Disorders of the Upper GI Tract Flashcards by Meley Gdey

Lower GI tract disorders can be divided into:

inflammatory
infective
structural
functional
neoplastic
other

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Give examples of lower GI tract inflammatory disorders.

inflammatory bowel disease

microscopic colitis

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Give examples of lower GI tract infective disorders.

C difficile

E coli

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Give examples of lower GI tract structural disorders.

diverticular disease
haemmorrhoids
fissures

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Give examples of lower GI tract functional disorders.

irritable bowel syndrome

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Give examples of lower GI tract neoplastic disorders.

colonic polyps

colon cancer

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examples of inflammatory bowel disease

ulcerative colitis

Crohn’s disease

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ulcerative colitis

limited to colonic mucosa, superficial, continuous, always involves the rectum, no granulomas M=F

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Crohn’s disease

Patchy chronic transmural granulomatous inflammation, tendency to form fistula or strictures
F>M

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types of ulcerative colitis

proctitis
proctosigmoiditis
distal colitis
extensive colitis 
pancolitis

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types of crohn’s disease

ileocolitis
ileitis
gastroduodenal crohn's
jejunoileitis
crohn's (granulomatous) colitis
perianal crohn's

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symptoms of colitis

bleeding
mucus
urgency
diarrhoea

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perianal symptoms

anal pain
leakage
difficulty passing stool

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symptoms of small bowel disease

abdominal pain
weight loss
tiredness/lethargy
diarrhoea
abdominal mass

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Extraintestinal manifestations of inflammatory bowel disease

arthritis: peripheral, axial (ankylosing spondylitis)
skin: erythema nodosum, pyoderma gangrenosum
eyes: Anterior uveitis
Episcleritis/Iritis
liver: autoimmune hepatitis

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what genes contribute to IBD?

NOD2
HLA
ATG
II23R

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aetiology of IBD

combination of an impaired mucosal immune response to the gut microbiota in a genetically susceptible host

what is dysbiosis?

an imbalance between the types of organism present in a person’s natural microflora, especially that of the gut, thought to contribute to a range of conditions of ill health

general management of inflammatory bowel disease

induce/ maintain clinical remission + improve QoL, heal mucosa, decrease hospitalisation/surgery, minimise complications

treatment therapies for inflammatory bowel disease

steroids
5 ASA
immune suppressants
biologic therapy 
other (diet, FMT, AB, probiotics)

how do steroids work as a treatment for IBD?

Diffuse and bind in nucleus to Glucocorticoid Responsive Elements (GRE) > interact with specific DNA sequences > Increase anti-inflammatory gene products, block pro-inflammatory genes

mode of delivery of steroids for IBD?

IV
orally
rectal enemas

describe the use of steroids for IBD

Short term
As a bridge to other therapy/interventions
In acutely unwell patients

side effects of steroid use for IBD treatment

growth retardation, cataracts, glaucoma, immunosuppression, diabetes, osteoporosis, myopathy, sleep/mood disturbance, psychosis, acne, hirsutism, oedema, hypertension, neuropathy

how do 5 ASA work as a treatment for IBD?

Inhibition of pro-inflammatory cytokines (IL-1 and TNF-a ), inhibition of the lipo-oxygenase pathway i.e. prostaglandin and leukotrienes, scavenging of free radicals, inhibition of NF-kB/ TLR via PPAR-gamma induction (perioxisome proliferator activated receptor-gamma)

mode of delivery of 5 ASA for IBD?

orally | rectal

side effects of 5 ASA

intolerance, diarrhoea, renal impairment, headache, malaise, pancreatitis, pneumonitis

how does azathioprine act as an immune suppressant?

6-TG interferes with adenine and guanine ribonucleotide production > reduced number of B and T lymphocytes, IG and IL > Another pathway potentially results in apoptosis of T cells

side effects of azathioprine

allergic reaction, GI disturbances, hepatotoxicity, infection, pancreatitis, bone marrow suppression, malignancy

when administering azathioprine, check for?

Thiopurine, Methyltransferase (TPMT), Hep B/C, HIV, Chicken pox, Vaccinations, TB, Frequent bloods on starting, Maintenance bloods

mechanism of methotrexate

Interferes with DNA synthesis & cell reproduction Increased adenosine levels (anti-inflammatory) Increased apoptosis of peripheral T cells

how long for methotrexate to work? how often should it be taken?

3 months | weekly

when administering methotrexate, check for?

Hx re liver abnormalities, monitor LFTs, FBC, advise NO pregnancy, folic acid supplements

side effects of methotrexate

Rash, Nausea, mucositis, Diarrohea, Bone marrow suppression, Hypersensitivity pneumonitis, ^ liver enzymes, Hepatic fibrosis/cirrhosis, Known abortifacient

list examples of biologics used for IBD treatment

infliximab adalimumab golimumab

mechanism for biologics used in IBD treatment

anti TNF alpha

side effects of biologics

opportunistic infections, site reaction, neutropenia, infection, demyelinating disease, HF, cutaneous reactions, malignancy, autoimmunity

combination therapy for IBD

AZA/ 6MP and aTNF

dietary therapy for IBD

``` Liquid therapy diet Increased use in children As effective as steroids Use in small bowel Crohns disease Weeks ```

what is Rigler's sign?

when air is present on both sides of the intestine; a Rigler's sign is present when air is present on the inside and the outside