Gastro Flashcards
What is coeliac disease?
autoimmune reaction where exposure to gluten causes immune reaction = inflammation of epithelial cells in intestines
Pathology of coeliac?
immune system activated - cytokines released & epithelial cells damaged
anti gliadin + anti TTG + anti (EMA) endomysium antibodies
Histopathological presentation for coeliac?
villous atrophy
raised intra-epithelial lymphocytes,
crypt hyperplasia
Coeliac symptoms?
bi-phasal: babies (intro to bread) & older
malabsorption
iron deficiency anaemia
stomach bloating
diarrhoea - pale and greasy
dermatitis herpetiformis on arms and legs (deposit of IgA in skin)
Investigations for coeliac disease?
patient needs to have ≥ 1 gluten meals per day for 6 weeks
serology
1st - total IgA + tTG + anti-gliadin
2nd - anti-endomysial antibodies (EMA)
gold = gastroscopy - duodenal biopsies
Genetic & antibodies association of coeliac?
anti-TTG (1st line), anti-EMA (2nd line)
HLADQ8 & HLADQ2
Associated diseases with coeliac?
thyrotoxicosis + hypothyroidism
addison’s
osteoporosis
treatment for coeliac?
exclusive diet for life
What’s a diverticulum?
outpouches of colonic mucosa through a muscular wall
Differentiate diverticular disease with diverticulitis?
diverticular disease = symptomatic conditions of outpouches
diverticulitis = inflammation of the outpouches
Differentiate diverticulosis with diverticulum?
diverticulum = outpouches
diverticulosis = asymptomatic conditions of the outpouches
Diverticulitis risk factors?
low fibre diet !!
COPD
NSAIDs
old age
connective tissue disease
Diverticulitis - symptoms?
Left lower quadrant tenderness
low grade fever
rectal bleeding / blood in diarrhoea
constipation
Investigations for diverticulitis?
CT or colonoscopy
Treatment for diverticular diseases?
Diverticulosis (asymptomatic)
high fibre diet - whole grains + fluid
Diverticular disease
* 1st line = bulk forming laxatives
* gold standard = surgery
* CI = stimulants (sena)
Treatment for diverticulitis
(inflammation of the outpouches)?
Mild
- 5 days co-amoxiclav, if allergic give cephalexin with metronidazole
- analgesic = not opiates or NSAIDs
Severe - blockage
- nil by mouth or clear fluids
- IV fluids + antibiotics
- CT + surgery
Common causes of obstruction related to blockage?
tumour, gallstones
diaphragm disease - NSAID
inflammation - Crohn’s
fibrosis - contract then obstruct
Diverticulitis
(faeces trapped in inflamed wall)
What is bowel obstruction?
complete or partial disruption of the normal flow of gastrointestinal content
Common causes of obstruction from contraction?
inflammation
intramural tumours
hirschsprung’s disease
nerve to contract gone
no poo, swollen belly, green vomit (bile)
Common causes of obstruction related to pressure?
adhesions
common!!!
volvulus = bowel twist on itself
intussusception = intestine slide into another, redcurrent jelly stool, 6m-2y M
Symptoms of bowel obstruction?
vomiting, consti / abdo pain
tenesmus
= wanna poo but dont have any
tympanic percussion = air
distension, bloating and swelling
Investigations for bowel obstruction?
DRE = large bowel
X ray: erect chest radiograph, abdominal radiograph → gas
CT abdomen / pelvis
FBC, U&E, lactate
How would you manage bowel obstruction and what are some red flags?
Drip and suck = IV fluids & placement of NG tube
Surgical if obstructing lesion, evidence of ischaemia or perforation, or a closed-loop
🚩 = + HR, hypotension, fever, tenderness and swelling
What is irritable bowel disease?
chronic functional GI symptoms (in absence of organic disease) but no obvious cause