Coeliac disease, Hernias Flashcards
What is coeliac disease?
Immune mediated intolerance to gluten (gliadin) causes cytotoxic T-cell inflammation s.bowel→ villous atrophy + enteropathy → ↓Absorption, ↑Excretion of H2O, Ulcers, Strictures
What are the classic signs of coeliac disease?
Diarrhoea + fatty stools
Weight loss/failure to thrive
Abdominal discomfort
What are the late signs of coeliac disease?
Muscle wasting (buttocks) Arthralgia Delayed puberty Mouth ulcers Dermatitis herpetiformis Peripheral oedema + ascites
What investigations are carried out for coeliac disease?
-Coeliac immunology screen: Reintroduce gluten into diet 6weeks before test- tTG (IgA)- 1st LINE
Endomysial Ab
-Bloods: FBC (↓Hb), ↓Folate, macrocytic anaemia, unexplained Fe deficiency (Fe absorbed in the duodenum)
-Endoscopic s.bowel biopsy= CONFIRMATION
What is usually seen on a coeliac biopsy?
Mainly jejunum + duodenum
Diffuse villous atrophy
↑IE lymphocytes in LP
Crypt hyperplasia
How is coeliac disease managed?
Dietary: AVOID wheat, rye, oats & barley
What are the complications of coeliac disease?
Coeliac crisis
T-Cell lymphoma
What is a coeliac crisis?
Life-threatening dehydration due to diarrhoea + malabsorption
What are the 2 types of inguinal hernia?
DIRECT: Post abdo wall via defect in Hesselbach’s triangle
INDIRECT: Internal ring → external inguinal ring due to patent processes vaginalis
Where to inguinal hernias pass with regards to the inferior epigastric vessels?
D =MEDIAL to inferior epigastric vessels
I = LATERAL to inferior epigastric vessels
What are risk factors for an inguinal hernia?
Male Chronic cough Obesity Constipation Urinary obstruction Heavy lifting Prev abdo surgery
How does an inguinal hernia present?
Intermittent swelling in groin/scrotum- emphasised by coughing
Sudden pain
Thickened spermatic cord (M)
Thickened round lig (F)
How is an inguinal hernia investigated?
Abdo Ex
External genital Ex
Transillumination
USS
How is an inguinal hernia managed?
Conservative: ↓weight, stop smoking, analgesia
Sustained compression
Surgery: Mesh repair- reinforces posterior wall
What are the complications of an inguinal hernia?
Irreducible/incarcerated: Reduce for 24-48hrs then surgery
Strangulation
Small bowel obstruction
Hydrocele
How is a hydrocele treated?
Self-limiting
Surgery if present 18-24m
How does a femoral hernia occur?
Bowel segment enters femoral canal
Downward pointing mass in upper medial thigh/ above inguinal ligament
Often irreducible → strangulation
What is the main risk factor for a femoral hernia?
Female
What are the boundaries of the femoral canal?
ANT: Inguinal lig
MED: Lacunar lig
LAT: Femoral vein
POST: Pectineus
How does a femoral hernia present?
Herniated mass pointing down leg
Appears on coughing/straining
Disappears when supine/relaxed
How is a femoral hernia managed?
EVERYONE = repair (due to risk of strangulation)
Dissect sac & close
What are the features of an umbilical hernia?
Congenital
Infantile = spont resolves
Adult = Ascites/preg/obesity
How is an umbilical hernia managed?
Child + <1cm: Watch &wait (most close by 5)
>1.5cm or >4yo: Mayo repair
Close defect w/stitches
How is an incisional hernia repaired?
Mesh
