Diverticular + IBD Flashcards
RF for diverticular
Low fibre diet
Increasing age
Smoking
NSAIDs
Mechanism of diverticular
Muscle hypertrophy + increased intraluminal pressure
Mucosa patches are pushed out through colonic wall
95% in sigmoid colon
Symptoms of diverticular
Altered bowel habit, colicky L sided abdo pain, nausea, flatulence
Symptoms improve with defecation + worsen with eating
Acute: can cause guarding in LIF. Fever, malaise, nausea
Abscess: swinging fever + pelvic pain
Signs of perforated diverticular
Ileus, peritonitis, shock
Investigations + what they show for diverticular
CXR - shows pneumoperitoneum
AXR - shows ileus, dilatation, obstruction
CT scanning for abscess
Management of diverticular
High fibre diet +- antispasmodics (mebeverine)
Acute: oral abx (co-amoxiclav + metronidazole)
Bulk forming laxatives
Complications of diverticular
Fistula
Haemorrhage - sudden + painless
Post infective stricture can cause colon obstruction
Ischaemic colitis
Peak age + RF of Crohns
Strong FHx, peak at 15-30 + 50-70
Common in caucasians
Smoking
NSAIDs exacerbate
Peak age + RF of UC
Peak at 15-25 + 55-65 Fam hx NSAIDs COCP Risk decreased in smokers
Mechanism of Crohns
Transmural granulomatous inflammation affecting all GI tract
Skip lesions
Mechanism of UC
Autoimmune triggered by colonic bacteria
Causes inflammation + ulcers from rectum upwards
S+S Crohns
Diarrhoea (bloody) Abdo pain Weight loss Periods of exacerbation + remission Mouth, skin, eyes + joint problems Anaemia, fever + hypotension in exacerbations
Pathological findings of Crohns
Gallstones
Cobble stone appearance
S+S UC
Bloody diarrhoea, colicky abdo pain, urgency, tenesmus
Joint, skin + eye problems
Signs of IBD
A PIE SAC Aphthous ulcers Pyoderma gangrenosum Iritis Erythema nodosum Sclerosing cholangitis Arthritis Clubbing
Investigations for IBD
Faecal calprotectin - positive
Endoscopy
Raised CRP, low Hb, low albumin, raised WCC + ESR
Crohns treatment
Monotherapy: prednisolone or budesonide 2nd: 5-ASA (mesalazine) Add in thiopurine Methotrexate next Infliximab if severe
UC treatment
Aminosalicylates to induce remission Prednisolone to induce remission Thiopurines 2nd line Ciclosporin for severe, rapid onset Infliximab to induce remission
Mechanism of coeliac disease
IgA immune mediated, inflammatory systemic disorder
Provoked by gluten
HLA-DQ2
Gliadin induces epithelial cells to express IL-15 which activates CD8+ intraepithelial lymphocytes
RF for coeliac disease
T1DM Autoimmune thyroid FH Downs Turner's
S+S coeliac
Persistent unexplained GI/ abdo S+S Faltering growth Weight loss Apthous mouth ulcers Angular stomatitis Iron, B12 or folate deficiency Steatorrhoea Abdo pain/ cramping Raised LFTs Anaemia Dermatitis herpetiformis
Investigations for coeliac
Autoantibodies - IgA tissue transglutaminase
Anaemia
Raised LFTs
Biopsy shows subtotal villous atrophy + crypt hyperplasia
Complications of coeliac disease
Nutrient deficiencies Osteoporosis GI cancer risk Ulcerative jejunitis Neuropathies
Histology for Crohns
Rose thorn ulcers
Increased goblet cells
Cobblestone appearance
