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Gastrointestinal System > Lecture 7.2: Other Disorders of the Bowel > Flashcards

Lecture 7.2: Other Disorders of the Bowel Flashcards

1
Q

What is Constipation?

A
  • Difficulty with defecation
  • Infrequent and/or hard to pass stool
  • Rome IV criteria: <3x a week
  • Sensation of incomplete evacuation or anorectal
    blockage
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2
Q

What is Chronic Constipation?

A

Constipation for >3months

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3
Q

What is Faecal Loading/Impaction?

A

Retention of faeces to the extent that spontaneous evacuation is unlikely (might require manual disimpaction)

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4
Q

What is Functional (primary or idiopathic) Constipation?

A

Chronic constipation without a known cause

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5
Q

What is Secondary Constipation?

A

Cause by medication or an underlying condition

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6
Q

How much higher is constipation in women than in men?

A

2-3 times

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7
Q

Risk Factors for Constipation: Social (7)

A
  • Low Fibre/Calorie Diet
  • Access to Toilet
  • Reduce Exercise
  • Privacy when Toileting
  • Low Educational Levels
  • Socio-Economic Deprivation
  • Family History
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8
Q

Risk Factors for Constipation: Psychological (4)

A
  • Anxiety
  • Depression
  • Eating Disorders
  • Abuse
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9
Q

Risk Factors for Constipation: Physical (6)

A
  • Female Sex
  • Older Age
  • Pyrexia
  • Poor Fluid Intake
  • Immobility
  • Sitting Position on Toilet Seat
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10
Q

What are the 2 categories of Secondary Causes of Constipation?

A
  • Organic Causes
  • Medication Related
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11
Q

Secondary Causes of Constipation: Medications (7)

A
  • Opiates
  • Tryciclics
  • NSAIDs
  • Antihistamines
  • Iron Supplements
  • Beta-Blockers
  • Calcium Channel Blockers
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12
Q

What are Organic Causes of Secondary Causes of Constipation (5)

A
  • Endocrine
  • Myopathic Conditions
  • Neurological Conditions
  • Structural Abnormalities
  • Other
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13
Q

Secondary Causes of Constipation: Endocrine (2)

A
  • Hypothyroidism
  • Hypercalciaemia
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14
Q

Secondary Causes of Constipation: Myopathic Conditions (3)

A
  • Scleroderma
  • Amyloidosis
  • Myotonic Dystrophy
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15
Q

Secondary Causes of Constipation: Neurological Conditions (3)

A
  • Multiple Sclerosis
  • Parkinson’s Disease
  • Spinal Cord Injury
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16
Q

Secondary Causes of Constipation: Structural Abnormalities (3)

A
  • Anal Fissures
  • Structuring IBD
  • Obstructive Mass
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17
Q

Secondary Causes of Constipation: Other (3)

A
  • CVD
  • IBS
  • Coeliac Disease
  • Hirschprungs
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18
Q

What is Hirschprungs?

A
  • Congenital
  • Developmental failure of Auberbach and Meissner
    plexuses
  • Absent from anorectal junction
  • Gut aperistaltic and spastic
  • Causes constipation and gut dilatation
  • Megacolon
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19
Q

What is Stool Impaction?

A

A faecal impaction is a large, hard mass of stool that gets stuck so badly in your colon or rectum that you can’t push it out

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20
Q

When should the diagnosis of Impaction be considered? (4)

A
  • Hard, lumpy stool which may be large and infrequent
  • Small and relatively frequent - ’rabbit droppings’ * Need manual methods to extract faeces
  • Overflow incontinence/loose stool
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21
Q

What is a Colonic Transit Study?

A
  • A test that shows how quickly food passes through the
    digestive system
  • It starts when you give your child some pellets to
    swallow on three consecutive days
  • On the fourth day, they will need to come into hospital
    for an x-ray
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22
Q

Red Flags in Bowel Issues (5)

A
  • PR bleed
  • Unintentional Weight Loss
  • Recent Change in Bowel Habit
  • New Abdominal Pain
  • Iron Deficiency/Anaemia
23
Q

How to treat Constipation? (6)

A
  • Dietetic Referral
  • Lifestyle Adjustments
  • Rectal Suppositories
  • Laxatives
  • Disimpaction
  • Obstructive defecation – refer for balloon expulsion
    test/anorectal manometry and biofeedback sessions
24
Q

What is Irritable Bowel Syndrome (IBS)

A

It is a chronic, relapsing, and often lifelong disorder of the lower gastrointestinal tract, with no discernible structural or biochemical cause

