GI Flashcards
Which parts of the GI tract are affected by crohns?
Anywhere from mouth to anus
Transmural inflammation occurs in which bowel condition?
Crohn’s
Which findings on investigation would indicate a diagnosis of crohn’s disease? (4)
- raised inflammatory markers
- increased faecal calprotectin
- anaemia
- low vit B12 and vit D
Which extra-intestinal features are associated with crohn’s disease ?
- arthritis
- episcleritis
- erythema nodosum
What is the differnece between the pattern of disease in UC and Crohn’s?
UC - continuous disease from rectum to ileocecal valve
Crohn’s - skip lesions from mouth to anus
What is the management for Crohn’s disease?
- Start monotherapy with prednisolone to induce remission at first presentation
- If there are multiple inflammatory exacerbations in 12 months then add azathioprine
- For severe active crohn’s disease - add infliximab
Give 4 symptoms of UC
- bloody diarrhoea
- tenesmus
- left iliac fossa pain
- extra-intestinal features
Which area of the GI tract is typically most affected in Crohn’s disease?
Terminal ileum
What is the management of UC to induce remission?
- First line = topical aminosalicylate e.g. mesalazine
- Second line = oral aminosalicylate
- topical/oral corticosteroids e.g. prednisolone
What would you find of biopsy of someone with UC?(4)
- red, raw, friable mucosa
- no inflammation beyond submucosa
- crypt abscesses
- depletion of goblin cells
What findings would you expect to see on an abdominal X ray of someone with UC?
lead pipe appearance of colon
Which extra-intestinal features are most commonly associated with UC? (3)
- arthritis
- primary sclerosing cholangitis
- uveitis
How would you treat a symptomatic perianal fistula in crohn’s disease?
metronidazole
What is the grading criteria for UC severity?
Truelove and Witts Criteria
Which symptoms would be graded as ‘severe UC’? (6)
- > 6 bowel movements/day
- blood in stool
- pyrexia
- pulse > 90 bpm
- anaemia
- ESR > 30
When would you admit someone with UC?
- severe colitis
- moderate disease that doesn’t respond to steroid treatment within 2 weeks
How would you treat an acute severe flare of UC?
- IV corticosteroids
- IV ciclosporin/surgery
What is a complication of UC that needs to be monitored for?
colorectal malignancy
What is diverticulosis?
Very common condition causing outpouching of bowel wall, no symptoms
What are risk factors for diverticular disease? (2)
- increasing age
- low-fibre diet
What are symptoms of diverticular disease? (2)
- altered bowel habit
- colicky left sided abdo pain
What are the symptoms of diverticulitis? (4)
- constant LIF pain and tenderness
- anorexia, N&V
- diarrhoea
- features of infection
How is diverticulitis managed?
Systemically unwell = oral co-amoxiclav
Features of complicated acute diverticulitis = NBM, IV fluids, IV AbX
What are 4 possible complications of acute diverticulitis?
- abscess formation
- peritonitis
- obstruction
- perforation
How do gastric ulcers present?
Epigastric discomfort or pain
Nausea and vomiting
Dyspepsia
Haematemesis/IDA
What are the 2 most common causes of peptic ulcer disease?
NSAIDs
Helicobacter Pylori infection
How would you manage someone with suspected peptic ulcer disease?
- Review and stop NSAIDs/aspirin/bisphosphonates/steroids/SSRIs
- Test for H Pylori infection
- negative + no NSAIDs = PPI 4-8wks
- negative + NSAIDs = PPI 8 wks
- positive + no NSAIDs = H Pylori eradication
What does H Pylori eradication involve?
PPI + 2 antibiotics
e.g. lansoprazole + amoxicillin + clarithromycin
How and when do you test for H Pylori?
How:
- Urea (13C) breath test
- Stool helicobacter antigen test
When:
- if dyspepsia symptoms have not improved after a month of PPI
- unexplained IDA after malignancy ruled out
- 6-8 weeks post treatment if no improvement
How is Barrett’s oesophagus managed?
- High dose PPI
- Metaplasia = endoscopic biopsies every 3-5 years
- Dysplasia = endoscopic ablation
How would you manage a patient with endoscopy confirmed GORD?
PPI 4-8 weeks
- 2nd line = H2 receptor antagonist (ranitidine)
Which drugs may exacerbate the symptoms of GORD?
- alpha-blockers
- anticholinergics
- benzodiazepines
- beta-blockers
- bisphosphonates
- calcium-channel blockers
- corticosteroids
- NSAIDs
- nitrates
- theophyllines
- tricyclic antidepressants
What are possible complications of GORD?
oesophagitis
ulcers
anaemia
benign strictures
Barrett’s oesophagus
oesophageal carcinoma
