Gastroenrology Flashcards
Non GI symptoms of IBS
Dysmenorrhoea Dysparaunia Increased urinary frequency and urge Back pains Headaches Poor sleeping Fatigue
Triggers for ibs
Anxiety Depression Stress GI infection Antibiotics Abuse Eating disorders
Associated disorders with ibs
TMJ dysfunction
ME
Fibromyalgia
Treatments of IBS constipation
Ispaghula husk
High fibre diet
Treatment of IBS diarrheoa
Loperamide
Codein
Treatment of IBS cramps
Mebevarine
Treatment of IBS mental state
Antidepressants
Psychiatrist
General treatment of IBS. What does it do?
Linaclotide - increases motility aiding consitpation and decreases bowel sensation
Diagnostic criteria for ibs
In last 3 months
At least 3 days a month of abdo pain/discomfort
With at least 2 of improves with deification, associated with change in stool frequency, associated with change in stool form
And no organic cause suspected
Extra gastroentestinal symptoms with inflammatory bowel disease
Arthritis or arthralgia Ankalosing spodylitis Clubbing Uveitis Erythema nodosum Pyoderma gangrenosum Sclerosing cholangitis Liver problems fatty to cirrhosis
Complications of inflammatory bowel disease
Anaemia
Bowel cancer
Decreased fertility and miscarriage
Toxic megacolon
General symptoms of inflammatory bowel disease (both types)
Diarrhoea day and night Abdominal pains Weight loss Anorexia Lethargy Nausea and vomiting
In which ibd is smoking protective?
Ulcerative colitis
Risk factors for ibd
Family history Jewish ethnicity Caucasian Upbringing - hygiene hypothesis Lack of breast feeding
What is a big risk factor in ibd for bowel cancer? What screening should be done?
Primary sclerosing cholangitis
Normal - colonoscopy every 2 yrs after 10 then yearly after 20
With AC - yearly colonoscopy
What immunological tests can be used in ibd?
What do they mean?
Faecal calprotectin - component of neutrophils thus if raised in faeces inflammation of bowel wall.
ANCA - antibodies against neutrophil proteins
Which ibd is more common in females?
Crohns
Which ibd is most common?
Uc
What are the clinical features that suggest crohns disease over uc?
Smelly faeces
Perianal disease
Internal fistulas with faceces appearing where it shouldn’t
Colicky pain
What condition may an acute presentation of crohns disease mimic
Appendicitis
What colonoscopic features would suggest crohns over uc?
Cobblestoning
Fistulas and abscesses
Aphthoid ulceration
What histological changes suggest crohns over uc?
Transmurial inflammation
Granulomas
What radiological features suggest crohns over uc?
Asymmetrical pattern
Stricturing
Skip lesions
String sign of cantor
What test would be needed to elicit string sign of cantor?
Barium swallow
What are treatment options for crohns disease exacerbations?
Mild attack - prendisolone
Severe attack - hydrocortisone, metronidazole, infliximab
Long term treatment options for crohns disease?
Azothioprine Sulfasalazine Infliximab Methotrexate Surgery
How can severity of uc be graded?
What else suggest severity?
severe - >6 per day with blood +++
Fever, tachycardia, anaemia, hypoalbuminia, high esr
In what gender is uc more common?
Males
What specific symptoms may uc patients complain of?
Blood and mucus in diarrhoea
Urgency or tenesmus
Which is more painful, crohns or uc?
Crohns
What would be seen on colonoscopy that would be suspicious of uc?
General inflammation and ulceration
Mucosal islands
What biopsy changes would suggest uc over crohns?
Superficial inflammation
Crypt abscesses
Inflammatory cells
Lack of goblet cells
Specific radiological signs of uc over crohns?
Thumb printing - thickening of mucosa on haustra
Loss of haustra - lead pipe sign
Collar button ulcers
Treatment to induce remission in uc?
Prednisolone
Ciclosporin
Drugs to maintain remission in uc?
Mesalazine
Azothioprine
How would mesalazine be give in UC ?
Suppository or modified release
What drugs would be considered in UC not directly related to immune modulation?
Heparin as high clotting risk! Bisphosphonate if on steroids Antibiotic cover if on immunosuppressants Laxitives if constipated Probiotics if pouchitis
What surgical options exist for ulcerative colitis?
Proctocolectomy with terminal ileostomy
Colectomy with ileo-anal pouch
When do most cases of crohns develop?
16-30
And 60-80
What age does UC most commonly develop?
15-25
What signs would present in a crohns disease patient with fistulas?
