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MBBS - Year 3 > Gastro - Lower GI Tract > Flashcards

Gastro - Lower GI Tract Flashcards

1
Q

what are the 2 subtypes of IBD

A

ulcerative colitis
Chronns disease

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2
Q

what is Ulcerative colitis

A

Diffuse mucosal inflammation limited to the colon

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3
Q

what is proctits

A

UC which is confined to the rectum

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4
Q

what is crohns disease

A

transmural disease - goes through the mucosal wall
occures from mouth to anus

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5
Q

what is incidence of crohns compared with UC

A

more crohns
can occur at any age
peak between 10-40

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6
Q

what causes IBD

A

smoking - for crohns
drugs - NSAIDS and abx
gut flora
diet
hygiene
appendix
geography
stress
infections
etc - more found every year

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7
Q

what are the resenting symptoms of UC

A

Frequent bloody diarrhoea
Mucus pr
Tenesmus - feel need to poo
Abdominal pain
Fever

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8
Q

crohns presenting symptoms

A

Fatigue
Weight loss
Fever
Diarrhoea +/- bleeding
Pain
Vomiting
Bloating
Fistula
Abscess

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9
Q

important things to know in history

A

Previous episodes
Family history - 10% if 1 parent 40% if both parents
Smoking
Appendicectomy
Travel
Contacts
Antibiotics/NSAIDs
Extra-intestinal manifestations

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10
Q

what are the key signs of IBD

A

Pyrexial
Tachycardic
Dehydrated
Pale
Tender abdomen
PR/rigid sigmoidoscopy

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11
Q

what initial investigations should be done (A and E)

A

Blood tests
Anaemia - B12 deficiency, blood loss, malnutrition of folate
Thrombocytosis - bleeding and inflammation
Raised ESR and CRP
Hypoalbuminaemia

Microbiology
Stool cultures and Clotridium difficile assay
giardia, campylobacter and E coli

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12
Q

what is this

A

pseudopolyps

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13
Q

what is this

A

pseudomembranous colitis
C.diff

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14
Q

whats wrong

A

featureless drainpipe colon (thin black line)

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15
Q

whats wrong

A

inflammed enlarged colon - gas patters seppareated by oedema in the bowel
thumbprinting

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16
Q

whats wrong

A

obstruction
large bowela dn small bowel have fluid levels
likely cancer but maybe crohns

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17
Q

whats wrong

A

small bowel obstruction

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18
Q

whats wrong

A

fistula
gas in the urinary bladder - pneumaturia
stool goes into bladder

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19
Q

what is some differential diagnosies of infection of the bowel

A

Gastroenteritis/dysentery
Clostridiodes difficile
Amoebiasis
Tuberculosis
CMV- can reactivate
Yersiniosis
Histoplasmosis - in the US

20
Q

what are some non-infective differential diagnosis of the bowel

A

Appendicitis
Diverticulitis
Diverticular colitis
Carcinoma
Ischaemic colitis
Lymphoma
Endometriosis
Carcinoid

21
Q

what is the managment of acute severe UC

A

admit
Toxic megacolon = surgical emergency
Early gastroenterology/colorectal surgery opinion

Do not delay steroids until stool cultures available; if necessary cover with antibiotics
Prednisolone 40mg od if less severe
Hydrocortisone 100mg tds-qds/ methylprednisolone 60-80mg/d

Stool chart
Daily AXR if initial dilatation or subsequent deterioration
Intravenous fluids
Blood prn
bloods
magnesium and cholesterol IFN gamma assay

22
Q

what is the managment of acute severe CD

A

Obstructive – inflammatory or fibrotic stricture?
If inflammatory, use steroids
Elemental/polymeric diet

Crohn’s colitis – treat as for UC
Perianal CD - metronidazole or ciprofloxacin for fistulae

23
Q

what is the treatment pyramid for IBD

A

aminoglycosides
corticosteroids
immuomodulators
surgery
and biologics throughout
more than 2 steroids a year - move up a step

