Digestion pathologies Flashcards
definition of coeliac disease
autoimmune reaction to gluten causing chronic inflammation
auto-antibodies in Coeliac disease?
- IgA Anti-endomyosial
- IgA Anti-tissue transglutaminase
2 typical histological features in coeliac disease
- Villous atrophy
- Crypt hyperplasia
- inflammatory infiltration (influx of immune cells into lamina propria)
gastrointestinal manifestations of malabsorption (4)
- bloating
- abdo pain
- loose stools
- steatorrhoea
skin condition that is strongly associated with coeliac disease?
Dermatitis herpetiformis
blistering skin condition; intensely pruritic rash
describe the rash of dermititis herpetiformis
extremely itchy papulovesicular rash on extenensor surfaces
subepidermal bullae are seen on histology with linear IgA deposite on dermal papillar
management of Dermatitis herpetiformis
dapsone
genetic associations with coeliac disease
HLA DQ2 gene
HLA DQ8 gene
Chrons NESTS pneumonic for Chrons disease
N - no blood/mucus E - entire GI tract S - Skip lesion on endoscopy T - Terminal ileum & transmural thickness S - Smoking is a risk factor
UC ‘Close up’ pneumonic
C - Continuous inflammation L - Limited to colon & rectum O - Only superficial mucosa affected S - Smoking is protective E - Excrete blood & mucus U - Use aminosalicylates P - Primary sclerosing cholangitis
extracolonic manifestations of UC
- uveitis
- episcleritis
- arthritis
- aphthous ulcers
- erythema nodosum
- PSC (isolated rise in ALP)
what is erythema nodosum
multiple, painful, purple nodules on the anterior aspect of the shins
screening required for patients with IBD?
surveillance colonoscopy due to increased risk of colorectal cancer
mechanism of ciclosprin
calcineurin inhibitor
mechanism of infliximab
monoclonal antiboy targeting TNF alpha
contraindications to infliximab?
latent TB
demyelination
active sepsis
smoking effect on Chrons disease
worsens chrons disease
type of IBD that can affect any part of thr GI tract
Chrons disease
pathophysilogical/histological features of Chrons disease
- Cobblestone appearance
- Rosethorn ulcers
- Obstruction
- Hyperplasia
- Narrowing of lumen
- Skin lesions
non caeseating granulomas
crohns disease
2 skin lesions seen in crohns disease
- erythema nodosum
- pyoderma gangrenosum
describe pyoderma gangrenosum
ulcerating nodules characterised by black (gangrenosum) edges & cdntral pus (pyoderma)
what marker is released following degranulation of neutrophils in IBD
Faecal calprotectin
number of bowel movements a day for mild, moderate & severe flare up?
mild - < 4 stools a day
moderate - 4 to 6 stools a day
severe - more than 6 stools a day
medication to induce remission in mild-moderate UC flare up
oral 5-ASA: sulfasalazine/mesalazine
management of severe UC flare up?
- admission
- IV fluids
- Hydrocortisone IV
- rectal steroids
- monitor stools & observations
2 types of aminosalicylate?
- mesalazine
- sulfasalazine
side effects of sulfasalazine
- headache
- rash
- nausea
- diarrhoea
adverse effects of azothioprine
- decrease blood counts
- nausea
- flu like sy,ptoms
- liver inflammation
- pancreatitis
radiological findings in UC
- loss of haustrations
if long standing: narrow colon, drainpipe colon
inheritance of Lynch syndrome?
autosomal dominant
most common cancers predisposed to with lynch syndrome
- Colorectal cancer
- Endometrial cancer
NICE diagnostic criteria for IBS
Abdominal pain/discomfort OR associated with change in bowel habit & 2 of: - Abnormal stool passage - Bloating - Worse symptoms after eatign - PR mucus
medication for diarrhoea in IBS?
Loperamide
medication for constipation in IBS?
laxative
medication for cramps in IBS?
Antispasmodic e.g. hyoscine butylbromide (Buscopan)
2nd & 3rd line medication for IBS
2nd - Amitriptyline (TCA)
3rd - SSRI
duration of symptoms needed for diagnosis of IBS
3 or more days a month and symptoms over 6 or more months
what does a positive and negative Carnett’s sign suggest?
positive - suggests abdominal wall cause of pain
negative - suggests an intra abdominal cause of pain
