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Altered Bowel Habit Flashcards

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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
What are the symptoms of E.coli 0157?
Dysentery, vomiting and abdominal cramps.
26
What is a complication of E.coli 0157?
Toxin destroys rbc leading to haemolytic uraemic syndrome.
27
Why should antibiotics be avoided in patients with infectious E.coli?
Increased risk of haemolytic uraemic syndrome.
28
Campylobacter is common in what type of people?
Travellers (travellers diarrhoea).
29
How is campylobacter spread?
Raw/uncooked chicken, untreated water and unpasteurised milk.
30
What are the symptoms of campylobacter?
Dysentery, vomiting, abdominal cramps and fever.
31
Campylobacter is linked to the development of which autoimmune condition?
Guillain-Barré syndrome
32
What is a classic cause of dysentery in young children?
Shigella
33
What type of toxin does shigella produce?
Shiga toxin —> HUS
34
How is salmonella spread and what symptoms does it cause?
Spread via eating raw eggs/chicken and food infected with faeces of animals. Dysentery, vomiting and abdominal pain.
35
Which bacteria causes vomiting after reheating rice?
Bacillus cereus
36
What is the incubation period for Bacillus?
Vomiting after 5 hours of ingestion and watery diarrhoea after 8 hours. Symptoms resolve within 24 hours.
37
Which bacteria causes dysentery, abdominal pain, fever and lymphadenopathy in children, but causes mesenteric lymphadenitis (right-sided abdominal pain) in older children/adults?
Yersinia enterocolitica
38
Give one example of how Yersinia enterocolitica is spread
Eating undercooked pork.
39
What toxin does Staphylococcus aureus produce?
Enterotoxin causing small intestinal inflammation.
40
How is Staphylococcus aureus spread?
Contained eggs, dairy and milk.
41
What is the incubation period of staphylococcus aureus?
Diarrhoea and vomiting start together within hours of ingestion and settle within 12-24 hours.
42
What symptoms does Clostridium perfringes produce?
Watery diarrhoea.
43
What is the most commonly identified pathogen in prolonged travellers diarrhoea?
Giardia
44
What are the symptoms of Giardia?
Watery diarrhoea, abdominal pain, decreased appetite, flatulence and bloating.
45
What is the treatment for Giardia infection?
Metronidazole
46
What other parasites are associated with travellers gastroenteritis?
Entamoeba (generally asymptomatic) and Cryptosporidium.
47
Describe the general management of gastroenteritis
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
How long should patient stay off work/school for after symptoms of gastroenteritis have completely resolved?
48 hours
49
Are antidiarrhoeals and antiemetics recommended in gastroenteritis?
No - but may be useful for mild/moderate symptom management. Avoided in dysentery, E.coli 0157 and Shigella.
50
Define IBS
Irritable bowel syndrome - functional bowel disorder characterised by abdominal pain and altered bowel habits.
51
What does ‘functional’ mean?
There’s no identifiable organic disease underlying the symptoms.
52
List the risk factors associated with IBS
Female, younger age, stressful life events, anxiety/depression, GI infection, somatic symptoms, endometriosis, FHx mental illness.
53
Describe the clinical features of IBS
Fluctuating bowel habits, diarrhoea (mucus), constipation, abdominal pain, bloating, symptoms worse after eating and improved by opening bowels.
54
What other pathology should be excluded before a diagnosis of IBS can be made?
IBD - negative faecal calprotectin. Coeliac disease - negative anti-TTG antibodies. Cancer. Normal FBC, ESR or CRP.
55
What nutritional advice should be given to IBS patients?
Low FODMAP diet, probiotics, decreased caffeine and alcohol, reduced processed food, regular small meals and adequate fluid intake.
56
What are the first line medications used in the treatment of IBS?
Loperamide for diarrhoea. Laxatives (ispaghula husk, movicol, linaclotide) for constipation. Antispasmodics (buscopan) for abdominal cramps.
57
Which laxative should be avoided in IBS?
Lactulose because it causes bloating.
58
What are the second line treatments for IBS?
Low dose TCA e.g. amitriptyline
59
What psychological therapies can be used in IBS treatment?
CBT
60
A patient presents with abdominal pain, diarrhoea and facial/neck flushing
Carcinoid syndrome
61
Define chronic constipation
Constipation >= 3 months.
62
List the causes of primary (functional constipation)
Normal transit constipation (most common), slow transit constipation and dyssynergic defecation.
63
List some causes of secondary constipation
Hypercalcaemia, hypothyroidism, opioids, IBS, IBD, colorectal cancer, bowel obstruction, pregnancy.
64
Describe the clinical features of constipation
Infrequent bowel motions (< 3 per week). Hard lumpy stools. Straining/difficulty passing stools. Incomplete emptying.
65
Describe the Bristol stool chart
1-2: constipation. 3-4: normal. 5-7: diarrhoea.
66
What investigations would you do for diarrhoea to exclude secondary causes?
Bloods: FBC, U&Es, LTFs, bone profile, HbA1c, TFTs. Stool: faecal calprotectin, FIT test. Imaging: abdominal X-ray, colonoscopy.
67
Describe the management plan for constipation
Lifestyle: fibre, whole grains, fruit and veg, fluids, exercise. Laxative: bulk forming (ispaghula husk), osmotic (lactulose, movicol), stimulant (senokot, bisacodyl).
68
A positive C.diff antigen and negative toxin shows what?
Exposure to the bacteria, rather than current infection.
69
What is the first-line medication for small intestine bacterial overgrowth syndrome (SIBO)?
Rifaximin
70
Diagnosis of C.difficile infection
C. difficile toxin in stool

GI and Surgery (14 decks)

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