Per Rectum Bleeding Flashcards
(43 cards)
What test should always be offered to any patient requiring admission to hospital with severe infectious bloody diarrhoea?
A test for HIV, as immunocompromise should be suspected.
What causes anaemia in Coeliac Disease?
Poor absorption of iron in the inflamed small bowel (rather than direct blood loss).
What is Giardia infection, and what are the symptoms? (5)
A parasitic infection of the bowel, causing:
-Foul smelling diarrhoea
-Bloating
-Cramping abdominal pain
-Weight loss
-Fatigue
[Symptoms can last for many weeks.]
What is the first line treatment for Giardia infection?
Metronidazole
Why does pancreatic exocrine insufficiency cause diarrhoea?
Reduced secretion of pancreatic digestive enzymes means food cannot be broken down and absorbed.
What is bile acid diarrhoea?
Failure to reabsorb bile acids in the terminal ileum, which can cause symptoms very similar to irritable bowel syndrome with diarrhoea predominance.
What conditions can cause diarrhoea, with the potential for visible blood loss? (7)
-Colorectal cancer
-Inflammatory bowel disease
-Ischaemic colitis
-Diverticulitis
-Shigella infection
-Shiga toxin producing E.coli infection
-Clostridium difficile (C. diff) infection
Which patients with Shigella infection should be treated with antibiotics?
Those with severe symptoms and immunocompromised patients.
Which antibiotic is currently first line in the UK for treating Shigella infection?
Azithromycin
Why is Shiga toxin producing E.coli infection NOT treated with antibiotics?
This increases the risk of a potentially fatal complication, haemolytic uraemic syndrome.
What complications can occur in severe cases of Clostridium difficile (C. diff) infection?
Dilation of the bowel, resulting in toxic megacolon and perforation.
What is pseudomembranous colitis?
A characteristic appearance of raised whitish yellow plaques on endoscopy, resulting from an exudate of inflammatory cells and mucus seen most commonly in Clostridium difficile infection.
How should Clostridium difficile infection be treated?
Vancomycin; oral route is preferred if possible.
What is an anal fissure?
A small tear in the lining of the anal canal.
What symptoms are associated with an anal fissure? (2)
Sharp pain on defecation
Bright red blood on stool or on wiping
What are haemorrhoidal cushions?
Normal vascular rich connective tissue cushions in the anal canal; can become haemorrhoids if they become swollen or inflamed, causing pain and bleeding.
What is loperamide?
An antimotility drug used to treat diarrhoea, but contraindicated in IBD as can increase risk of bowel dilation and toxic megacolon.
How does chronic inflammation affect albumin?
Chronic inflammation causes increased degradation of albumin, leading to lower serum albumin.
Give five causes of hypokalaemia.
-Profuse diarrhoea
-Vomiting
-Loop/thiazide diuretics
-Mineralocorticoid excess
-Disorders causing excess renal loss of potassium
What are the next steps on discovering hypokalaemia on a blood test? (3)
Perform an ECG
Check levels of other electrolytes (magnesium, phosphates and calcium)
Provide adequate replacement therapy
What are the four main causes of hypoalbuminaemia?
-Inflammation (acute or severe) causing increased albumin degradation
-Primary liver disorder affecting synthesis of albumin
-Malabsorption in bowel or kidneys
-Abnormally high losses from bowel or kidneys
What is recommended as part of a fluid challenge?
Giving 500mL of 0.9% sodium chloride over less than 15 minutes, reevaluating the response in blood pressure after and giving another 500mL if needed.
What should never be infused as a rapid bolus?
Potassium containing fluid - it can precipitate ventricular arrhythmias and death.
What is the maximum concentration of potassium containing fluid that can be given via peripheral infusion?
40mmol/L (higher concentrations can cause phlebitis)
