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Semester 2 (3rd year) > Case 13: Change in bowel habit > Flashcards

Case 13: Change in bowel habit Flashcards

1
Q

VITAMIN CDE causes of diarrhoea

A

Vascular= bowel ischemia

Infectious= viral, parasitic Inflammatory= IBD

Traumatic= recent trauma Toxic= lead poisoning

Autoimmune= coeliac

Metabolic= neuropathic complication of diabetes

Iatrogenic= opiates such as codeine

Neoplastic= bowel and ovarian cancer

Congenital= N/A

Degenerative= diverticulosis

Endocrine= thyrotoxicosis

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1
Q

what would the presentation of bowel ischaemia be like

A

severe pain
worse after eating
pain out of proportion to symptoms

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2
Q

what is tenesmus

A

the feeling of incomplete defecation
could be a sign of cancer

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3
Q

what is mesenteric ischaemia

A

blood supply to the bowel is disrupted by arterial thrombosis or embolism

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4
Q

risk factors for mesenteric ischaemia

A

similar to those of CVD
much more common in those with CVD

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5
Q

what is a mechanical bowel obstruction

A

blockage of the bowel inhibiting movement. adhesions, hernia, tumors, impacted feces, volvus or twisting of the intestines, intussusception

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6
Q

what does mechanical bowel obstruction sound like on auscultation

A

tinkling bowel sounds

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7
Q

what is a functional bowel obstruction

A

the intestine muscles cannot move contents thought the bowel

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8
Q

what does a functional bowel obstruction sound like on auscultation

A

absent bowel sounds

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9
Q

difference between diverticular disease, diverticulosis and diverticulitis

A

diverticular disease= symptomatic diverticulosis

diverticulosis= multiple diverticula in the colon

diverticulitis= diverticula become inflamed

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10
Q

risk factors for diverticular disease

A

genetic predisposition
age over 40
diet low in fibre, high in fatty foods and red meat
obesity
sedentary lifestyle
smoking
alcohol
medication- NSAIDs

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11
Q

pathology of diverticular disease

A

increased pressure inside the colon

mucosa and submucosa bubble out through weak spots

can mean blood vessels rupture causing GI bleeding

bacteria and undigested food can get stuck into these protrusions and cause infection- diverticulitis

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12
Q

complications of diverticulitis

A

perforation

bowel obstruction

abscess (pocket of infected puss)

fistulae (abnormal connections with adjacent organ/structure)

peritonitis

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13
Q

clinical manifestations of an acute episode of diverticulitis

A

abdominal pain (LLQ)
fever
nausea
vomiting
change in bowel habits (alternating constipation and diarrhoea)
painless hamatochezia (red/maroon coloured stools)

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14
Q

diagnosis of diverticulosis

A

colonoscopy

can also be found incidentally on CT

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15
Q

diagnosis of diverticulitis

A

history + examination

CT abdomen and pelvis

complete blood count- leukocytes, raised inflammatory markers (CRP)

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16
Q

management of diverticular disease

A

high fibre diet

drinking 2 litres of clear fluid per day (avoid solids with diverticulitis)

simple analgesia- paracetamol (avoid NSAIDs)

bulk-forming laxatives for constipation (ispaghula husk)

oral antibiotics (co-amoxiclav)

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17
Q

management of diverticular disease where there is severe GI bleeding

A

coagulation therapy

surgical clips applied to the bleeding artery to seal it

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18
Q

management of severe diverticulitis

A

hospital admission and CT

IV fluids and antibiotics

surgical intervention for serious complications

19
Q

can diverticula form in the rectum

A

no due to the outer longitudinal muscle layer which adds extra support

20
Q

which areas of the colon are most vulnerable to developing diverticula

A

areas which do not have teniae coli (the centre has it)

21
Q

which area of the bowel is most likely to be affected by diverticula

A

sigmoid colon (but anywhere in the bowel can be affected)

22
Q

which type of laxatives should be avoided with diverticular disease

A

stimulant laxatives (these can make matters worse)

23
Q

VITAMIN CDE for causes of consptiation

A

Vasular= haemorrhoids

Infectious/inflammatory= N/A

Traumatic/toxic= N/A

Autoimmune= coealiac

Metabolic= N/A

Iatrogenic= diet/lifestyle, medications (opiates, antihistamines, antispasmodics, diuretics)

Neoplastic= bowel cancer

Congenital= any congenital neurological illness (Duchennes muscular dystrophy)

Degenerative= Parkinsons, IBS

Endocrine= hypothyroidism

24
Q

what may suggest an anal prolapse

A

constipation

sensation of anal/rectal mass

rectal/anal pain

rectal bleeding/mucus

incontinence

25
Q

anal fissure typical presentation

A

constipation

fresh blood in stools

extreme pain during defecation (often worsens constipation as patients fear passing stool)

may be history of trauma

examination will reveal fissure

26
Q

which is the area of the colon most often affected by cancer

A

the recto-sigmoid colon

(caecum is second most affected)

27
Q

is the left or right side of the colon more commonly affected by cancer

A

the left

28
Q

which staging criteria is used for bowel cancer

A

TNM staging and Dukes criteria

29
Q

what does dukes criteria for bowel cancer look at

A

looks at the stage of cancer- how far it has spread and chances of 5 year survival due to this

staged A-D

A= 90% chance of survival at 5 years

D= less than 10 chance of survival at 5 years

30
Q

what is a bag attached to the colon called

A

colostomy

31
Q

what is a bag attached to the small intestine called

A

ileostomy

32
Q

what is found on DRE with mechanical bowel obstruction

A

collapsed rectum (all of the bowel distal to the obstruction will be collapsed)

33
Q

what is found on DRE with functional bowel obstruction

A

the entirety of the bowel will be distended and capacious, including the rectum

34
Q

what could cause functional bowel obstruction

A

ileus
pseudo-obstruction

35
Q

causes of RUQ/right hypochondrium pain

A

acute pancreatitis
duodenal ulcer
gallbladder disease
pneumonia (referred)

36
Q

cause of epigastric pain

A

duodenal ulcer
pancreatitis
peptic ulcer

37
Q

causes of LUQ/hypochondrium pain

A

pneumonia
spontaneous splenic rupture

38
Q

causes of umbilical pain

A

AAA
early appendicitis
mesenteric thrombosis
SBO

39
Q

causes of left lumbar pain

A

pyelonephritis
renal colic

40
Q

causes of RIF pain

A

acute appendicitis
acute diverticulitis
crohns
ectopic pregnancy
renal colic
ruptures ovarian cyst
salpingitis

41
Q

causes of hypogastric (suprapubic) pain

A

ectopic pregnancy
urinary retention
UTI

42
Q

causes of LIF pain

A

acute diverticulitis
ectopic pregnancy
ruptured ovarian cyst
salpingitis

43
Q

management of large bowel obstruction secondary to bowel tumour

A

NBM

IV fluids and correct electrolyte disturbance

NG tube to decompress bowel and suck to prevent aspiration

urinary catheter for fluid balance

analgesia

antiemetics

VTE prophylaxis (there is a higher risk of DVT with the cancer)

antibiotics

44
Q

what is a complication of anastomosing ends of the colon together surgically

A

anastomotic leak

45
Q

what is the eligibility for bowel cancer screening in the UK

A

everyone aged 60-74 every 2 years

46
Q

which test is used for screening of bowel cancer

A

FIT test of FOB (fecal occult blood) depending on area of the UK

Semester 2 (3rd year) (12 decks)

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