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GI and Surgery > Altered Bowel Habit > Flashcards

Altered Bowel Habit Flashcards

1
Q

What is the first line treatment for C.difficile infection?

A

Oral vancomycin for 10 days.

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2
Q

What is the second line treatment for C.difficile infection?

A

Oral fidaxomicin

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3
Q

What is the third line treatment for C.difficile infection?

A

Oral vancomycin +/- IV metronidazole

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4
Q

What is the management for recurrent C.difficile infection within 12 weeks of symptom resolution?

A

Oral fidaxomicin

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5
Q

What is the management for recurrent C.difficile infection after 12 weeks of symptom resolution?

A

Oral vancomycin or fidaxomicin.

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6
Q

What is the treatment for life threatening C.difficile infection?

A

Oral vancomycin and IV metronidazole

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7
Q

What is the leading cause of C.difficile?

A

Second and third generation cephalosporins.

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8
Q

Other than antibiotics what are the other risk factors for C.difficile infection?

A

PPIs.

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9
Q

How is C.difficile transmitted?

A

Via faecal-oral route by ingestion of spores.

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10
Q

What are the clinical features of C.difficile infection?

A

Watery diarrhoea, abdominal pain and raised WCC.

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11
Q

What features are used to determine life-threatening C.difficile?

A

Hypotension, ileus, toxic megacolon.

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12
Q

Melanosis coli is most commonly caused by what?

A

Prolonged laxative use.

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13
Q

A patient develops abdominal pain, vomiting and watery diarrhoea soon after eating leftover fried rice that has been left at room temperature. Patient recovers within 24 hours. What is the cause?

A

Bacillus cereus (unlike other causes of gastroenteritis, bacillus resolves within 24 hours, whereas other causes usually within 1 week. Also short incubation period period of 5-8 hours, whereas other gastroenteritis symptoms begin within 1-3 days).

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14
Q

What questions would you ask a patient presenting with gastroenteritis?

A

Hx of food intake (e.g. takeaway) and exposure to contaminated water.
Recent foreign travel.
Exposure to unwell individuals (e.g. care home).
Occupation.
Recent antibiotic use.
Immunosuppression.

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15
Q

Describe the possible post-gastroenteritis complications

A

Lactose intolerance
Irritable bowel syndrome
Reactive arthritis
Guillain–Barré syndrome

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16
Q

What conditions are associated with IBS?

A

Functional dyspepsia, anxiety, depression, overactive bladder, fibromyalgia, chronic fatigue syndrome.

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17
Q

Define gastroenteritis

A

Inflammation of stomach and intestines, presenting with diarrhoea and vomiting.

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18
Q

What is the most common cause of gastroenteritis?

A

Viral - specifically norovirus.

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19
Q

What is the most common cause of gastroenteritis in children?

A

Rotavirus

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20
Q

How does rotavirus present?

A

Watery diarrhoea and vomiting.

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21
Q

When does norovirus commonly occur?

A

Winter

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22
Q

What is the most common cause of bacterial gastroenteritis?

A

Campylobacter jejuni

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23
Q

How does infectious E.coli spread?

A

Via contact with infected faeces, unwashed salads or water.

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24
Q

What strain of E.coli produces shiga toxin?

A

E.coli 0157

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25
Q

What are the symptoms of E.coli 0157?

A

Dysentery, vomiting and abdominal cramps.

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26
Q

What is a complication of E.coli 0157?

A

Toxin destroys rbc leading to haemolytic uraemic syndrome.

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27
Q

Why should antibiotics be avoided in patients with infectious E.coli?

A

Increased risk of haemolytic uraemic syndrome.

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28
Q

Campylobacter is common in what type of people?

A

Travellers (travellers diarrhoea).

29
Q

How is campylobacter spread?

A

Raw/uncooked chicken, untreated water and unpasteurised milk.

30
Q

What are the symptoms of campylobacter?

A

Dysentery, vomiting, abdominal cramps and fever.

31
Q

Campylobacter is linked to the development of which autoimmune condition?

A

Guillain-Barré syndrome

32
Q

What is a classic cause of dysentery in young children?

A

Shigella

33
Q

What type of toxin does shigella produce?

A

Shiga toxin —> HUS

34
Q

How is salmonella spread and what symptoms does it cause?

A

Spread via eating raw eggs/chicken and food infected with faeces of animals.
Dysentery, vomiting and abdominal pain.

35
Q

Which bacteria causes vomiting after reheating rice?

A

Bacillus cereus

36
Q

What is the incubation period for Bacillus?

A

Vomiting after 5 hours of ingestion and watery diarrhoea after 8 hours. Symptoms resolve within 24 hours.

37
Q

Which bacteria causes dysentery, abdominal pain, fever and lymphadenopathy in children, but causes mesenteric lymphadenitis (right-sided abdominal pain) in older children/adults?

