Flashcards in Gastroenterology Deck (212)
Acute causes of diarrhoea?
Diverticulitis = LLQ and fever
Constipation causing overflow = Hx of alternating diarrhoea and constipation
Chronic causes of diarrhoea?
IBS = Abdo pain, bloating and change in bowel habit
UC = Bloody diarrhoea and crampy abdominal pain
Crohns = Cramby abdo pain + malabsorption, obstruction, mouth ulcers and perianal disease
Staph aureus gastroenteritis typical Hx, incubation and management ?
Meat and eggs, no fever / abdo pain.
B. Cereus gastroenteritis typical Hx, incubation and management ?
vomiting or diarrhoea
Salmonella gastroenteritis typical Hx, incubation and management ?
Source = pets or food
Nausea, fever and vomiting
self-limiting, if persists = ciprofloxacin
E. Coli gastroenteritis typical Hx, incubation and management ?
Watery stools and abdominal cramps
Listeria gastroenteritis typical Hx, incubation and management ?
Fever, watery diarrhoea and cramps
Shigella gastroenteritis typical Hx, incubation and management ?
Children at nursery
Water diarrhoea progressing to bloody mucoid diarrhoea
Vomiting and abdo pain
Avoid antibiotics, ciprofloxacin if needed
Campylobacter gastroenteritis typical Hx, incubation and management ?
Meat and dairy
Flu like prodrome, followed by severe abdominal pain and fever
Only treat if immunocompromised = Macrolide e.g. erythromycin
Complication = GBS
V. Cholera gastroenteritis typical Hx, incubation and management ?
Water and food with human faeces e.g. shell fish
Rice water stool
treat the fluid losses
Giardiasis gastroenteritis typical Hx, incubation and management ?
Endemic area travel = Eastern Europe, Africa and Asia
Prolonged non-bloody diarrhoea
Flatulence and cramps, no fever
Amoebiasis gastroenteritis typical Hx, incubation and management ?
Flask shaped ulcer
Gradual onset bloody diarrhoea and abdo pain. Can last weeks
Metronidazole and Paromomycin in luminal disease
Associated antibiotics with C. Diff diarrhoea?
Clinical features of C. Diff diarrhoea?
= severe systemic features, abdo pain and bloody diarrhoea
Management of C. Diff diarrhoea?
Stop causative antibiotics and fluids
Metronidazole 400mg TDS PO for 2 weeks
2nd line = Vancomycin 125mg QDS PO
If severe = vancomycin first then add metronidazole
What bowel histology do you see in laxative abuse?
What is IBS?
Chronic condition characterised by abdominal pain associated with bowel dysfunction, but no organic cause identified
Clinical features of IBS?
Abdo pain and bloating
Combo of diarrhoea and constipation
Worse on eating, relieved by defecation
What are the ROME criteria for IBS?
Abdo discomfort for >12 weeks, which has 2 of:
Relieved by defecation
Change in stool frequency
Change in stool form
Plus two of:
Abdo bloating / distension
Worsening symptoms after food
ROME exclusion criteria for IBS?
Diarrhoea at night
Management of IBS?
Exclude other diagnosis with investigations
Conservative = reassure and educate
Eliminate any triggers e.g. caffeine. Increase fibre
Diarrhoea dominant = Loperamide 4mg PO OD
Constipation dominant = Lactulose
what is coeliacs?
Genetic autoimmune condition caused by sensitivity to the protein gluten = immune activation in the small intestine
HLA- DQ2 and DQ8
What associated conditions also need screening for coeliacs?
1st degree relative with coeliacs
Clinical features of coeliacs?
G -- GI = malabsorption:
Carbs - weight loss, fatigue and distension
fat = steatorrhoea
haematinics - anaemic
vitamins - osteoporosis, B2 = angular stomatitis
L -- Lymphoma enteropathy T-cell associated
I -- Immune
A -- Anaemia
D - Derm = dermatitis herpetiformis = very itchy vesicles on extensor surface
Investigations for coeliacs?
Bloods - FBC, LFT's, INR (don't absorb Vit k), bone profile
Antibodies 1st line = anti-TTG (but low with exclusion diet or IgA deficiency)
Jejunal biopsy = sub-villous atrophy, crypt hyperplasia and intra-epithelial lymphocytes
Management of coeliacs?
Lifelong gluten avoidance
Ok = maize, corn and rice
Pneumovax as hyposplenism
Dermatitis herpetiformis = dapsone
Macroscopic features of UC?
Rectum to ileocaecal valve
No strictures or fistulas
Macroscopic features of Crohns?
Mouth to anus, patchy
Strictures and fistulas
Microscopic features of UC?
Mucosal inflammation, not beyond the submucosa
Broad shallow ulcers + pseudo-polyps