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Inflammatory and GI diseases > Week 5 > Flashcards

Week 5 Flashcards

1
Q

What does type 1 look like on the Bristol stool form scale?

A

Separate hard lumps, like nuts hard to pass

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2
Q

What does type 2 look like on the Bristol Stool Form Scale?

A

Sausage shaped but lumpy

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3
Q

What does type 3 look like on the Bristol Stool Form Scale?

A

Like sausage but with cracks on its surface

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4
Q

What does type 4 look like on the Bristol Stool Form Scale?

A

Like sausage or snake, smooth and soft

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5
Q

What does type 5 look like on the Bristol Stool Form Scale?

A

Soft blobs with clear cut edges (passed easily)

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6
Q

What does type 6 look like on the Bristol Stool Form Scale?

A

Fluffy pieces with ragged edges, a mushy stool

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7
Q

What does type 7 look like on the Bristol Stool Form Scale?

A

Watery, no solid pieces

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8
Q

What type on the Bristol Stool Form Scale is considered normal stool?

A

Type 3 or 4

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9
Q

What is the definition of diarrhoea?

A
  • A change in normal bowel habit resulting in increased frequency of bowel movements and the passage of soft or watery stool
  • May be accompanied by colicky pain
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10
Q

What may cause colicky pain in diarrhoea?

A

Because as the body is trying to expel the material, there will be increased contraction of that smooth muscle which can also lead to additional production of gas and cause discomfort.

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11
Q

Is diarrhoea a symptom or a disease?

A

A symptom

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12
Q

What is acute diarrhoea?

A

Abrupt onset of more that 3 loose stools/day and lasts no longer than 14 days.

  • It can have dietary causes such as various foods e.g. alcohol or spicy food
  • Can be due to bacterial/viral infections
  • Majority of acute diarrhoea resolves within 2-3 days without specific treatment
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13
Q

What is the cause of chronic diarrhoea?

A
  • Usually a pathological cause
  • Lasts longer than 14 days
  • Probably a flare up of a previously diagnosed condition such as IBS
  • Needs further investigation to get the underlying cause
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14
Q

How common is diarrhoea?

A
  • Difficult to determine as many cases self limiting and not reported
  • Common in children under 5 (Most common is gastroenteritis) + between 1-3 cases per year
    This may be due to kids habits and under developed GI system which makes them more prone to such conditions.
  • Adults
    Just under 1 episode per year
    22% food related
    Travellers diarrhoea
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15
Q

Acute diarrhoea is the second highest cause of childhood mortality. True or False

A

True

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16
Q

What two host factors are most important in determining severity and duration of diarrhoea?

A
  • Age
  • Nutritional status
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17
Q

The older the child, the higher risk for severe, life-threatening dehydration. True or False

A

False (younger the child - immune system is not as strong)

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18
Q

What is the definition of constipation?

A

The passage of hard stools (faeces) less frequently than the patient’s own normal pattern

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19
Q

What are the goals of constipation management

A
  1. Achieve an individual’s normal frequency of defecation
  2. Establishing regular, comfortable defecation
  3. Preventing laxative dependence
  4. Relieving discomfort
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20
Q

What is the pathophysiology of diarrhoea?

A

The change in the balance between the absorption and secretion of water and electrolytes

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21
Q

What are the 2 inflammatory disorders of the gastro-intestinal tract

A
  • Crohn’s disease (CD)
  • Ulcerative Colitis (UC)
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22
Q

What is Crohn’s disease?

A
  • Affects any part of the G.I. tract from mouth to rectum
  • Inflammation extends through all layers of the gut wall
  • Inflammation is patchy in distribution
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23
Q

What is Ulcerative Colitis?

A
  • Affects the colon and rectum only
  • Only affects the mucosa (and submucosa)
  • Inflammation is diffuse in distribution
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24
Q

Causative agents of IBD are unknown. True or False

A

True

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25
Q

What factors are thought to have a role in IBD?

A
  • Environmental (Diet, Smoking, Infection, Drugs etc.)
  • Genetic
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26
Q

What factors of diet have been associated with IBD?

A
  • Fat intake
  • Fast food ingestion
  • Milk and fibre consumption
  • Total protein and energy intake
  • Refined carbohydrates

Many patients are able to identify foods that aggravate or exacerbate their symptoms - e.g. cows milk or spicy foods

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27
Q

How does smoking affect IBD?

A
  • Worsens the clinical course of the disease
  • Increases the risk of relapse and need for surgery
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28
Q

How does smoking help prevent the onset of Ulcerative Colitis?

