Gastroenterology Flashcards
Symptoms of IBS
Abdo pain (on defacation)
Diarrhoea/constipation
Bloating
Nausea
Mucus in poo
Diagnosis of IBS
Rule out DDs
Dx on hx
Treatment for IBS
Lifestyle changes
Cut out certain foods
Symptom management
Risk Factors for Diverticulitis
> 60 y/o
Low fibre diet
diverticulosis
Cause of diverticulitis
Increased intraluminal pressure in sigmoid + weakness of intestinal wall -> pouches (diverticula)
or
Chronic inflammation -> acute (erosion of diverticular wall)
Symptoms of diverticulitis
LLQ pain
Mass
Blood/mucus in poo
Acute constipation
Polyuria
Acute abdomen (emergency)
Dx of Diverticulitis
Contrast CT
raised WBC/CRP
neg dipstick
pos FOBT (faecal occult blood test)
Treatment for diverticulitis
If uncomplicated, no Abx, just pain relief
->
Oral Abx
->
IV Abx, surgical resection
Oral – co-amoxiclav 500/125mg TDS/5d OR trimethomprim 200mg BD/5d + Metronidazole 400mg TDS/5d (in penicillin allergic)
IV – co-amoxiclav 1.2g TDS or Ciprofloxacin 400mg BD/TDS + Metronidazole 500mg TDS (in penicillin allergic)
AGM (Amoxicillin, Gentamicin, Metronidazole) in severe cases
Risk Factors for Ulcerative Colitis
15-35/55-65 y/o
HLA-B27 gene
+ve FHx
more common in White population
Pathophysiology of Ulcerative Colitis
Increased permeability of the luminal epithelium -> more bacteria can enter -> upregulation of lymphatic cells in the bowels
Upregulated immune response -> inflammation and damage of the bowel mucosa and submucosa
Cause of Ulcerative Colitis
Autoimmune attack on the mucosal/submucosal layers of the rectum
Always begins in the rectum and the progresses continuously proximally, but never surpasses the ileocaecal valve
Symptoms & Signs of Ulcerative Colitis
bloody diarrhoea + mucus
urgency
LLQ pain
Tenesmus
Osteoarthritis/ankylosing spondylitis
Erythema nodosum
Pyoderma gangrenosum
Ix Ulcerative Colitis
pANCA -> +ve
raised WBC/CRP
anaemia
Calprotectin (raised)
Stool Cultures
Endoscopy & Biopsy:
- Early – friable mucosa that bleeds on contact, inflamed and erythematous, small ulcers covered by fibrin
Late - Widespread ulceration with preservation of surrounding mucosa (pseudopolyps – repeated ulceration -> granulation process), deep ulcers, loss of haustra (seen also on imaging)
Biopsy – inflammatory cells infiltrates in the lamina propria, crypt abscess (neutrophil infiltration of the lumen due to breakdown of crypt epithelium), epithelial dysplasia (increased risk of developing bowel cancer)
Treatment for Ulcerative Colitis
Aminosalicylates (mesalazine) rectal -> + oral
+/- oral steroids -> IV
IV Ciclosporin if severe
Azathioprine/Mercaptopurine
Proctocolectomy + J pouch
Smoking is protective
Risk Factors for Crohn’s Disease`
15-35/55-65 y/o
HLA B27 gene
+ve FHx
White
Pathophysiology of Crohn’s Disease
Autoimmune attack on all layers of the entire GI tract
Transmural fissures and inflammation
Areas of inflammation interrupted by healthy gut - known as skip lesions
Why is there a higher chance of perforation and fistula formation in Crohn’s compared to UC?
because Crohn’s involves all layers of the gut wall, whereas UC only involves the mucosal and submucosal layers
Signs and symptoms of Crohn’s
RLQ pain +/- mass
Chronic diarrhoea w/ NO bleeding
Malabsorption
Uveitis (eye)
Erythema nodosum
Pyoderma gangrenosum
Ix Crohn’s
pANCA is -ve, rules out UC
raised WBC/CRP
anaemia
calprotectin raised
stool cultures
Endoscopy + biopsy:
- cobblestone appearance: inflammation surrounded by deep necrosis
- granuloma formation
- inflammation in all layers of the gut
Treatment for Crohn’s
Prednisolone +/- Azathioprine/Mercaptopurin for induction, no steroid for maintenance
Infliximab and Adalimumab (anti-TNF) for severe
Smoking is exacerbating
What is oesophagitis?
Inflammation of the oesophagus most commonly due to GORD (gastro-oesophageal reflux disease)
Sx of oesophagitis
retrosternal pain
vomiting a small volume of blood
resolves spontaneously
Tx for oesophagitis
PPI cover for 8w
If not resolving test for H. Pylori (urea-breath)
Tx for GORD
omeprazole 20mg OD -> 40mg OD
