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Abdominal symptoms > Symptoms, signs and investigations of altered bowel habit > Flashcards

Symptoms, signs and investigations of altered bowel habit Flashcards

1
Q

What on the Bristol stool chart is the best stool?

A

Type 4- Sausage smooth and soft

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2
Q

What are changes of the bowel habit?

A 
Change in frequency
Diarrhoea or constipation
Tenesmus
Bleeding
Steatorrhoea
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3
Q

What is tenesmus

A

feeling that you need to pass stools, even though your bowels are already empty

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4
Q

What can blood in stools be like?

A

Dark altered blood -melena

Fresh red blood- hematochezia

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5
Q

What is steatorrhoea

A

Fatty offensive floaty stools

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6
Q

What common causes of altered bowel movement do we need to know about?

A 
Irritable bowel syndrome 
Gastroenteritis 
Medication
Diet
Coeliac disease 
Diverticular disease
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7
Q

What uncommon but important causes of altered bowel movement do we need to know about?

A

Malignancy
Inflammatory bowel disease
Bowel obstruction

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8
Q

What type of disorder is irritable bowel syndrome?

A

Functional disorder

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9
Q

What does it mean to have a functional disorder

A

Blood tests microscopy all normal

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10
Q

How does codeine affect bowel movement

A

Constipation

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11
Q

How does metformin affect bowel movement

A

Diarrhoea

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12
Q

What is metformin used for?

A

Treating diabetes type two

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13
Q

What diet makes soft stool?

A

High fibre diet

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14
Q

How does high fibre diet affect bowel movement

A

Soft stools

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15
Q

How can we investigate altered bowel habit?

A 
Bloods
Endoscopy
Capsule endoscopy
CT
MRI
Ultrasound
Stool samples
Nuclear medicine
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16
Q

What blood tests are important for altered bowel movements

A 
FBC
ferritin
CRP
LFTs
GlucosefribAlc
Thyroid function tests
Calcium
Lipase
Tissue transglutaminase (TTG)
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17
Q

What can thyroid function tests tell us?

A

Super active thyroid speeds up bodily processes = diarrhoea

Underactive = constapation

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18
Q

What can calcium tell us?

A

High calcium= diarrhoea

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19
Q

What does TTG check for?

A

Celiac diseases

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20
Q

How to make a definitive diagnosis of celiac disease?

A

Positve TTG test

need an upper GI endoscopy to take a biopsy from the duodenum to confirm the diagnosis histologically

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21
Q

What does gastroescopy cover?

A

From mouth
Oesophagus
Stomach
first part of the small bowel duodenum

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22
Q

What does colonoscopy cover?

A

Descending colon
Transverse colon
Ascending colon
to terminal ileum

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23
Q

What does capsule endoscopy cover?

A

From duodenum to the terminal ileum

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24
Q

What is a capsule endoscopy

A

Pill taken that takes photos as it moves through the small bowel

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25
Q

What stool samples can be taken?

A

Microscopy, culture and sensitivity (MC&S)
Faecal calprotectin
Helicobacter pylori stool antigen
Faecal elastase

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26
Q

What is Microscopy, culture and sensitivity (MC&S) stool sampling

A

Send stools to lab to find signs of infection
Any bacteria causing gastroenteritis
worm eggs
what sensitivities are to antibiotics

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27
Q

What is faecal calprotectin

A

CRP for poo

measures the inflammation within the bowel

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28
Q

What can you exclude by looking at faecal calprotectin

A

e possibility of inflammatory bowel disease

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29
Q

What is Helicobacter pylori stool antigen looking for

A

Helicobacter infection in the stomach that could be causing gastritis

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30
Q

What is Faecal elastase for?

A

exocrine function of your pancreas and looking whether it’s producing enzyme

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31
Q

A 20 year old female student presents to her GP with increased stool frequency with diarrhoea for a year. She reports bloating relieved with defaecation. She has no PR bleeding, and her weight is stable. There is no recent foreign travel.
Diagnosis? Why?

A

Irritable bowel syndrome

Obs normal= functional disorder

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32
Q

When looking at woman with altered bowel movements what needs checking?

A

PREGNANCY

33
Q

What criteria is used for IBS?

A

Rome IV Criteria

34
Q

What are symptoms of IBS?

A

Recurrent abdominal pain, on average, at least I day/week in the
last 3 months, associated with two or more of the following
criteria:

Related to defecation
Associated with a change in frequency of stool
Associated with a change in form (appearance) of stool.

35
Q

What are the different classes of IBS?

A

IBS- D
IBS-C
IBS-M

36
Q

What is IBS-D?

A

diarrhoea predominate IBS

37
Q

What is IBS-C?

A

constipation predominate IBS

38
Q

What is IBS-M?

A

Mixed IBS C and D

39
Q

What causes IBS

A

No underlying pathophysiology

40
Q

Caues of diarrhoea

A

IBS, malignancy, inflammatory bowel disease and infections
drugs, constipation with overflow
Diabetes
overactive thyroid gland, bile acid malabsorption, diverticulitis

41
Q

What is constipation with overflow

A

Constipation blocking bowel but diarrhoea makes around blockage

42
Q

A 65 year old man presents to his GP with lower abdominal pain for 4 weeks, He reports a trend towards looser stool for the last 6 weeks and noticing blood mixed with stool for the last 2. He reports no weight loss and no foreign travel,
What do we need to exclude from this? Best to worst? Why?

