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Flashcards in Gastroenterology Deck (212)
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1

Acute causes of diarrhoea?

Gastroenteritis

Diverticulitis = LLQ and fever

Antibiotic therapy

Constipation causing overflow = Hx of alternating diarrhoea and constipation

2

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

Coeliacs

3

Staph aureus gastroenteritis typical Hx, incubation and management ?

Meat and eggs, no fever / abdo pain.
Severe vomiting

1-6 hours

Self limiting

4

B. Cereus gastroenteritis typical Hx, incubation and management ?

Rice.
vomiting or diarrhoea

6-12 hours

Self limiting

5

Salmonella gastroenteritis typical Hx, incubation and management ?

Source = pets or food
Nausea, fever and vomiting

12-48 hours

self-limiting, if persists = ciprofloxacin

6

E. Coli gastroenteritis typical Hx, incubation and management ?

Travellers diarrhoea
Contaminated food
Watery stools and abdominal cramps
No fever
HUS....

12-48 hours

Avoid antibiotics

7

Listeria gastroenteritis typical Hx, incubation and management ?

Refrigerated food
Fever, watery diarrhoea and cramps

12-48 hours

Ampicillin

8

Shigella gastroenteritis typical Hx, incubation and management ?

Children at nursery
Water diarrhoea progressing to bloody mucoid diarrhoea
Vomiting and abdo pain

2-3 days

Avoid antibiotics, ciprofloxacin if needed

9

Campylobacter gastroenteritis typical Hx, incubation and management ?

Meat and dairy
Flu like prodrome, followed by severe abdominal pain and fever

2-3 days

Self limiting
Only treat if immunocompromised = Macrolide e.g. erythromycin
Complication = GBS

10

V. Cholera gastroenteritis typical Hx, incubation and management ?

Water and food with human faeces e.g. shell fish
Rice water stool

1 week

treat the fluid losses

11

Giardiasis gastroenteritis typical Hx, incubation and management ?

Endemic area travel = Eastern Europe, Africa and Asia
Prolonged non-bloody diarrhoea
Steatorrhoea
Flatulence and cramps, no fever

1 week

Metronidazole

12

Amoebiasis gastroenteritis typical Hx, incubation and management ?

Flask shaped ulcer
Gradual onset bloody diarrhoea and abdo pain. Can last weeks

1 week

Metronidazole and Paromomycin in luminal disease

13

Associated antibiotics with C. Diff diarrhoea?

Cephalosporins
Cipro
Clindamycin

14

Clinical features of C. Diff diarrhoea?

Mild diarrhoea

Pseudomembranous colitis
= severe systemic features, abdo pain and bloody diarrhoea

15

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

16

What bowel histology do you see in laxative abuse?

Melanosis coli

17

What is IBS?

Chronic condition characterised by abdominal pain associated with bowel dysfunction, but no organic cause identified

18

Clinical features of IBS?

Abdo pain and bloating
Combo of diarrhoea and constipation
Worse on eating, relieved by defecation

19

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:

Urgency
Incomplete evacuation
Abdo bloating / distension
Mucous PR
Worsening symptoms after food

20

ROME exclusion criteria for IBS?

>40
bloody stool
Anorexia
Weight loss
Diarrhoea at night

21

Management of IBS?

Exclude other diagnosis with investigations

Conservative = reassure and educate
Eliminate any triggers e.g. caffeine. Increase fibre
CBT

Medical:

Diarrhoea dominant = Loperamide 4mg PO OD

Constipation dominant = Lactulose

22

what is coeliacs?

Genetic associations

Genetic autoimmune condition caused by sensitivity to the protein gluten = immune activation in the small intestine

HLA- DQ2 and DQ8

23

What associated conditions also need screening for coeliacs?

Autoimmune thyroid
Dermatitis herpetiformis
IBS
T1DM
1st degree relative with coeliacs

24

Clinical features of coeliacs?

GLIAD

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
IgA deficiency
T1DM

A -- Anaemia

D - Derm = dermatitis herpetiformis = very itchy vesicles on extensor surface

25

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

26

Management of coeliacs?

Lifelong gluten avoidance
Ok = maize, corn and rice

Pneumovax as hyposplenism
Dermatitis herpetiformis = dapsone

27

Macroscopic features of UC?

Rectum to ileocaecal valve
Continuous
No strictures or fistulas

28

Macroscopic features of Crohns?

Mouth to anus, patchy
Strictures and fistulas

29

Microscopic features of UC?

Mucosal inflammation, not beyond the submucosa

Crypt abscesses

Broad shallow ulcers + pseudo-polyps

NO fibrosis

30

Microscopic features of Crohn's?

Transmural = all layers

Goblet cells and granulomas

Deep and thin cobblestone ulcers

FIBROSIS