Gastrointestinal Flashcards
1st line tx for mild-moderate flare of ulcerative colitis
Topical (rectal) aminosalicylates
oral possible if rectal declined
fts of moderate flare of ulcerative colitis
- 4-6 bowel movements/day
- b/w mild - severe blood in stools
- no pyrexia (<37.8C)
- pulse <90
- no anaemia
- ESR <30
Management of acute severe flare/first presentation of ulcerative colitis
IV prednisolone
2nd line tx for moderate flare ulcerative colitis
oral prednisolone/any corticosteroid
indication for surgery for ulcerative colitis
acute severe UC admitted to hospital
mild ulcerative colitis flare fts
- < 4 stoold/day
- small amount of PR blood
severe falure of ulcerative colitis fts
- > 6 blood stools per day
- systemic upset (purexia, tachy, anaemia, raised inflam markers)
Inducing remission of Crohn’s first line
- glucocorticoids
- +/- azathioprine
2nd line tx - inducing remission in Crohn’s
5-ASA drugs (mesalazine)
When is infliximab used to tx Crohn’s
- refractory disease
- fistulating Crohn’s
Drug tx for isolated peri-anal disease in Crohn’s
Metronidazole
Maintaining remission in Crohn’s
- quit smoking
- azathioprine/mercaptopurine (1st line)
- methotrexate (2ndline)
What test should be done before starting azathioprine/mercaptopurine
thiopurine methyltransferase (TPMT)
Classic diverticulitis fts
- LLQ pain
- diarrhoea
- fever
Classic presentation of UC
- chronic ( +/-bloody) diarrhoea
- crampy abdo pain
- weight loss
- faecal urgency
- tenesmus
Classic fts Crohn’s disease
- chronic diarrhoea
- crampy abdo pain
- malabsorption
- mouth ulcers
- perianal disease
- intestinal obstruction
Classic presentation coeliac children
- failure to thrive
- chronic diarrhoea
- abdominal distension
Classic presentation coeliac adults
- lethargy
- anaemia
- weight loss
- chronic diarrhoea
- co-existing auto-immune conditions
Basic pathophys of haemochromatosis
disorder of iron aborption and metabolism = iron accumulation
Fts of haemochromatosis
1- early
2- reversible complications
3- irreversible complications
1- asymptomatic; fatigue, erectile dysfunction, arthralgia (hands)
2- bronze skin pigmentation; cardiomyopathy (but progress to cardiac failure - 3); chronic liver disease with hepatomegally (but progress to cirrhosis or hepatocellular deposition - 3)
3- DM; hypogonadotrphic hypogonadism (cirrhosis + pituitary dysfunction); arthritis
Genetic/ other Ca a/w pancreatic cancers
- hereditary non-polyposis colorectal carcinoma
- multiple endocrine neoplasia
- BRCA2 gene
- KRAS gene mutation
Main type of pancreatic tumour
> 80% adenocarcinomas
Endoscopy findings Crohn’s
deep ulcers
skip lesions
‘cobble-stone’
Endoscopy findings UC
widespread ulceration
preservation of adjacent mucosa (appearance of polyps - ‘pseudopolyps’)
Radiology Crohn’s
1. type used
2. findings
- Small bowel enema (specifically looking at terminal ileum)
- Kantor’s string sign = strictures; prox bowel dilatation; ‘rose thorn’ ulcers; fistulae
Radiology UC
1. type used
2. findings
- barium enema
- loss of haustrations; sup ulcerations ‘pseudopolyps’; long standing disease = narrow and short colon (‘drainpipe colon’)
Histology Crohn’s
inflammation in all layers of mucosa
- incr goblet cells
- granulomas
Histology UC
No inflammation beyond submucosa (excl fulminant disease)
- inflam cell infiltrate in lamina propria
- neut migrate through walls of glands - form crypt abscesses
- depletion of goblet cells and mucin from gland epithelium
- granulomas are infrequent
Lesion pattern in Crohn’s
anywhere from mouth to anus
+/- skip lesions
Lesion pattern in UC
start at rectum and spreads proximal, nevery beyond ileocaecal valve
continuous disease
Complications Crohn’s
- obstruction
- fistula
- colorectal cancer
Complications UC
colorectal cancer (higher than Crohn’s)
toxic megacolon
Classic fts of Crohn’s
- diarrhoea (non bloody)
- weight loss (> than UC)
- upper GI sx - mouth ulcers
- perianal disease
- abdo mass palpable in RIF
Classic fts of UC
- bloody diarrhoea more common
- abdo pain in LLQ
- tenesmus
Fts of mesenteric ischaemic (acute)
- sudden onset severe abdo pain out of keeping with physical exam
- rectal bledeing
- diarrhoea
fever - bloods= elevated WCC; lactic acidosis
- commonly BG of AF (thrombus of artery, i.e SMA)
Mx of acute mesenteric ischaemia
Urgent surgery
Pathophys of ischaemic colitis
acute but transient compromise in blood flow to large bowel
can lead to inflammation, ulceration and haemorrhage
> likely in ‘watershed’ areas (splenic flexure)
viral hepatitis presentation
- N&V, anorexia
- myalgia
- lethargy
- RUQ pain
foreign travel or IVDU
Presentation of congestive hepatomegaly
only painful if stretched (commonly due to congestive heart failure)
if severe - cirrhosis
Biliary colic presentation
- pain: RUQ, intermittent, aburpt onset, subsides gradually
- attacks occur after eating
- commonly: nausea
risk factors: female, forties, fat, fair, fertile
Acue cholecystitis
- biliary pain (RUQ, intermittent, acute onset after food) but > severe and persistent
- +/- radiation to R shoulder
- +/- fever
- Murphy’s positive
Ascending cholangitis presentation
- fever (rigors)
- RUQ pain
- jaundice
gallstone ileus presentation
abdominal pain
abdominal distension
vomiting
(SBO 2ry impacted galstone)
cholangiocarcinoma presentation
- persistent bilicary colic
- anorexia
- jaundice
- weight loss
- palpable mass in RUQ (Courvoisier)
- periumbilical lymphadenopathy (sister May Joseph nodes)
- left supraclavicular adenopathy (Virchow node)
Acute pancreatitis presentation
- severe epigastric pain
- vomiting common
- +/- ileus, tenderness, low grade fever
+/- Periumbilical discolouration (Cullen’s sign) /flank (Grey-Turner’s sign) – rare