Pneumatouria
Faecouria
How does pyoderma gangrinosum present?
Rapid onset rapidly enlarging ulcer often with a purple edge
How should pyoderma gangrinosum be treated?
Remove necrotic tissue but NO wide excision
Swab and abx if +ve
Steroids
If severe immunosuppression
What are the stages of proximal progression of uc?
Proctitis Proctosigmoiditis Left sided Extensive Pancolitis Backwash ilitis
Other forms of ibd than uc and cd
Microscopic ulcerative colitis
Microscopic lymphocytic colitis
Microscopic collagenous colitis
What environmental factors may play a role in ibd?
Hygiene hypothesis
Breast feeding
Nutrition
Smoking (CD - exacerbates, UC protective)
Appendectomy (UC - protective, CD - exacerbates)
Intestinal microflora - immune response against?
Where is particularly influenced by crohns?
Terminal ilium
Ascending colon
Which of uc or cd increases gallstone risk?
CD
Differentials of IBD?
Lymphoma
Infection
Carcinoma
What sorts of anaemia appear in IBD?
Microcytic iron deficiency
Normocytic of chronic disease
Megaloblastic due to terminal ilial disease
Tests to run on a ?IBD patient?
Bloods - FBC (anaemia, infection), CRP (inflammation), liver biochemistry (liver involvement), ANCA
Stool cultures
Abdo xray
Barium follow through or oral contrast CT
Colonoscopy
When should colonoscopy be performed in suspected UC?
After acute episode due to risk of perforation during
What are disease activity markers in CD?
Hb
Albumin
Inflammatory markers
Normal sizes for small, large and cecum on AXR?
3,6 and 9 cm
Signs of toxic megacolon on axr
Colon >6cm
Thin walled
Gas filled
Mucosal islands
How could lone proctitis be treated in UC?
Rectal steroids
What would trigger surgery in a chronic presentation of UC?
Incomplete response to meds
Excessive steroid use
None compliance
Cancer risk
Acute indications for surgery in UC?
Toxic megacolon
Failure of treatment
Haemorrhage
Perforation
What are the presentations of the microscopic colitis’s?
Watery diarrhoea
Macroscopically normal
Prevalence of diverticular disease?
> 50% of over 50s with 95% being asymptomatic
Presentation of chronic diverticular disease?
Left iliac fossa pain, erratic bowel habits, constipation
Diagnosis of chronic diverticular disease?
Colonoscopy
Treatment of chronic diverticular disease
High fibre diet
Smooth muscle relaxants
Symptoms of acute diverticulits
Severe left iliac fossa pain
Bowel disturbance
Fever
Signs of acute diverticulitis
Tenderness guarding and rigidity
Sometimes palpable mass
Diagnosis of acute diverticulitis?
Ct showing colonic wall thickening, diverticula and abscesses
Do not do colonoscopy!
Bloods in acute diverticulitis?
Raised esr and crp
Leucocytosis
Treatment of acute diverticulitis
Cephalosporin and metronidazole
Iv fluids
Complications of acute diverticulitis
Perforation - peritonitis, fistula
Obstruction
Bleeding
Causes of upper gi bleeding
Peptic ulcer Mallory weiss tear Oesophageal varices Nsaids/steroids/anticoagulants/thrombolytics Oesophagitis Gastric erosions Malignancy
What can cause gastritis?
Alcohol, nsaids, hpylori, atrophic gastritis, granulomas (chrones, sarcoidosis), reflux
Presentation of gastritis?
Epigastric pain, vomiting, haematemesis
Diagnosis of gastritis?
Endoscopy and biopsy
Treatment of gastritis
Ppi or ranitidine,
Hpylori eradication
What score can be used to predict mortality in upper gi bleeding? Components?
Rockall score
Age
SBP and pulse
Comorbidites
Acute management of a upper gi bleed?
Airway High flow O2 Cannulate with resuscitation fluids Bloods - fbc, u+e, lft, clotting, crossmatch Catheter and monitor Cxr, abg, ecg Omeprazole bolus and ivi Urgent endoscopy Inform surgeons Keep nil by mouth
What may show on U+Es in a GI bleed?
Increased urea from digested blood
What does an itch tell you about jaundice?
That it is a conjugated hyperbilirubinaemia not unconjugated. Unconjugated does not itch.
What would be found in the urine in: Conjugated Unconjugated Bilirubinaemia And heamolytic anaemia
Conjugated - bilirubin
Unconjugated - urobiliogen
Hamolytic - haemoglobin
