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Block 32- GI/surgery > altered bowel habit > Flashcards

altered bowel habit Flashcards

(84 cards)

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1
Q

4 important things to ask about in assessment of diarrhoea

A

red flag symptoms
frequency
antibiotics
travel

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2
Q

4 causes of acute diarrhoea

A

dietary indiscretion
infection
constipation with overflow
pseudomembranous colitis

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3
Q

pseudomembranous colitis after

A

oral antibiotic use

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4
Q

chronic diarrhoea=

A

> 4 weeks history with no response to medicaitons or treatment

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5
Q

causes for chronic diarrhoea (7)

A
  • IBD
  • coeliac disease
  • colonic and pancreatic cancer
  • whipples disease
  • laxative abuse
  • IBS
  • infection
  • cystic fibrosis
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6
Q

5 causative agents of gastroenteritis

A 
campylobacter 
salmonella 
escherichia coli 
cryptosporidium 
norovirus
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7
Q

most common cause of infectious diarrhoea in the UK

A

campylobacter

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8
Q

when do symptoms start occuring with campylobacter

A

2-5 days after ingestion

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9
Q

what foods are infected with campylobacter

A

milk or poultry

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10
Q

presentation of campylobacter (3)

A

malaise
bloody diarrhoea
abdo pain

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11
Q

management pf campylobacter

A

usually self-limiting

erythromycin or ciprofloxacin if needed

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12
Q

salmonella usually in contaminated

A

poultry
meat
eggs

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13
Q

symptoms of salmonella

A

vomiting
diarrhoea
abdominal pain
fever

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14
Q

loperamide=

A

m-opioid anti-diarrheal

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15
Q

E.coli causative agent for gastroenteritis

A

E-coli 0157:H7

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16
Q

what toxin does E.coli produce

A

shiga toxin

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17
Q

what does shiga toxin do (2)

A
  • premature destruction of erythrocytes

- damage to GI mucosa

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18
Q

what condition can shiga toxin cause

A

hemolytic uremic syndrome

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19
Q

how is E.coli transmitted (5)

A
  • infected vegetables
  • undercooked meat
  • raw milk products
  • touching infected person
  • infected water
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20
Q

treatment of E.coli

A

self limiting - water and ORT

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21
Q

cryptosporidium=

A

protozoan disease

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22
Q

how is cryptosporidium spread

A

through infected water

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23
Q

presentation of cryptosporidium (5)

A
  • profuse watery diarrhoea
  • abdo cramps
  • nausea
  • anorexia
  • fever and malaise
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24
Q

treatment of cryptosporidium

A

ORT

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25
most common cause of infectious gastroenteritis in UK
norovirus
26
norovirus especially common in
hospitals and schools
27
IBS=
chronic relapsing and remitting condition of unknown cause
28
symptoms of IBS (5)
- crampy abdominal pain - bloating - change in bowel habit - excessive flatulence - nausea and fatigue
29
treatment of IBS
- lifestyle changes -more water, less fiber and lower intake of resistant starch - antispasmodics - probiotics - antidiarrhoeals - antiemetic
30
what antispasmodics are available
mebeverine peppermint oil hyoscine
31
Ondansetron=
5-HT3 antagonist
32
clinical features of chronic constipation (5)
- high pitched bowel sounds with hyper-peristalsis - nausea - emesis - colicky abdo pain - inability to pass flatulence
33
management of chronic constipation
- bowel rest with NG tube - IV fluids - bowel decompression
34
symptoms of colonic carcinoma causing a stricture (6)
- change in bowel habits - nausea and vomiting - anorexia - weight loss - hematochezia - abdominal pain
35
investigations in colorectal cancer suspected
``` FBC LFTs U&Es Colonscopy double contrast barium enema ```
36
what may be seen with colorectal cancer on a double contrast barium enema
apple core colonic lesions
37
which side is abdominal cramping in diverticular disease
left usually
38
treatment of crohns (5)
``` mesalazine budesonide infliximab azathioprine corticosteroid ```
39
anal fissure symptoms (4)
- pain on defecation - tearing sensation passing stools - rectal bleeding - anal spasm
40
first line conservative treatment for anal fissures
- high fiber diet, - fluid intake, - hot baths, - topical analgesia
41
medical treatment for anal fissures
- laxatives - topical glyceryl trinitrate - topical diltiazem
42
what is used for opiate induced constipation
methynaltrexone
43
methylnaltrexone =
peripheral opioid antagonist
44
what other medications can cause constipation
SSRIs
45
first line laxatives in adult constipation
bulk forming laxatives
46
2 bulk forming laxatives
isphaghula husk | methylcellulose
47
lactulose=
osmotic laxative
48
2 stimulant laxatives
senna | sodium picosulphate
49
possible stimuli of IBS
- environmental -stress, smoking | - luminal -foods, dysbiosis, inflammation
50
who gets IBS more
females
51
coeliac disease=
autoimmune response to gliadin peptide antigens
52
genetic predisposition to coeliac disease 2 mutations
HLA-DQ2 | DQ8
53
in coeliac what part of the immune system does gliadin stimulate
innate and adaptive
54
which cytokine does gliadin stimulate
IL-5
55
what does IL-5 do in coeliac
stimulates intraepithelial lymphocytes leading to epithelial damage
56
what are gluten peptides deaminated by
tissue transglutaminase
57
TH1 role in coeliac
cytotoxic lymphocytes cause cell death and villous atrophy
58
Th2 role in coeliac
B plasma cell maturation to form anti-gliadin antibodies
59
villous atrophy leads to (7)
``` malabsorption steatorrhea weight loss diarrhoea abdo cramping bloating N&V ```
60
2 types of colorectal cancer
FAP | HNPCC
61
FAP mutation =
APC tumour suppressor gene regulating beta-catenin
62
signalling pathway beta-cat triggers
wnt
63
HNPCC mutation=
mismatch repair genes correcting errors made by polymerase during DNA replication -microsatellite DNA mutations
64
extra-intestinal manifestations of Crohn's
arthritis ankylosing spondylitis aphthous ulcers
65
complications of UC
bleeding toxic megacolon colonic perforation colonic cancer
66
most common cause of hypothyroidism
hashimoto thyroiditis
67
symptoms of hypothyroidism (6)
``` fatigue constipation weight gain poor appetite SOB carpal tunnel ```
68
why constipation in hypothyroidism
weakened contractions of muscles of GI tract
69
common area of diverticular disease
sigmoid colon -small diameter
70
TNM not applicable to
leukaemia | CNS cancer
71
Tx=
main tumour cannot be measured
72
Tis=
carcinoma in situ
73
T4=
invaded surrounding tissue
74
N1=
presence of cancerous cells in one surrouding lymph node
75
MX
metastasis cannot be measured
76
M1=
cancer has spread to other parts of body
77
most common place for metastasis
liver and lungs
78
dukes tumour staging system used for
extent of rectal cancers
79
Dukes tumour staging A=
tumour confined to mucosa = good prognosis
80
dukes tumour staging D=
distant metastases <1% 5 year survival
81
what does Dukes tumour staging use
CT, MRI, ultrasound
82
neoadjuvant chemotherapy=
preoperatively reduce tumour size via chemo
83
adjuvant chemotherapy=
post-operative chemotherapy
84
what is a general margin in tumour resection to ensure all cancerous tumour is removed
2-5 cm

Block 32- GI/surgery (9 decks)

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