gastro Flashcards
coeliac symptoms?
Malabsorption = steatorrhea (fatty stool) Iron, B12, folate deficiency anaemia Weight loss Failure to thrive in young children Mouth ulcers TATT Abdominal bloating Diarrhoea Dermatitis herpetiformis = itchy/blistering, bumpy papular skin rash - IgA antibodies bind to transglutaminase (diagnostic)
Rarely -
peripheral neuropathy
cerebellar ataxia
epilepsy
investigate coeliac?
Gluten = more than 1 meal per day for 6 wks (to ensure it is being tested)
- Serology:
1st line screen = total IgA + tTG + anti-gliadin (rarely done)
2nd line = anti endomysial (90% of coeliac patients) antibodies (EMA)
- Gold = Gastroscopy – Duodenal biopsies: would show Crypt hypertrophy and
Villous atrophy
also test all new cases of type 1 diabetes as conditions are linked
genetic associations and auto antibodies involved in coealic’s? why do you test IgA?
Genetic Associations:
HLA-DQ2 gene (90%)
HLA-DQ8 gene
Auto-antibodies:
Tissue transglutaminase antibodies (anti-TTG)
Endomysial antibodies (EMAs)
Deaminated gliadin peptides antibodies (anti-DGPs)
must test for total IgA bc if total IgA is low due to IgA deficiency then the coeliac test will be negative even when they have coeliacs
which other conditions is coeliac associated with?
Type 1 Diabetes Thyroid disease Autoimmune hepatitis Primary biliary cirrhosis Primary sclerosing cholangitis
complications if coeliac left untreated?
Vitamin deficiency Anaemia Osteoporosis Ulcerative jejunitis Enteropathy-associated T-cell lymphoma (EATL) of the intestine Non-Hodgkin lymphoma (NHL) Small bowel adenocarcinoma (rare)
treatment for coeliac?
Lifelong gluten-free diet
wtf is coeliac disease?
autoimmune condition where exposure to gluten causes autoimmune reaction causing inflammation in the small bowel (esp jejunum)
usually develops in early childhood but can start at any age
auto-antibodies are created in response to exposure to gluten that target the epithelial cells of the intestine = inflam
how do diverticula form?
large intestine contains layer of circular muscle, where this layer is penetrated by blood vessels there is weakness
increased pressure inside lumen over time can cause a gap to form in these areas, allowing mucosa to herniate through layer and pouches form (diverticula)
Diverticula terminology?
diverticulum = pouch or pocket in the bowel wall
Diverticulosis = presence of diverticula, without inflammation or infection (asymptomatic)
Diverticular disease = patients experience symptoms
Diverticulitis = inflammation and infection of diverticula
why do diverticula not form in rectum?
it has an outer longitudinal muscle layer that completely surrounds the diameter of the rectum, adding extra support
(the rest of the colon has 3 longitudinal muscles forming strips or ribbons called teniae coli - they don’t surround entire diameter = areas that are not covered are vulnerable to diverticula)
wtf is diverticulosis? + RF
‘wear and tear of bowel’
most commonly affects sigmoid colon (but can affect it all)
RF: old age COPD low fibre diet obesity connective tissue disease use of NSAIDs (also risk of haemorrhage)
investigate and treat diverticulosis?
colonoscopy or CT scans
no treatment necessary if asymptomatic but advice for high fibre and weight loss
if causing lower left abdominal pain, constipation or rectal bleeding: increase fibre, bulk-forming laxatives (e.g. ispaghula husk)
AVOID stimulant laxatives eg. Senna
significant symp: surgery to remove affected area
symptoms of diverticular disease/itis? complications?
left lower quadrant tenderness (left iliac fossa)
constipation
rectal bleeding
fever
diarrhoea
nausea/vomiting
Palpable abdominal mass (if an abscess has formed)
Raised inflammatory markers (e.g., CRP) and white blood cells
comp:
perforation, peritonitis, fistula, ileus obstruction, haemorrhage, diverticular abscess
treatment of diverticular disease?
Diverticular disease 1st line = Bulk forming laxatives (ispaghula husk) Gold standard = surgery Contraindications = Stimulants (sena) Significant bleeding = admit ASAP
treatment of diverticulitis?
Mild 5 days of Co-amoxiclav, if allergic give cephalexin with metronidazole Analgesics - not opiates or NSAIDs 2-3 days of liquid food follow up within 2 days to review
Severe - blockage Nil by mouth or clear fluids only IV fluids + antibiotics analgesia CT + Surgery
types of obstruction?
- blockage
- pressure
- contraction
physical obstruction prevents flow of faeces through the intestines = back-pressure through the gastrointestinal system = causing vomiting and absolute constipation (patient is unable to pass stools or wind)
causes of a blockage-related obstruction?
Tumour
Diaphragm disease – caused by NSAIDs
Gallstones in ileum (rare)
Inflammation
Crohn’s = fibrosis - coarctation - obstruction
Diverticular disease = Outpouching - Faeces trapped - inflammation - obstruction
causes of a pressure-related obstruction?
Adhesions
Volvulus = free floating areas with mesentery - sigmoid
Intussusception (telescoping)
causes of a contraction-related obstruction?
Inflammation
Intramural tumours
Hirschsprung’s disease (missing nerve cells in muscles of baby’s colon leading to lack of contraction, congenital)
obstruction causes in adults vs children?
adults-
adhesions (scar tissue binding abdominal contents tog, may be caused by surgery, peritonitis, infection, endometriosis), hernias, crohn’s, malignancy
children-
volvulus (twists on itself), intussusception (telescoping, child’s bowel more flexible), Hirschsprung’s disease, appendicitis
symptoms of small bowel obstruction?
Vomiting Constipation / obstipation (inability to pass hard stool) Abdo pain Tenesmus (need to poo but bowels are empty) Tympanic percussion (air-filled) Distension/ bloating and swelling Weight loss Bowel sounds
Immediate surgical signs = perforation (peritonitis) + strangulation
increased HR, hypotension and raised temperature Tenderness and swelling
investigate bowel obstruction?
DRE - large bowel
Xray = shows gas collection
FBC + U+E + Lactate (electrolyte imbalances, raised lactate in bowel ischaemia)
CT, Ultrasound, MRI
treat bowel obstruction?
Nil by mouth
IV fluids to hydrate patient and correct electrolyte imbalances
NG tube with free drainage to allow stomach contents to freely drain and reduce the risk of vomiting and aspiration
Fluid resuscitation Bowel decompression Analgesia and anti-emetics Antibiotics Surgery e.g. laparotomy bypass segments. Catheterise bladder Stents may be inserted into the bowel (during a colonoscopy) in patients with obstruction due to a tumour
causes and symptoms of malabsorption?
causes:
Intake
Digestion = pancreatic or bile secretion problem
Absorption= coeliac or crohn’s = villous atrophy
symp:
Diarrhoea
Steatorrhea
Weight loss
investigations and complications of malabsorption?
investigate:
FBC = MCV + increased INR + decreased calcium/iron/B12/folate
Coeliac test
Stool sample microscopy
comp: Anaemia = low iron + folate + B12 Bleeding disorders = low vitamin K Oedema = low protein Metabolic bone disease = low vitamin D
