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
2
Q
What are changes of the bowel habit?
A
Change in frequency Diarrhoea or constipation Tenesmus Bleeding Steatorrhoea
3
Q
What is tenesmus
A
feeling that you need to pass stools, even though your bowels are already empty
4
Q
What can blood in stools be like?
A
Dark altered blood -melena
Fresh red blood- hematochezia
5
Q
What is steatorrhoea
A
Fatty offensive floaty stools
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
7
Q
What uncommon but important causes of altered bowel movement do we need to know about?
A
Malignancy
Inflammatory bowel disease
Bowel obstruction
8
Q
What type of disorder is irritable bowel syndrome?
A
Functional disorder
9
Q
What does it mean to have a functional disorder
A
Blood tests microscopy all normal
10
Q
How does codeine affect bowel movement
A
Constipation
11
Q
How does metformin affect bowel movement
A
Diarrhoea
12
Q
What is metformin used for?
A
Treating diabetes type two
13
Q
What diet makes soft stool?
A
High fibre diet
14
Q
How does high fibre diet affect bowel movement
A
Soft stools
15
Q
How can we investigate altered bowel habit?
A
Bloods Endoscopy Capsule endoscopy CT MRI Ultrasound Stool samples Nuclear medicine
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)
17
Q
What can thyroid function tests tell us?
A
Super active thyroid speeds up bodily processes = diarrhoea
Underactive = constapation
18
Q
What can calcium tell us?
A
High calcium= diarrhoea
19
Q
What does TTG check for?
A
Celiac diseases
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
21
Q
What does gastroescopy cover?
A
From mouth
Oesophagus
Stomach
first part of the small bowel duodenum
22
Q
What does colonoscopy cover?
A
Descending colon
Transverse colon
Ascending colon
to terminal ileum
23
Q
What does capsule endoscopy cover?
A
From duodenum to the terminal ileum
24
Q
What is a capsule endoscopy
A
Pill taken that takes photos as it moves through the small bowel
25
What stool samples can be taken?
Microscopy, culture and sensitivity (MC&S)
Faecal calprotectin
Helicobacter pylori stool antigen
Faecal elastase
26
What is Microscopy, culture and sensitivity (MC&S) stool sampling
Send stools to lab to find signs of infection
Any bacteria causing gastroenteritis
worm eggs
what sensitivities are to antibiotics
27
What is faecal calprotectin
CRP for poo
| measures the inflammation within the bowel
28
What can you exclude by looking at faecal calprotectin
e possibility of inflammatory bowel disease
29
What is Helicobacter pylori stool antigen looking for
Helicobacter infection in the stomach that could be causing gastritis
30
What is Faecal elastase for?
exocrine function of your pancreas and looking whether it's producing enzyme
31
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?
Irritable bowel syndrome
| Obs normal= functional disorder
32
When looking at woman with altered bowel movements what needs checking?
PREGNANCY
33
What criteria is used for IBS?
Rome IV Criteria
34
What are symptoms of IBS?
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
What are the different classes of IBS?
IBS- D
IBS-C
IBS-M
36
What is IBS-D?
diarrhoea predominate IBS
37
What is IBS-C?
constipation predominate IBS
38
What is IBS-M?
Mixed IBS C and D
39
What causes IBS
No underlying pathophysiology
40
Caues of diarrhoea
IBS, malignancy, inflammatory bowel disease and infections
drugs, constipation with overflow
Diabetes
overactive thyroid gland, bile acid malabsorption, diverticulitis
41
What is constipation with overflow
Constipation blocking bowel but diarrhoea makes around blockage
42
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?
