Bowel conditions and colonoscopy procedures

Question 1

Discuss fibre

Answer 1

30-40g a day

Edible part of plants and carbs that is not digested

Insoluble fibre = bowel regularity (legumes, vegetables, fruits, nuts, wheat, oats, brown rice)

Soluble fibre = slows rate of digestion and absorption of food (barley, ispaghula, rye, vegetables

Question 2

Three main features of diverticular disease

Answer 2

Development of diverticula

bowel wall thickened

internal diameter of bowel is narrowed

Question 3

Signs and symptoms of Diverticular disease

Answer 3

Early stage = no symptoms, cramping lower left abdominal discomfort

diarrhoea, incontinence, blood may mix with stool

infection may cause fever, nausea, vomiting

Question 4

Diverticular disease management

Answer 4

asymptomatic = no treatment

bowel rest = low fibre or fluid only diet

antibiotics = infection no complication, respond in few days

Pain relief

Severe or acute = hospitalisation, surgery, untreated (bleeding, blockage, abscess, perforation of bowel wall)

Question 5

How can diverticular disease be prevented?

Answer 5

30g fibre in diet

Diet = fruits, vegetables, whole grain cereals

Inc water intake = 8 cups a day

regular exercise

Question 6

How is coeliac disease diagnosed?

Answer 6

Serological blood test = for patient consuming gluten, unreliable in children <4 yrs

gastroscopy & biopsies = small bowel to confirm diagnosis, dont need to stop gluten

genotype testing = patient on gluten free diet, screened for human leukocyte antigen, disease excluded if negative

Question 7

List coeliac disease symptoms

Answer 7

Asymptomatic

fatigue, weakness, lethargy, GI problems (bloating, flatulence, nausea, abdominal pain, indigestion)

nutrition deficiencies (folate, zinc, Vit D, Vit B12)

anaemia, osteoporosis, infertility in women

Question 8

How is coeliac disease treated?

Answer 8

Remove cause - lifelong gluten free = no wheat, barley, rye

Initiate = vitamin/mineral supplement, Ca2+ supplement,

temporary restriction of lactose = due to damage of villi

assess meds for gluten, refer to dietician

Question 9

What is coeliac disease?

Answer 9

chronic inflam disease of small intestines = damage to small bowel due to exposure to dietary gluten

Flat, reduced surface area of small intestine = malabsorption of nutrients, minerals

Question 10

Bowel cancer symptoms

Answer 10

No symptoms until advanced (Sometimes)

common symptoms = rectal bleeding, bright red

altered bowel habits = constipation, diarrhoea

unexplained tiredness, anaemia

abdominal pain/cramping

Question 11

List bowel cancer risk factors

Answer 11

> 50 yrs of age
family history
previously had polyps
IBD = crohns, ulcerative colitis
smoking, alcohol, obesity
poor diet = lack fibre, high fat

Question 12

What screening is done for bowel cancer?

Answer 12

Faecal occult blood test (FOBT) = detect small amounts of blood, not 100% accurate, most well researched screening, test every 2 yrs

Done in Aus for people aged 50, 55, or 65

Invited to screen every 2 yrs until 74

Question 13

When can FOBT not be completed?

Answer 13

during/within 3 days of either side of menstrual period

haemorrhoids if bleeding

recently had colonoscopy

blood present in urine/present in toilet bowl

Question 14

Outline general preparations for colonoscopy

Answer 14

Clear liquid diet for 1-3 days before procedure

Laxatives taken to prepare bowel

different prep instruction depending on time of day of procedure

Question 15

What products are used in colonoscopy prep?

Answer 15

Macrogol 3350 = osmotic laxative

Magnesium +/- sodium picosulfate = osmotic laxative

sodium phosphate = osmotic laxative

Question 16

What are the requirements for Macrogol 3350?

Answer 16

No food 2 hours prior to starting, every 15-20 mins until faecal discharge is clear

reduced fluid shifts

less risk of dehydration & electrolyte disturbances

Question 17

What are the requirements for magnesium +/- sodium picosulfate?

Answer 17

same efficacy of macrogol, less volume, better tolerated

Risk of fluid shifts, dehydration, electrolyte disturbances

use with caution in advanced age (>65 yrs), kidney or heart disease

Question 18

What are the requirements for sodium phosphate?

Answer 18

Not first line = inc risk of complications, 3 portions in 20 mins, repeat dosing after 10-12 hrs

Avoid = advanced age, kidney or heart disease, dehydration, hypercalcaemia, people taking drugs affecting renal perfusion and function

Question 19

Describe a food intolerance

Answer 19

non-immune mediate ADR

causes pain/emotional distress but not life threatening

exposure via GI

Question 20

Describe food allergy

Answer 20

immune-mediated response –> release of IgE

Anaphylactic reaction

involves exposure via GI, skin, and/or airways

Question 21

How to prevent food allergies

Answer 21

Probiotics and prebiotics (foods)= help bacteria stick and grow

hypoallergenic formulations = hydrolysed formula

Time complementary feeding no earlier than 4 months

Omega 3 fatty acids, vit D = immune system

Question 22

What are the common allergies in Australia?

Answer 22

milk, eggs, soy, tree nuts, fish, shellfish, and wheat

Question 23

What tests diagnose allergies?

Answer 23

Skin prick test = allergen drop placed on back or forearm and skin is pricked. Positive reaction (15-2 mins)= wheal and flare (>3mm diameter) at site of test

ELISA-based assy = measure food specific IgE in circulation

Immediate skin application food test (I-SAFT) = determine contact sensitivity, raw food to unbroken skin, positive result = wheal/flare response

Food challenge = determine if allergy is out grown, small but inc amounts of food and monitor

Question 24

What is a primary deficiency of lactose?

Answer 24

minimal lactase from birth, continues to decline and req dietary modification

Question 25

What is secondary deficiency of lactose?

Answer 25

GI illness/intestinal disorders damage small intestine BB

Onset = 30 mins to 2 hrs of lactose ingestions

Question 26

Lactose intolerance symptoms

Answer 26

bloating, cramps, flatulence, diarrhoea, nausea, stomach pains

Symptoms occur due to inc fluid and gas in bowel

Question 27

Where can colostomies be found?

Answer 27

created out of the end of the large intestine to divert waste from GI tract

Ascending (not very common), transverse (temporary), descending (most common), sigmoid

Question 28

explain the one piece colostomy system

Answer 28

Pouch and skin barrier are combined in single unit

Closed ended system w/ disposable pouch for one time use, lightweight and flexible

Drainable system = allows pouch to be drained and reused

Question 29

Explain the two piece colostomy system

Answer 29

pouch and skin barrier are two separate pieces coupled together with plastic ring

allows patient to change pouch without removing skin barrier

closed or drainable pouches

Question 30

How do you influence stoma output?

Answer 30

Inc output = laxative

Dec output = loperamide (reduce gut motility) or PPIs (reduce gastric secretion)

Question 31

What are some common skin complications seen with stoma?

Answer 31

irritant dermatitis = appliance leaking, wrong size
- red, weepy, painful
- apply protective paste

Skin allergies = reaction to remover wipes, tapes, or adhesive barrier
- red, itchy, stinging
- remove cause and consider antihistamine and steroid cream if severe