Diseases of the GIT Flashcards
IBD, diarrhoea
The difference between where in the GI ulcerative colitis and chrons disease are seen
UC only affects the colon. Usually starts in the rectum, can stay local or extend to involve entire colon. Inflammation is continuous.
CD most commonly involves end of small intestine and start of colon. May affect any part of GI tract (“mouth to anus”) in a patchy pattern (“skip lesions”).
The difference between which layers of the bowel wall are inflamed in ulcerative colitis and chrons disease
UC only inflames the inner mucosal layer of the bowel
CD has transmural inflammation of the bowel wall (all layers are inflamed)
- can result in fistula formation (abnormal connection between 2 compartments)
- mucosal ulceration seen leads to fibrosis and fistulas
Which condition has characteristic granulomas - ulcerative colitis or Chrons?
Chrons has non-caseating granulomas
Granulomas absent in UC
What is perianal disease
Fistulas and abscesses around the perineum (rectum)
Common in Chrons (rare in UC)
IBD encompasses
UC and Chron’s
IBD investigations
History and exam Bloods - anaemia due to chronic blood loss/inflammation, or iron/B12 malabsorption - leucocytosis (raised WBC) - raised CRP Stool - rule out C diff, other pathogens Abdominal X-ray - stenosis & dilation of lumen in CD
Further investigation
Biopsy - histology
Colonoscopy, sigmoidoscopy - image ulceration
Abdominal CT scan - localise pathology
Chrons treatment
Immuno-suppressants (Azathioprine)
Anti-TNFa antibodies (Infliximab)
Segmental resection
Ulcerative colitis treatment
Anti-inflammatories (aminosalicylates)
Steroids
Colectomy/hemicolectomy, elective panproctocolectomy (remove all of the colon, rectum and anus) with ileo-anal pouch (ileum joined to anus)
Gastroenteritis =
inflammation somewhere in GIT
Gastroenteritis =
inflammation somewhere in GIT due to infection
Most common bacterial cause of infective diarrhoea
campylobacter (mainly in meat)
Main cause of acute diarrhoea
infection
Most common symptom of acute inflammation in the GIT
diarrhoea
The 4 types of diarrhoea
secretory
hypermotility
defective ion transport
osmotic
Difference between acute and chronic diarrhoea
acute infective diarrhoea (gastroenteritis) - less than 2 weeks
chronic - more than 2 weeks
Difference between acute and chronic diarrhoea
acute diarrhoea - less than 2 weeks
chronic - more than 2 weeks
Coeliac disease =
Inappropriate immune response to gluten.
Patients with active coeliac disease have immunoglobulin (Ig)A and IgG antibodies that are specific for the autoantigen tissue transglutaminase.
Causes of chronic diarrhoea
Inflammatory:
IBS
Malabsorptive:
coeliac disease
acute pancreatitis
Common presentation of IBD
diahorreoa for over 2 weeks (chronic)
abdominal pain - can be worse after eating
blood in stool
Gastro-oesophageal reflux disease (GORD) =
chronic symptoms or mucosal damage produced by the abnormal reflux of gastric acid into the oesophagus
Symptoms of GORD
heartburn regurgitation dysphagia cough hoarseness chronic earache
Causes of GORD
Main 2: Obesity and hiatus hernia (most commonly sliding)
Also:
drugs lowering tone of lower oesophageal sphincter
pregnancy
zollinger ellison syndrome (gastrin secreting tumour)
What is heartburn and what causes it
- characterised by retrosternal discomfort or burning sensation
- Intermittent symptom following eating, exacerbated by exercise and lying
- oesophageal reflux
What is the difference between a sliding hiatus hernia and a rolling hiatus hernia
Rolling - Gastrooesophageal junction (normally in the abdomen) migrates up through oesophageal hiatus and to sit in the thorax
Sliding - Gastric fundus pops through the oesophageal hiatus and sits in the thorax
