GI Flashcards
Define Gastro-Oesophageal Reflux Disease (GORD)
Reflux of stomach contents causing 2 or more heartburn episodes/week
Aetiology of GORD
- Lower oesophageal sphincter hypotension
- Hiatus hernia
- sliding hiatus hernia = gastro-oesophageal junction + part of stomach slides up into chest above diaphragm
- Rolling hiatus = part of fundus of stomach prolapses through hiatus alongside oesophagus
- Loss of oesophageal peristaltic function
- Abdomen obesity
- Drugs - antimuscarinic, CCB, nitrates
Clinical presentation of GORD
- Heartburn
- Belching
- Food/acid brash
- Water brash
- Painful swallowing
- Nocturnal asthma
- Chronic cough
What are some differential diagnoses for GORD
- CAD
- Biliary colic
- Peptic ulcer disease
- Malignancy
Diagnosis of GORD
- Diagnosis usually possible without investigation UNLESS alarm bell signs such as weight loss, haematemesis (coughing up blood), trouble swallowing
- Investigations if alarm bell signs
- Endoscopy
- If endoscopy normal - do 24h oesophageal pH monitor
- Barium swallow
- Endoscopy
Treatment of GORD
LIFESTYLE
1. Weight loss
2. Smoking cessation
3. Small regular meals
4. avoid hot drinks, alcohol, citrus, food < 3h before bed
MEDICAL
1. ANTACIDS - Mg Trisilicate mixture
2. Alginates - Gaviscon
3. PPI - Lansoprazole
4. H2 receptor antagonist - Cimetidine
SURGICAL
1. Nissen fundoplication - laparoscopically increase resting LOS pressure
Complications of GORD
- Peptic stricture
- Inflammation of oesophagus -> narrowinf of oesophagus
- Barrett’s oesophagus
- Distal oesophageal epithelium undergoes metaplasia: squamous -> columnar
What are the 2 major forms of IBD
- Ulcerative colitis - affects only COLON
- Crohn’s disease - ANY PART OF GI
Define IBD
Mucosal immune system exerts inappropriate response to luminal antigens
Define ulcerative Colitis
- Relapsing and remitting inflammatory disorder of colonic mucosa
- May effect entire colon UP TO ileocaecal valve, NEVER proximal to it
Risk factors of UC
- Family history
- NSAIDS
- Chronic stress & depression
Pathophysiology of UC
- Restricted mucosal disease - differentiates from Crohn’s
- Affects only colon
- Circumferential and continuous inflammation - NO SKIP LESIONS
- Mucosal inflammation - DOES NOT GO DEEPER
- No granulomata
- Depleted goblet cells
- Increased crypt abscesses
Clinical presentation of UC
- Remissions and exacerbations
- Pain restricted to lower left quadrant
- Episodic or chronic diarrhoea with blood and mucus
- Cramps
- Tachycardia
Diagnosis of UC
- Blood test
- Raised WCC and platelets
- Iron deficient anaemia
- ESR and CRP raised
- Stool sample to exclude C.diff etc
CAROTECTIN - Colonoscopy with mucosal biopsy (GOLD STANDARD)
What organs can be involved in complications with UC
- Liver
- Colon
- Skin
- Joints
- eyes
Treatment of UC
1st line - Oral or IV Corticosteroid
Define Crohn’s Disease (CD)
- Chronic inflammatory GI disease
- Transmural granulomatous inflammation
- Affecting any part of gut from mouth to anus
- Skip lesions
Pathophysiology of CD
- Transmural granulomatous with skip lesions
- Inflammation affects any part of gut
- Affects terminal ileum and proximal colon in particular
- Involved bowel = thickened and narrowed
- Cobblestone appearance due to ulcers and fissures in mucosa
- Goblet cells present
Clinical presentation of CD
- Diarrhoea with urgency, bleeding and pain
- Abdominal pain - acute right iliac fossa pain mimics appendicitis
- Weight loss
- Lethargy
- Perianal abscess
Complications of CD
- Perforation and bleeding
- Fistula formation
- Malabsorption
- Toxic dilation of colon
- Colorectal cancer
Differential diagnosis of CD
- Alternative causes of diarrhoea must be excluded (salmonella etc)
- Chronic diarrhoea
Diagnosis of CD
- Tenderness of right iliac fossa
- Anal examination
- Bloods
- Anaemia - due to malabsorption
- deficiency of iron and folate
- Raised ESR and CRP
- Raised WCC and platelets
- Anaemia - due to malabsorption
- Stool sample to exclude C.difficile
- Colonoscopy
- Biopsy for spot lesions and granulomatous transmural inflammation
Treatment of CD
- Smoking cessation
- Anaemia - Iron,B12 or folate replacement
- Mild attacks
- Controlled release corticosteroids - BUDESONIDE
- Moderate to severe attacks
- Glucosteroids - Oral PREDNISOLONE
- Severe attacks
- IV HYDROCORTISONE
- Antibiotics - IV METRONIDAZOLE
- If no improvement
- Anti-TNF antibodies - INFLIXIMAB
- Maintain remission
- AZATHIOPRINE
- Surgery
Define IBS
- Mixed group of abdominal symptoms
- No organic cause can be found
What are the 3 types of IBS
- IBS -C - with constipation
- IBS-D - with diarrhoea
- IBS-M - with both
Risk factors of IBS
- Female
- Previous severe and long diarrhoea
- High hypochondrial anxiety and neurotic score at time of illness