A 
Colorectal cancer -BLOOD
 Irritable bowel syndrome 
 Inflammatory bowel disease 
 Diverticulitis- No foreign travel
Gastroenteritis - No foreign travel
43
Q

What are two week ait referrals

A

quick way of referring people with suspected cancer to get urgent investigations

44
Q

What are red flags for altered bowel movement

A 
PR bleeding
Weight loss
Family history colorectal cancer
Nocturnal symptoms
Abdominal mass
Anaemia
45
Q

What is PR bleeding

A

Rectal bleeding

46
Q

What are nocturnal symptoms

A

Symptoms happening at night

47
Q

What is diverticular disease?

A

presence of these outpouching in the bowel wall

48
Q

What is the difference between diverticulitis and diverticulosis

A

diverticulosis is the presence of these outpouching in the bowel wall
Diverticulitis is when they become inflamed

49
Q

How is diverticular disease treated?

A

broad spectrum antibiotics in the community.

50
Q

What are the two subtypes of inflammatory bowel disease?

A

Crohn’s Disease

Ulcerative colitis

51
Q

Where does ulcerative colitis affect?

A

Colon mainly, although gastritis is recognized

52
Q

Where does Crohn’s disease affect?

A 
Entire gastrointestinal tract. 
although the most common 
site of inflammation is the 
transition between the 
small and large intestine
53
Q

How does the Crohn’s disease develop?

A

Uneven spread, inflamed
intestinal segments
between healthy intestinal
areas

54
Q

How does the ulcerative colitis develop?

A

Uniform progression spread
from the rectum through
the colon

55
Q

What are the potential intestinal symptoms of Crohn’s disease?

A 
Abdominal pain
Weight loss
Diarrhea
Perforation of the colon
Toxic megacolon
56
Q

What are the potential intestinal symptoms of ulcerative colitis ?

A

Bloody diarrhea
Abdominal pain
Weight loss
Ulceration and bleeding

57
Q

What are the potential extraintestinal symptoms of Crohn’s disease?

A 
Fistulas
abscesses
anemia
fever
arthritis
skin changes
58
Q

What are the potential extraintestinal symptoms of ulcerative colitis ?

A 
Liver diseases
anemia 
fever
arthritis
skin changes
59
Q

What are the main differences between ulcerative colitis and Crohn’s disease

A

Crohns affects any part of the body
UC - only large bowel

Crohns- different parts affected at the same time

UC- one long infection

60
Q

A 40 year old man presents to A&E with colicky central abdominal pain that started last night.
He has been vomiting for the last 6 hours.
On examination he has a distended tender abdomen with tinkling bowel sounds.
Diagnosis

A

Bowel obstruction

61
Q

What is classic presentation of bowel obstruction?

A

Tinkling bowel sounds

Vomiting

62
Q

What are causes of small bowel obstruction Common to rare

A 
Adhesions (60-70%) 
Hernia (20%) 
Malignancy (5%) 
Strictures (5%) 
Foreign bodies (<5%)
63
Q

What are causes of large bowel obstruction Common to rare

A

Primary malignancy (60%)
Strictures (20%) diverticular>Crohn’s
Volvulus (5%)
Luminal bodies (5%)

64
Q

What are adhesions?

A

Scar tissue that form between loops of bowel

65
Q

WWhat are strictures?

A

Scarring and narrowwing within the bowel itself lumen narrowing

66
Q

What is a volvulus?

A

large redundant and floppy sigmoid colon that can twist around itself.

67
Q

What can lead to a volvus?

A

Chronic constapation?

68
Q

What does a volvus look like on a scan?

A

Coffee-bean

69
Q

How do you treat volvus?

A

rectilinear deflation

70
Q

WWhat is paralytic ileus?

A

Muscle or nerve problem that stops peristalsis — not a physical blockage

71
Q

What is the main cause of paralytic ileus?

A

Post operatively

72
Q

Causes of paralytic ileus?

A

Drugs, metabolic disturbances, local inflammation

73
Q

What are the symptoms of paralytic ileus?

A

Vomiting, abdominal distension. Absent or infrequent bowel sounds.

74
Q

WWhat are causes of constipation of the elderly

A 
Often multifactorial
Medication
Diet
Reduced mobility
Comorbidity
Depression
75
Q

what are functions of the large bowel?

A

Absorb salt and water
Absorb short chain fatty acids
Store faeces
Expel faeces

76
Q

What is the rectosphincteric reflex

A

Faeces in rectum stimulates mass
movement

Relaxation of internal anal sphincter,
contraction of external sphincter

If inappropriate to defaecate, internal
sphincter contracts and rectal contents
return to colon by retroperistalsis

Further drying (dessication) of faeces

77
Q

What is the common cause of constipation of children?

A

When not going to toilet frequently faeces dry out so constipation more likely

78
Q

What is steatorrhoea

A

Pale bulky stools that are difficult to flush

Due to increased fat content

79
Q

What causes steatorrhea

A 
Pancreatic exocrine insufficiency
Blockage of bile ducts
Coeliac disease
Crohn's
Cystic fibrosis

Abdominal symptoms (7 decks)

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