A
  • Chemicals in smoking affect colon smooth muscle, it alters gut motility and transit time.
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29
Q

How does having an infection affect IBD?

A
  • Some evidence that exposure to Mycobacterium paratuberculosis can cause Crohn’s disease.
  • Ulcerative colitis can occur after episode of infective diarrhoea
  • Association with measles and mumps infections
  • Possibly immune system does not switch off after infection leading to autoimmunity
30
Q

How can enteric microflora affect IBD?

A
  • IBD patients have loss of immunological tolerance to intestinal microflora
  • Can be manipulated by antibiotics, probiotics and prebiotics to balance favourably.
31
Q

How can drugs affect IBD?

A
  • NSAIDs can exacerbate IBD by inhibiting the synthesis of cytoprotective prostaglandins
  • Antibiotics can change enteric microflora and precipitate a relapse
  • Oral contraceptive pill can increase the risk of developing Crohn’s disease. It is possibly caused by vascular changes.
  • Drug: Isotretinoin - for acne - possible risk factor
32
Q

How can appendectomy affect IBD?

A
  • It has a protective effect in CD and UC
33
Q

How can stress affect IBD?

A
  • Can trigger a relapse in IBD
  • Activates inflammatory mediators at enteric nerve endings in gut wall
34
Q

How genetic factors influence the risk of IBD?

A
  • By causing disruption of epithelial barrier integrity
  • By causing deficits in autophagy (body’s cellular recycling system)
  • By causing deficiencies in innate pattern recognition receptors
  • By causing problems with lymphocyte differentiation, especially CD
35
Q

What other genetic factors affect IBD?

A
  • Inappropriate response of the immune system in the mucosa of the GI tract to normal enteric flora
  • Mutations of the gene CARD15/NOD2 located on chromosome 16 - Its associated with small intestine CD in white populations
  • The genes OCTNI on chromosome 5 and DLG5 on chromosome 10 have also been linked to CD
36
Q

50% of UC patients have anti-neutrophil cytoplasmic antibodies (p-ANCA). True or False

A

False - 70%

37
Q

What are the ethical factors involved in IBD?

A
  • Jews are more prone than non-jews
  • IBD incidence is lower in non-white races
38
Q

What are the familial factors involved in IBD?

A
  • First-degree relatives of those with IBD have up to 20-fold increase in developing the disease

-15-fold greater concordance for IBD in identical twins than non-identical twins

39
Q

What is IBD?

A

Inflammatory bowel disease (IBD) is a term for two conditions (Crohn’s disease and ulcerative colitis) that are characterised by chronic inflammation of the gastrointestinal (GI) tract. Prolonged inflammation results in damage to the GI tract.

40
Q

What can be IBD due to?

A
  • Increased activity of effector lymphocytes and pro-inflammatory cytokines that override normal control mechanisms
  • Primary failure of regulatory lymphocytes and cytokines
  • In CD, T cells are resistant to apoptosis after inactivation
41
Q

What part of the gut does Crohn’s disease affect?

A

Affects any part of the gut:
- Involving one area or multiple areas
- Usually the terminal ileum & ascending colon
- Discontinuous

42
Q

What happens to the area affected by Crohn’s disease?

A

Affected area are thickened, oedematous & narrow:
- Deep ulcers can appear
-Mucous membrane between fissures has a cobblestone appearance
- Can progress to deep fissuring ulcers, fibrosis & strictures

43
Q

Crohn’s disease can lead to bowel obstructions, abscesses and gut perforations. True or False

A

True

44
Q

What can be seen microscopically for Crohn’s disease?

A
  • Non-specific granulomatous inflammation
  • Inflammation extends throughout all layers of the bowel (transmural)
    -Inflammatory cells are seen throughout - lymphocytes and plasma cells
  • Th1-associated
45
Q

Chronic inflammation leads to an decreased risk of cancer. True or False

A

False - Increased

46
Q

Which areas are affected by Ulcerative Colitis?

A
  • Only the mucosa & submucosa are affected
  • Continuous, starting in rectum
47
Q

How does the area affected by ulcerative colitis look?

A
  • Mucosa looks red, inflamed and bleeds easily
  • Formation of crypt abscesses & mucosal ulceration
48
Q

What can be seen microscopically for Ulcerative Colitis?

A
  • Inflammatory cells infiltrate the lamina propria and crypts
  • Th2-associated
  • Dysplasia can be seen from biopsies -> can progress to carcinomas
49
Q

What is the definition of diarrhoea? (pathophysiology)

A

The change in the balance between the absorption and secretion of water and electrolytes.

50
Q

What are the 2 main reasons diarrhoea can be due to?