```
Colorectal cancer -BLOOD
Irritable bowel syndrome
Inflammatory bowel disease
Diverticulitis- No foreign travel
Gastroenteritis - No foreign travel
```
43
What are two week ait referrals
quick way of referring people with suspected cancer to get urgent investigations
44
What are red flags for altered bowel movement
```
PR bleeding
Weight loss
Family history colorectal cancer
Nocturnal symptoms
Abdominal mass
Anaemia
```
45
What is PR bleeding
Rectal bleeding
46
What are nocturnal symptoms
Symptoms happening at night
47
What is diverticular disease?
presence of these outpouching in the bowel wall
48
What is the difference between diverticulitis and diverticulosis
diverticulosis is the presence of these outpouching in the bowel wall
Diverticulitis is when they become inflamed
49
How is diverticular disease treated?
broad spectrum antibiotics in the community.
50
What are the two subtypes of inflammatory bowel disease?
Crohn's Disease
| Ulcerative colitis
51
Where does ulcerative colitis affect?
Colon mainly, although gastritis is recognized
52
Where does Crohn's disease affect?
```
Entire gastrointestinal tract.
although the most common
site of inflammation is the
transition between the
small and large intestine
```
53
How does the Crohn's disease develop?
Uneven spread, inflamed
intestinal segments
between healthy intestinal
areas
54
How does the ulcerative colitis develop?
Uniform progression spread
from the rectum through
the colon
55
What are the potential intestinal symptoms of Crohn's disease?
```
Abdominal pain
Weight loss
Diarrhea
Perforation of the colon
Toxic megacolon
```
56
What are the potential intestinal symptoms of ulcerative colitis ?
Bloody diarrhea
Abdominal pain
Weight loss
Ulceration and bleeding
57
What are the potential extraintestinal symptoms of Crohn's disease?
```
Fistulas
abscesses
anemia
fever
arthritis
skin changes
```
58
What are the potential extraintestinal symptoms of ulcerative colitis ?
```
Liver diseases
anemia
fever
arthritis
skin changes
```
59
What are the main differences between ulcerative colitis and Crohn's disease
Crohns affects any part of the body
UC - only large bowel
Crohns- different parts affected at the same time
UC- one long infection
60
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
Bowel obstruction
61
What is classic presentation of bowel obstruction?
Tinkling bowel sounds
| Vomiting
62
What are causes of small bowel obstruction Common to rare
```
Adhesions (60-70%)
Hernia (20%)
Malignancy (5%)
Strictures (5%)
Foreign bodies (<5%)
```
63
What are causes of large bowel obstruction Common to rare
Primary malignancy (60%)
Strictures (20%) diverticular>Crohn's
Volvulus (5%)
Luminal bodies (5%)
64
What are adhesions?
Scar tissue that form between loops of bowel
65
WWhat are strictures?
Scarring and narrowwing within the bowel itself lumen narrowing
66
What is a volvulus?
large redundant and floppy sigmoid colon that can twist around itself.
67
What can lead to a volvus?
Chronic constapation?
68
What does a volvus look like on a scan?
Coffee-bean
69
How do you treat volvus?
rectilinear deflation
70
WWhat is paralytic ileus?
Muscle or nerve problem that stops peristalsis — not a physical blockage
71
What is the main cause of paralytic ileus?
Post operatively
72
Causes of paralytic ileus?
Drugs, metabolic disturbances, local inflammation
73
What are the symptoms of paralytic ileus?
Vomiting, abdominal distension. Absent or infrequent bowel sounds.
74
WWhat are causes of constipation of the elderly
```
Often multifactorial
Medication
Diet
Reduced mobility
Comorbidity
Depression
```
75
what are functions of the large bowel?
Absorb salt and water
Absorb short chain fatty acids
Store faeces
Expel faeces
76
What is the rectosphincteric reflex
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
What is the common cause of constipation of children?
When not going to toilet frequently faeces dry out so constipation more likely
78
What is steatorrhoea
Pale bulky stools that are difficult to flush
| Due to increased fat content
79
What causes steatorrhea
```
Pancreatic exocrine insufficiency
Blockage of bile ducts
Coeliac disease
Crohn's
Cystic fibrosis
```