25
Symptoms of IBS
* Stomach Pain/Cramps * Bloating * Diarrhoea * Constipation
26
When can IBS be diagnosed?
Abdominal pain/discomfort, in association with altered bowel habit, for at least 6 months, in the absence of alarm symptoms or signs
27
What are possible mechanisms of IBS? (6)
* Visceral hypersensitivity * Abnormal gastrointestinal immune function * Changes in colonic microbiota * Abnormal autonomic activity * Abnormal central pain processing of afferent gut signals (altered 'brain-gut interactions') * Abnormal gastrointestinal motility
28
Possible Risk Factors of IBS? (6)
* Genetic * Enteric infection (e.g. following gastroenteritis) * Gastrointestinal inflammation (e.g. secondary to inflammatory bowel disease) * Dietary factors (alcohol, caffeine, spicy and fatty foods) * Drugs (antibiotics) * Psychosocial (stress, anxiety and/or depression)
29
What demographic is IBS most common in?
* 20-30 years * Women > men
30
Consider the diagnosis of IBS in a person who has had any of the following symptoms for at least 6 months: ABC
Abdominal Pain Bloating Change in bowel habit
31
Make a diagnosis of IBS if a person has abdominal pain which is associated with either..? (8)
* Related to defecation * Associated with altered stool frequency * Associated with altered stool form or appearance * Altered stool passage * Abdominal bloating * Symptoms worsened by eating * Passage of rectal mucus * Alternative conditions with similar symptoms have. been excluded
32
Investigations for IBS- most;y to rule out other conditions (6)
* Full blood count (FBC) * Erythrocyte sedimentation rate (ESR) * C-reactive protein (CRP) * Antibody testing for coeliac disease * Fecal calprotectin to r/o IBD * Consider FIT testing in 50+ population
33
Treatment of IBS: Lifestyle Changes (6)
* Encourage addressing psychological causes * Increase water intake * Reduce insoluble fibre (wholemeal) * Reduce food that exacerbate (caffeine, alcohol, carbonated drinks, gas-producing food) * Fibre supplements * Encourage 30mins exercise 5x a week
34
Treatment of IBS: Pharmacological (5)
* Antispasmodics (mebeverine, peppermint oil capsules) * Laxatives (avoid lactulose) * Loperamide (for antimotility) * TCA second line (Amitriptyline/Nortryptilline): for IBS-D * SSRI second line (Citalopram): for IBS-C
35
When should Linaclotide be considered for treating IBS? (3)
* Optimal or maximum tolerated doses of previous laxatives from different classes have not helped * Constipated 12months + * Need follow up after 3months
36
What causes Bile Acid Malabsorption?
An over-production of bile acids (BA) due to defective feedback inhibition of hepatic bile acid synthesis
37
Small Intestinal Bacterial Overgrowth (SIBO)
Excessive amount of bacteria (dysbiosis) populates the small intestines
38
Symptoms of SIBO (7)
* Bloatiness * Abdominal Pain * Diarrhoea * Loss of appetite * Nausea/Vomiting * Unintentional Weight Loss * Malnutrition
39
Conditions associated with SIBO (4)
* Gut Dysmotility * Anatomical Changes * Altered GI Secretions * Impaired Gut Immunity
40
Investigations to diagnose SIBO (2)
* Gold standard dg: quantitative culture of jj aspirates (invasive, non-practical) * Real life dg tests: glucose and lactulose breath tests
41
Treatment of SIBO (5)
* Avoid Sugar * Smoking Cessation * Avoid NSAIDs * Low FODMAP Diet * Antibiotics: Rifaximin 550mg bd for 7-14/7, Ciprofloxacin 500mg bd, Metronidazole 500mg tds
42
What is Coeliac Disease?
Chronic immune-mediated systemic disorder in genetically predisposed people, triggered by exposure to dietary gluten
43
What is Potential Coeliac Disease?
Symptomatic patients or those who are asymptomatic with +ve antibodies but no villous atrophy on biopsy
44
What is Non-Responsive Coeliac Disease?
Persistent symptoms and enteropathy that do not response after 6-12 months of treatment
45
What is Refractory Coeliac Disease?
Persistent or recurrence of otherwise unexplained symptoms and villous atrophy despite 12+ adherence to treatment
46
What is Coeliac Disease characterised by? (3)
* Inflammatory small bowel enteropathy * GIT and /or systemic symptoms * Presence of coeliac-specific autoantibodies
47
Predisposing Factors of Coeliac Disease (4)
* Genetic : strong association with HLA-DQ2/-DQ8 * Immune-mediate disorder driven by immune response to gluten * Link with other auto-immune diseases (diabetes, thyroid disease) * Gluten exposure
48
What signs indicate that Coeliac Disease should be suspected? (8)
* Persistent, unexplained GI symptoms * IBS * Faltering growth/delayed development * Prolonged fatigue/lethargy * Unexplained Fe, B12 or folate deficiency/anaemia not responding to treatment * At diagnosis of auto-immune disease * Selective IgA deficiency * First degree relative with condition
49
Consider a diagnosis of Coeliac Disease in a person with what conditions? (8)
* Osteomalacia/-penia/-porosis or fragility fracture * Unexplained anxiety/depression * Unexplained Peripheral neuropathy * Unexplained Recurrent miscarriage or subfertility * Unexplained Persistently raised LFTs * Dental enamel defects * Hyosplenism * Downs/Turners/Williams syndrome
50
What is Dermatitis Herpetiformis?
A chronic, intensely itchy, blistering skin manifestation of gluten-sensitive enteropathy, commonly known as celiac disease
51
Treatment of Coeliac Disease
Gluten Free Diet
52
Complications of uncontrolled/undiagnosed Coeliac Disease (9)
* Reduced quality of life * Mental health disorders * Faltering growth and delayed puberty in children * Nutritional deficiencies * Anaemia * Reduced bone density * Hyposplenism * Malignancy/risk of lymphoma * Refractory coeliac disease
53
What is the Valsalva Maneuver?
It is the performance of forced expiration against a closed glottis

Gastrointestinal System (22 decks)

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