A
  1. Osmotic forces that drive water into the gut lumen e.g. after ingestion of non absorbable sugars
    • Proportional to the intake and responsive to fasting
                            OR
  2. Enterocytes (cells lining the GI tract) actively secreting fluid e.g enterotoxin-induced diarrhoea
    - Not responsive to fasting
    - Ion transporters activated by e.g. bacteria resulting in pathogens:
    ~ Invading enterocytes or
    ~ Producing enterotoxins which damage cells or inducing cytokine secretion to produce prostaglandins which stimulate secretion
    (CAUSED BY PATHOGENS)
51
Q

What happens during the invasive mechanism of bacteria causing diarrhoea?

A
  • Directly attach the musical cells which causes diarrhoea
  • Stools may contain blood and pus
  • Fever
  • E.g. Shigella, Salmonella, Yersinia, Enteroinvasive E coli
52
Q

What happens during the non-invasive mechanism of bacteria causing diarrhoea?

A
  • Does not directly damage the gut
  • Bacteria produce enterotoxins that disrupt normal of water and electrolytes secretion
  • Watery diarrhoea
    E.g. S aureus, B cereus, C perfingens, Enterotoxigenic E coli
53
Q

What happens during the virally-induced mechanism of bacteria causing diarrhoea?

A
  • enterocytes become secretory resulting in watery diarrhoea
  • (mechanism not fully understood)
54
Q

In terms of diagnosis, what symptoms would we look out for in diarrhoea?

A
  • Accompanying symptoms (temp, fever, blood in stools etc)
  • Rapid onset
  • Absence of stool formation?
55
Q

In terms of diagnosis, what trigger factors would we look out for in diarrhoea?

A
  • Bad/usual food
  • Alcohol
  • Drugs
  • Consumed contaminated water
56
Q

What are the common causes of diarrhoea in infants?

A
  • Infectious gastroenteritis
  • Toddlers diarrhoea
  • Food intolerance
  • Coeliac disease
57
Q

What are the common causes of diarrhoea in school age children?

A
  • Infectious gastroenteritis
  • Drugs (antibiotics)
58
Q

What are the common causes of diarrhoea in adults?

A
  • Infectious gastroenteritis
  • IBS
  • IBD
  • Drugs
  • XS alcohol and spicy food
  • Coeliac disease
59
Q

What are the common causes of diarrhoea in older people/elderly?

A
  • Infectious gastroenteritis
  • Large bowel cancer
  • Faecal impaction
  • Drugs
  • Ischaemic colitis
60
Q

What is the most common organism that causes diarrhoea in children under 5?

A

Rotavirus most common: onset 12-48hr

61
Q

What is the most common organism that causes diarrhoea in adults?

A

Campylobacter most common: onset 2-5 days, followed by rotavirus

62
Q

What are some examines of drugs that can induce diarrhoea?

A
  • Antibiotics (most common)
  • Laxatives
  • Metformin
  • Ferrous sulphate (iron)
  • NSAIDs
  • Colestyramine
  • Antacids - Mg Salts
  • Beta blockers
  • Digoxin
  • Misoprostol
63
Q

How to prevent diarrhoea?

A

Good hygiene: Wash hands
- After visiting the toilet
- Before touching food
- After gardening
- After playing with pets
- Between handling raw and cooked food

64
Q

What is diarrhoea?

A

Diarrhoea is a change in normal bowel habit resulting in increased frequency and soft or watery stools

65
Q

What considerations are considered in the treatment of diarrhoea?

A
  • Age, frequency, duration
  • Assess dehydration risk
66
Q

What class of drugs are used in the management of diarrhoea?

A

Anti-motility drugs

67
Q

What are the treatment aims for acute diarrhoea in adults?

A
  • Prevention and reversal of fluid and electrolyte depletion
  • Management of dehydration (if present)
68
Q

What does IBS stand for?

A

Irritable bowel syndrome

69
Q

What symptoms are present in IBS?

A
  • Abdominal cramping
  • Diarrhoea/constipation/alternating
  • Flatulence
  • Bloating
  • Urgency to defecate
  • Acid indigestion
  • Nausea
  • Lethargy
  • Eating may worsen symptoms
  • Passing mucus in stools
70
Q

What factors are considered in diagnosing IBS?

A
  • Abdominal pain present for at least 6 months
  • Relieved by defecation OR:
  • Increased/decreased bowel frequency or stool form

Plus at least 2 of the following:
- Abdominal bloating/distension
- Altered stool passage (straining, urgency, incomplete evacuation)
- Worsened by eating
- Passing mucus

Inflammatory and GI diseases (22 decks)

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