Gastrointestinal - Bowel Disease Flashcards
what occurs in coeliac disease?
T cell mediated AI disease of the small bowel
results in an enteropathy to gluten
features of coeliac disease?
diarrhoea pale stools wt loss steatorrhoea bloating ulcers fatigue
what is the intolerance to in coeliac disease? what is this in?
prolamin
alcohol soluble proteins (wheat, barley, rye, oats)
Ix for coeliac disease and results?
FBC (anaemia) ferritin stool culture B12/folate anti TTG endoscopy + duodenal biopsy
what is seen on duodenal biopsy in coeliac disease?
villous atrophy
intra epithelial WBCs
crypt hyperplasia
how can paeds diagnose coeliac disease?
blood tests if tTG >10x normal
if not, still need scope and biopsy
Tx for coeliac disease?
gluten free diet
what malignancy are those with coeliac disease at higher risk of?
T cell lymphoma (gastric)
what rash is associated with coeliac disease?
dermatitis herpetiformis
describe dermatitis herpetiformis?
extensors
buttocks
small blisters on a red base
itchy
what is seen on biopsy of dermatitis herpetiformis?
granular deposits of dermal papillary IgA on immunofluorescence
what is used to treat dermatitis herpetiformis?
gluten free diet dapsone gel (Abx)
where can crohn’s effect?
mouth to anus
describe crohns pathology?
transmural skip lesions cobblestone deep fissures abscesses
features of crohn’s?
diarrhoea blood urgency abdo pain fever ulcers abscesses fistulae
what other non GI symptoms can occur in crohn’s?
clubbing
erythema nodosum
gallstones
anterior uveitis
what type of arthritis do those with crohn’s get? features?
enteropathic
peripheral joints and spine
diagnostic Ix for crohn’s? what can be done in kids?
colonoscopy and biopsy
MRI small bowel barium study
what other Ix should be done for crohn’s ?
LFTs, FBC, U+Es, CRP, ferritin, B12, folate
tTG
stool culture
what faecal marker can be used to assess IBD?
faecal calprotectin
Tx for crohn’s?
steroids in attacks AZA/MTX infliximab stop smoking ileostomy colectomy
complications of crohn’s?
bowel obstruction fistulae abscesses toxic dilatation osteoporosis
what size is classed as toxic colon dilatation?
> 6cm
what IBD is made worse by smoking?
crohn’s
what non GI symptoms can occur in UC?
clubbing ulcers erythema nodosum pyoderma gangrenosum joint pain anterior uveitis
where does UC affect?
rectum to ileocaecal valve
what is found on UC pathology?
crypt abscesses
peudopolyps
goblet cell depletion
drainpipe colon (thin wall)
what IBD is PSC more common in?
UC
what IBD is bloody diarrhoea more common in?
UC
Ix for UC?
FBC, U+E, CRP, Ferritiv
faecal calprotectin
stool culture
colonoscopy
Tx for UC?
topical mesalazine (rectal disease)
oral mesalazine
sulfasalazine
steroids
what surgery is curative in crohn’s?
ileostomy (R sided) formed through a colectomy or proctocolectomy
what cancer can occur as a complication of UC?
colorectal
what are the categories of UC severity?
mild = <4stools mod = 4-6 stools severe = >6 stools and systemic upset
features of IBS?
bloating urgency tenesmus mucus nocturia worse when stressed
what is the rome IV criteria for IBS?
Recurrent abdo pain/discomfort for ≥1 day/week in the last 3 months
+ 2 or more of
- pain associated with defecation (better/worse)
- Onset associated with stool frequency
- Onset associated with stool form
Ix for IBS?
FBC, ESR, CRP
TTG
Ca125 (if suspicious)
colonoscopy (if suspicious)
Tx for IBS?
FODMAP diet
reduce caffeine
loperamide
amitriptyline