A

Yersinia enterocolitica

38
Q

Give one example of how Yersinia enterocolitica is spread

A

Eating undercooked pork.

39
Q

What toxin does Staphylococcus aureus produce?

A

Enterotoxin causing small intestinal inflammation.

40
Q

How is Staphylococcus aureus spread?

A

Contained eggs, dairy and milk.

41
Q

What is the incubation period of staphylococcus aureus?

A

Diarrhoea and vomiting start together within hours of ingestion and settle within 12-24 hours.

42
Q

What symptoms does Clostridium perfringes produce?

A

Watery diarrhoea.

43
Q

What is the most commonly identified pathogen in prolonged travellers diarrhoea?

A

Giardia

44
Q

What are the symptoms of Giardia?

A

Watery diarrhoea, abdominal pain, decreased appetite, flatulence and bloating.

45
Q

What is the treatment for Giardia infection?

A

Metronidazole

46
Q

What other parasites are associated with travellers gastroenteritis?

A

Entamoeba (generally asymptomatic) and Cryptosporidium.

47
Q

Describe the general management of gastroenteritis

A

Patient should be isolated to prevent spread.
Faeces sample for microscopy, culture and sensitivities (not always required).
Assess for dehydration by fluid challenge: if patient tolerate oral fluid —> outpatient, rehydration solutions given (dioralyte), if dehydrated and not tolerating oral —> IV fluids.
Introduce light small diet slowly.

48
Q

How long should patient stay off work/school for after symptoms of gastroenteritis have completely resolved?

A

48 hours

49
Q

Are antidiarrhoeals and antiemetics recommended in gastroenteritis?

A

No - but may be useful for mild/moderate symptom management.
Avoided in dysentery, E.coli 0157 and Shigella.

50
Q

Define IBS

A

Irritable bowel syndrome - functional bowel disorder characterised by abdominal pain and altered bowel habits.

51
Q

What does ‘functional’ mean?

A

There’s no identifiable organic disease underlying the symptoms.

52
Q

List the risk factors associated with IBS

A

Female, younger age, stressful life events, anxiety/depression, GI infection, somatic symptoms, endometriosis, FHx mental illness.

53
Q

Describe the clinical features of IBS

A

Fluctuating bowel habits, diarrhoea (mucus), constipation, abdominal pain, bloating, symptoms worse after eating and improved by opening bowels.

54
Q

What other pathology should be excluded before a diagnosis of IBS can be made?

A

IBD - negative faecal calprotectin.
Coeliac disease - negative anti-TTG antibodies.
Cancer.
Normal FBC, ESR or CRP.

55
Q

What nutritional advice should be given to IBS patients?

A

Low FODMAP diet, probiotics, decreased caffeine and alcohol, reduced processed food, regular small meals and adequate fluid intake.

56
Q

What are the first line medications used in the treatment of IBS?

A

Loperamide for diarrhoea.
Laxatives (ispaghula husk, movicol, linaclotide) for constipation.
Antispasmodics (buscopan) for abdominal cramps.

57
Q

Which laxative should be avoided in IBS?

A

Lactulose because it causes bloating.

58
Q

What are the second line treatments for IBS?

A

Low dose TCA e.g. amitriptyline

59
Q

What psychological therapies can be used in IBS treatment?

A

CBT

60
Q

A patient presents with abdominal pain, diarrhoea and facial/neck flushing

A

Carcinoid syndrome

61
Q

Define chronic constipation

A

Constipation >= 3 months.

62
Q

List the causes of primary (functional constipation)

A

Normal transit constipation (most common), slow transit constipation and dyssynergic defecation.

63
Q

List some causes of secondary constipation

A

Hypercalcaemia, hypothyroidism, opioids, IBS, IBD, colorectal cancer, bowel obstruction, pregnancy.

64
Q

Describe the clinical features of constipation

A

Infrequent bowel motions (< 3 per week).
Hard lumpy stools.
Straining/difficulty passing stools.
Incomplete emptying.

65
Q

Describe the Bristol stool chart

A

1-2: constipation.
3-4: normal.
5-7: diarrhoea.

66
Q

What investigations would you do for diarrhoea to exclude secondary causes?

A

Bloods: FBC, U&Es, LTFs, bone profile, HbA1c, TFTs.
Stool: faecal calprotectin, FIT test.
Imaging: abdominal X-ray, colonoscopy.

67
Q

Describe the management plan for constipation

A

Lifestyle: fibre, whole grains, fruit and veg, fluids, exercise.
Laxative: bulk forming (ispaghula husk), osmotic (lactulose, movicol), stimulant (senokot, bisacodyl).

68
Q

A positive C.diff antigen and negative toxin shows what?

A

Exposure to the bacteria, rather than current infection.

GI and Surgery (14 decks)

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