Gastrointestinal Flashcards
What is inflammatory bowel disease?
- umbrella term for disease causing inflammation of the GI tract
- associated with periods of remission and exacerbation
- crohn’s and ulcerative colitis
Crohn’s vs UC: Crohn’s
NESTS
- no blood or mucous (less common)
- entire GI tract
- skip lesions on endoscopy
- terminal ileum most affected and transmural (full thickness) inflammation
- smoking is a risk factor
also associated with weight loss, strictures and fistulas
Crohn’s vs UC: UC
CLOSEUP
- continuous inflammation
- limited to colon and rectum
- only superficial mucosa affected
- smoking is protective
- excrete blood and mucus
- use aminosalicyclates
- primary sclerosing cholangitis
Presentation of inflammatory bowel disease
- diarrhoea
- abdominal pain
- passing blood
- weight loss
Testing for inflammatory bowel disease
- routine bloods
- CRP → inflammation and active disease
- faecal calprotectin
- DIAGNOSTIC = endoscopy (OGD/colonoscopy) with biopsy
- imaging → complications
What is faecal calprotectin?
- released by intestines when inflamed
- >90% sensitive and specific to IBD in adults
What does management of IBD involve?
- inducing remission
- maintaining remission
- surgery
Inducing remission in Crohn’s
- steroids → oral prednisolone, IV hydrocortisone
- consider adding immunosuppressants
What immunosuppressants can be used in Crohn’s
- azathioprine
- mercaptopurine
- methotrexate
- infliximab
- adalimumab
Maintaining remission in Crohn’s
based on risks, side effects, nature of the disease, patient’s wishes
- azathioprine, mercaptopurine
alternatives = rest of the immunosuppressants
Surgery in Crohn’s
- if only distal ileum affected → surgical resection of area to prevent further flare ups
- treat stricture and fistulas
Inducing remission in UC
mild to moderate
- aminosalicylates eg mesalazine
- corticosteroids eg prednisolone
severe
- IV corticosteroids eg hydrocortisone
- IV ciclosporin
Maintaining remission in UC
- aminosalicylates
- azathioprine
- mercaptopurine
Surgery in UC
- removal of colon and rectum → panproctocolectomy
- patient left with permanent ileostomy or ileo-anal anastomosis
What is IBS?
- functional bowel disorder
- no identifiable organic disease underlying symptoms
- result of abnormal functioning of normal bowel
- very common, more common if young/female
Symptoms of IBS
ABCDEF
- abdominal pain
- bloating
- constipation
- diarrhoea
- eating makes it worse
- fluctuating bowel habit
- improved by opening bowels
Diagnostic criteria of IBS
diagnosis of exclusion
- normal bloods
- faecal calprotectin -ve
- coeliac disease serology -ve
- cancer not suspected/excluded
Management of IBS
- general healthy diet and exercise advice
- loperamide for diarrhoea, linaclotide for constipation, antispasmodics for cramps
- tricyclic antidepressants
- SSRIs
can also offer CBT
What is coeliac disease?
- exposure to gluten = autoimmune reaction that causes inflammation in small bowel
- usually develops in early childhood
Pathophysiology of coeliac disease
- auto-antibodies created in response to gluten
- target epithelial cells of the intestine → inflammation
- affects small bowel esp jejunum
- causes atrophy of intestinal villi and crypt hypertrophy
- malabsorption of nutrients → symptoms
Presentation of coeliac disease
- often asymptomatic
- failure to thrive in children
- diarrhoea
- fatigue
- weight loss
- mouth ulcers
- anaemia secondary to iron, B12, folate deficiency
- dermatitis herpetiformis
- neurological symptoms (rare)
What is dermatitis herpetiformis?
itchy blistering skin rash that typically appears on the abdomen
Diagnosis of coeliac
- raised anti-TTG
- raised anti-EMA
- total IgA levels → exclude IgA deficiency first
- endoscopy and intestinal biopsy → crypt hypertrophy and villous atrophy
What auto-antibodies are created in response to gluten?
- anti-tissue transglutaminase (anti-TTG)
- anti-endomysial (anti-EMA)