendectomy (open or laproscopic)

51
Q

what are signs of an appendicular abscess?

A

swinging pyrexia
worsening symptoms of appendicitis
failure of conservative management

gastrointestinal system (9 decks)

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