24
Q

what are corticosteroids used for in IBD

A

Oral/topical
Active UC or CD

Orally acting topical steroids
Budesonide CR (Entocort/Budenofalk)
Budesonide MMX (Cortiment)
Beclometasone (Clipper)

25
Q

What are aminosalicylates used for in IBD

A

pH dependent release/resin coated (Asacol, Salofalk, or Ipocol, Mesren);

time controlled release (Pentasa);

delivery by carrier molecules, with release of 5-ASA after splitting by bacterial enzymes in the large intestine (sulphasalazine (Salazopyrin), olsalazine (Dipentum), balsalazide (Colazide))

MMX – Mezavant – multimatrix system – delayed release

Topical therapy

26
Q

what are thiopurines used in IBD

A

Azathioprine/mercaptopurine
Unlicensed!
Induce T-cell apoptosis

Effective for active disease and maintaining remission
Slow onset of action
Steroid sparing agents
Blood tests

27
Q

what post op prophylaxis is needed for CD

A

Smoking
Mesalazine
Thiopurines
Metronidazole 3/12
(Biologics)

28
Q

why do we check TPMT

A

you can poison 1 in 3 people

29
Q

what are the 2 main motilty symptoms

A

diarrhoea
constipation

30
Q

how do you describe poo

A

bristol stool chart

31
Q

what is dysentery

A

diarrhoea with visible blood or mucus; commonly associated with fever and abdominal pain

32
Q

define acute, persistnet and chronic diarrhoea

A

Acute — 14 days or fewer in duration

Persistent — more than 14 but fewer than 30 days in duration

Chronic — more than 30 days in duration

33
Q

what causes diarhoea

A

reduced absorbsion of water out of the gut
increased secretion of water into the gut

34
Q

what causes diarfhoea

A

usually
infection or drug

35
Q

what is osmotic diarhoea

A

water is drawn into or retained in the bowel due to the presence of solutes within the lumen, typically due to:
ingestion of a poorly absorbed solute
malabsorption
if you stop eating - diarrhoea stops

36
Q

what causes osmotic diarhoea

A

carbohydrate malabsorption - lactose intolerance

magnesium-induced - heartburn and GORD

osmotic laxatives - lactulose

small intestinal mucosal disease - coeliac, crohns

reduced absorptive area - surgery, radiation or coeliac

bile acid malabsorption - facilitate fat absorbsion

pancreatic exocrine insufficiency - chronic pancreatitis

37
Q

what causes secretory diarrhoea

A

bacterial endotoxins - C diff, cholera, E coli

stimulant laxatives - senecot

hormones - hyperthyroidism

bile acid malabsorption

mucosal inflammation - UC

rectal villous adenoma

38
Q

how do you treat diarhoea

A

Treat underlying disorder
Opiates
decreased urgency, bowel frequency, stool volume
codeine phosphate, loperamide
Beware IBD, shigellosis

Anti-secretory drugs
Octreotide – somatostatin analogue

39
Q

what causes constipation

A

endocrine
metabolic
neurological
neuromuscular
psychological
physiological
mechanical

40
Q

what are the general treatments for constipation

A

identify anatomical abnormalities
identify biochemical causes
stop constipating drugs
exercise
increase fluid intake
increase dietary fibre (SE - bloating, flatulence)

41
Q

what are bulk forming laxitives for and give 2 examples

A

mild constipation
cannot increase dietary fibre
improves bowel frequency rather than consistency/straining
e.g.ispaghula, sterculia

42
Q

what are stimulant laxitives for and give 2 examples

A

chronic constipation
increases motility, frequency, improves consistency
minimise usage to decrease atonic colon
e.g. bisacodyl, senna, sodium picosulphate

43
Q

what are stool softeners for and give example

A

Limited efficacy
Widely used
e.g. sodium docusate, liquid paraffin, arachis oil enema

44
Q

what are the 2 osmotic laxitives

A

lactulose and magnesium

45
Q

how does lactulose used

A

syrup derived from lactose
decreases colonic pH by generation of fatty acids and fermentation products
SE - bloating, flatulence

46
Q
A

MBBS - Year 3 (13 decks)

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