irritable bowel syndrome & bowel ischaemia

Question 1

what is irritable bowel syndrome

Answer 1

’ functional bowel disorder’

mixed group of abdo symptoms with no organic cause

Question 2

epidemiology of IBS

Answer 2

Age of onset under 40yrs
more common in femalles
1 in 5 in the western world

Question 3

risk factors for IBS

Answer 3

Previous gastroenteritis
Previous severe long-term diarrhoea
Anxiety and depression
Psychological stress, trauma, abuse

Question 4

What are the three types of IBS

Answer 4

IBS-C – with constipation
IBS-D – with diarrhoea
IBS-M – mixed, with alternating constipation & diarrhoea

Question 5

clinical presentation of IBS

Answer 5

Abdo pain
Bloating
Change in bowel habit

Question 6

diagnosable criteria of irritable bowel syndrome

Answer 6

Abdominal pain/discomfort associated with 2+ of:
Relieved by defecation
Altered stool form
Altered bowel frequency

Question 7

what other symptoms may a patient complain of

Answer 7

Urgency
Incomplete evacuation
Abdo bloating/distension
Mucus in rectum & stool
Worsening of symptoms after food
Abdo tenderness

Question 8

symptoms are exacerbated by

Answer 8

stress
menstruation
gastroenteritis
food

Question 9

red flag symptoms for colon cancer

Answer 9

• Unexplained weight loss
• Bleeding on defecation/wiping
• Abdo/rectal mass
• Raised inflammatory markers
• Anaemia
• Aged over 50

Question 10

what investigations would you do for ibs

Answer 10

blood test
faecal calprotectin
colonoscopy

Question 11

management for mild IBS

Answer 11

-Education and reassurance
- dietary modification
- keep a food diary - to identify triggers

Question 12

management for IBS-C

Answer 12

• stool softeners
  -oral laxatives
• avoid alcohol

Question 13

management for IBS-D

Answer 13

AVOID insoluble fiber
Makes diarrhoea
Cereals, whole-wheat bread, lentils, apples, avocados

Question 14

medication for bloating

Answer 14

antispasmodics
buscopan

Question 15

medication for diarrhoea

Answer 15

loperamide

Question 16

medication for constipation

Answer 16

laxatives- macrogol

Question 17

What is the mesentery

Answer 17

Mesenteries are double layers of peritoneum in the abdominal cavity and are continuations of the visceral and parietal peritoneum

Question 18

What is chronic mesenteric ischaemia

Answer 18

narrowing of GI blood vessels causing decreased supply to bowel. same as angina in heart

Question 19

Risk factors for chronic mesenteric ischaemia

Answer 19

same as cardiac

Question 20

classic triad of signs and symptoms of chronic mesenteric ischaemia

Answer 20

• central colicky abdominal pain after food
• weight loss
• abdominal bruit

Question 21

investigations for CMI

Answer 21

CT contrast angiography

Question 22

Define acute mesenteric ischaemia

Answer 22

blockage of mesenteric arteries/ veins – leading to small bowel ischaemia
Affects superior mesenteric artery

Question 23

Mesenteric ischaemia epidemiology

Answer 23

Age: >40
F>M

Question 24

Aetiology of mesenteric ischaemia

Answer 24

Arterial - thrombosis, embolism
Venous - Thrombosis
Non- occlusive - Hypoperfusion

Question 25

RFs for mesenteric ischaemia

Answer 25

Age AF Atherosclerosis MI Vasculitis IE

Question 26

Physiology of SI blood circulation

Answer 26

- SI need high oxygen for digestion > susceptible to tissue injury from ischaemia - Reduce risk: mesenteric arteries branch and reconnect at points froming collateral circulation - blood flow reduced one way blood received from another pathway

Question 27

S + S of mesenteric ischaemia

Answer 27

Rectal bleeding DIARRHOEA N/V Fever Weight loss

Question 28

Small Bowel infarction (mesenteric ischaemia)

Answer 28

- SBI - decrease in BF to SI - ISchaemic injury leads to production of ROS > damage DNA,RNA and protein in cell leading to cell death - BF returns to tissue called reperfusion causes reperfusion injury - ROS triggers inflammatory response - neutrophils remove dead cells + release cytokines TNFa - Blood vessels become more permeable to fluid + immune cells > bowel oedema

Question 29

examples of mesenteric vessels

Answer 29

superior + inferior mesenteric artery SMV IMV right and middle colic artery

Question 30

What does acute mesenteric ischaemia cause

Answer 30

Bowel infarction + perforation Short bowel syndrome Strictures

Question 31

Most commonly affected vessel

Answer 31

SMA

Question 32

Causes of acute mesenteric ischaemia

Answer 32

- embolus - low perfusion - thrombus

Question 33

classic triad of signs and symptoms for acute mesenteric ischaemia

Answer 33

-severe colicky abdominal pain - abdominal bruit - rapid hypovolaemia

Question 34

How does chronic mesenteric ischaemia present

Answer 34

- abdo pain after eating - fear of eating - weight loss

Question 35

investigations for AMI

Answer 35

- History and diagnosis 1st line- CT contrast/ angiography GOLD- colonoscopy

Question 36

treatment for ami

Answer 36

Supportive - IV fluids - Catheter - o2 - analgesia

Question 37

What is ischaemic colitis

Answer 37

Bowel ischaemia which affects the large bowel. This is mainly due to pathology in the inferior mesenteric artery territory and can range from mild ischaemia to gangrenous colitis.

Question 38

Causes of ischaemic colitis (intestinal ischaemia when intestines small and large dont get sufficient blood)

Answer 38

Non occlusive: HF, Renal impairment, Cocaine use Arterial: Thrombus, embolism Venous: Embolism

Question 39

RFs for Ischaemic colitis

Answer 39

Older age Peripheral vascular disease AF Atherosclerosis MI Cocaine

Question 40

what is the most common ischaemic bowel disease

Answer 40

ischaemic collitis

Question 41

S+ S of IC

Answer 41

Abdom tenderness Pyrexia Tachycardia Diarrhoea Fever Haematochezia

Question 42

what is most commonly affected in ischamic collitis

Answer 42

splenic flexure despite dual blood supply of sma and ima

Question 43

Investigations for IC

Answer 43

FBC, U&Es, VBG GI endoscopy - GS CT

Question 44

signs and symptoms of ischaemic colitis

Answer 44

- severe colicky abdominal pain - abdominal bruit - rapid hypovolaemia

Question 45

Management of IC

Answer 45

NBM IV Fluid Broad spectrum ANTIBIOTICS