Gastro - IBD Flashcards
What are the general presenting features for Crohn’s disease?
Often fever, lethargy, weight loss without abdo symptoms.
Growth failure. Delayed puberty.
Abdo Pain
Diarrhoea (with blood/mucus, urgency, tenesmus)
Weight Loss
Fever
What are the extracolonic features of IBD?
Oral lesions Perianal skin tags Uveitis, episcleritis Arthralgia Ankylosing spondylitis Clubbing Erythema nodosum Pyoderma gangrenosum Renal stones
What are clinical investigations suggestive of Crohn’s
Raised ESR, CRP
IDA
Low serum albumin
What is the pathology of Crohn’s disease?
Transmural
Focal
Subacute or chronic
Acutely inflamed, thickened bowel. Strictures of bowel and fistulae may develop eventually (between bowel, other organs, skin).
May affect any part of GI, but terminal ileum and proximal colon are commonest
“Skip lesions”
How is Crohn’s diagnosed
Endoscopy and histology of biopsy
How are episodes of Crohn’s managed?
Nutritional Therapy
Whole protein modular feeds for 6-8 weeks.
Effective in 75%
If ineffective: systemic steroids
Relapse is common, thus immunosuppressants may be required (azathioprine, mercaptopurine, methotrexate)
Anti-TNF agents (infliximab, adalimumab) if conventional treatment failed
Surgery is necessary for the complications (obstruction, fistulae, abscess)
What is the pathology of UC
Recurrent
Inflammatory and ulcerating disease of the mucosa of colon
In contrast to adults, 90% of children have pancolitis
Otherwise, rectum is commonest site of involvement
What is the presentation of UC
Rectal bleeding
Diarrhoea
Colicky pain
There may be weight loss and growth failure, but less commonly than Crohn’s
Extracolonic manifestations of UC
Erythema nodosum
Arthritis
Management of UC
Mild: aminosalicylates (balsalazide and mesalazine) for induction and maintenance
Topical steroids if confined to sigmoid/rectum
Systemic steroids for acute exacerbations to induce remission (PO prednisolone or IV methylprednisolone) plus immunomodulators for maintenance (azathioprine, ciclosporin, tacrolimus, methotrexate)
How is severe fulminating disease (UC) managed
Medical emergency
IV fluids + steroids
Ciclosporin if previous fails
Colectomy with ileostomy or ileorectal pouch is undertaken if complicated by toxic megacolon or chronic uncontrolled
GI signs in IBD
Aphthous ulcers Abdominal tenderness Abdominal distension (UC>CD) RIF mass (CD) Peri-anal disease (abscess, sinus, fistula, skin tags, fissure, stricture)
Surgical treatment of UC
Total colectomy and ileostomy, later pouch creation and anal anastomosis. Cures UC, but there is 10-20% complications
Surgical management of Crohns
Local surgical resection for severe localised disease. High re-operation rate because inflammation recurrence is universal
Causes of gastritis
H. pylori infection Stress ulcer - post trauma Drug related - NSAIDs Increased acid secretion (Zollinger Ellison syndrome, multiple endocrine neoplasia type I, hyperparathyroidism) Crohn's disease Autoimmune gastritis
Symptoms of gastritis
Often asymptomatic Chronic abdominal and epigastric pain N+V GI haemorrhage FTT + anorexia IDA
Perforation (very rare)
Indigestion, bloating, hiccups, loss of appetite
Specific symptoms of peptic ulcer (duodenal)
Gnawing/burning feeling in the abdomen, below ribs and above umbilicus
Pain often reduced by eating food, drinking milk or taking antacids
Ulcers can bleed causing haematemesis or melena
What is the role of H. pylori in gastritis
Usually it does not cause a problem in gastrits. But if left untreated, it can cause gastritis, peptic ulcer and stomach cancer in later life
Most infectiosn are silent and asymptomatic. Otherwise they cause gastritis and peptic ulcer disease
Diagnosis and treatment of H pylori
urease 13C breath test
Stool antigen may be positive, but serological testing is unreliable in children
Treat with quadruple therapy discussed
Lifestyle factors in gastritis
Eat smaller and more frequent meals
Avoid irritant foods - acidic, spicy, fried
Drink alcohol in moderation
Avoid NSAIDs
Manage stress
Reduce smoking
Treatment of gastric duodenal ulcers
Treat underlying cause eg. H. pylori (quadruple therapy: 7-10 days oral amoxycillin (clarythromycin), bismuth, metronidazole ± omeprazole)
Decrease gastric acid production - PPI, H2, antagonist, sucralfate (cytoprotective)
Antacids (Aluminum hydroxide)
Presentation of Mesenteric Adenitis
Fever
Malaise
Central abdominal pain
Nonspecific abdominal pain. Diagnosis can only be made definitely on seeing large mesenteric nodes at laparotomy/scopy (WITH NORMAL APPENDIX)
NSAP resolves 24-48hrs
Pain is less severe than appendicitis and RIF tenderness is variable. Often accompanied by URTI with cervical lymphadenopathy
