GI Flashcards
what is coelic dieseas
autoimmuen t4 hypersensitivity due to gluten intolerance causing abdo pain and malabsorption
what type of hypersensitivity is coeliacs disease
t4
pathophysiology coeliacs disease
gluten is broken down into gliadin (prolamin) which triggers an immune reposne of anti tTG and anti EMA (tissue transglutaminase and endomysial antibodies) this causes complete villous atrophy, crypt hyperplasia, and intraluminal lymphocytes
AB involved in coeliac disease
anti tTG (tissue transglutaminase)
anti EMA (endomysial antibodies)
signs and symptoms coeliac disease
- anaemia (fe/ folate/ b12 deficiency)
- wt loss
- abdo pain
- bloating
- diarrhoea
- dermatitis herpeformis
diagnosis of coeliac disease
1st anti tTG
2nd anti EMA
gold. duodenal biopsy
what si seen on duodenal biopsy for coeliacs disease
complete villous atrophy
crypt hyperplasia
intraluminal lymphocytes
managment of coeliacs disease
stop eating gluten
folate, iron, n12 supplements
common vit/ mineral def w coeliac disease
iron, b12, folate
what is IBS
functional chronic bowel condition with changed bowel habits and abdo pain with no structural abnormalities
who is commonly affected with IBS
women with stress/ anxiety/ depression/ recent gastroenteritis
risk factors/ exacerbating factors for iBS
recent gastroenteritis
anxiety
stress
depression
food triggers
what si seen on duodenal biopsy for coeliacs disease
complete villous atrophy
crypt hyperplasia
intraluminal lymphocytes
signs and symptoms for IBS
- abdo pain - worse on eating and better on defecation
- bloating
- change in bowel habits - constipation, diarrhoea, mucus in stool
3 classes of ibs
ibs-c constipation
ibs-d diarrhoea
ibs-m mixed
diagnosis of ibs
diagnosis of exclusion
- esr/crp for inflam
- faecal calprotectin for ibd
- colonoscopy for colorectal cancer
- anti tTG and EMA for coeliac d
differentials for ibs
ibd
lactose intolerance
coeliacs
colorectal cancer
management for ibs
- education
- avoid triggers
- cbt for anxiety/ depression
- lactatives for constipation
- loperamide (immodium) for diarrhoea
whats anti tTG and EMA associated with
coelaics disease
what is tropical sprue
chronic inflammation due to travel to the tropics eg SEA, india, caribbeans
what is the diagnosis of tropical sprue
jejunal biopsy-> partial villous atrophy
treatment for tropical sprue
AB - tetracycline for 6 months and folate supplements
what is ulcerative colitis
autoimmune mucosal inflammation of the rectum, variably spreading proximally to the colon stopping before the ileum
type of IBD
GI signs and symptoms of ulcerative colitis
left lower quadrant abdo pain
blood and mucus in stool
diarrhoea
urgency
non GI signs of ulcerative colitis
arthritis
ankylosing spondolitis
amyloidosis
primary sclerosing cholangits
clubbing
erythema nodusum
iritis
investigations for ulcerative colitis
1st. +ve faecal calprotectin
2nd. +ve pANCA
gold: colonoscopy and biopsy
results colonscopy and biopsy for ulcerative colitis
colonoscopy: continuous ‘leadpipe’ inflammation
biopsy: crypt abscesses, mucosal inflammation pseudopolyps
treatment for mild ulcerative colitis
- aminosalicylate (mesalazine)
- then add prednisolone
- with azathioprine for remission
treatment for severe/ moderate ulcerative colitis
- IV hydrocortisone (steroids)
- then add TNFa inhib (infliximab)
- azathioprine for remission
layers affected by ulecerative colitis
mucosal
featuresof ulcerative colitis
continuous mucosal inflammation
mucosal ulceration and psuedopolyps
rectal -> ileocaecal valve
LLQ pain
smoking and ulcerative colitis
a protective factor
what is crohns
type of IBD with transmural inflammation with non caseating granuloma formation n occur anywhere in the GIT
what are the 3 types of bowel ischaemia
acute mesenteric
chronic mesenteric
ischaemic colitis
what is the main cause of bowel ischaemia
thromboembolism
also vasospasm
what are the risk factors for bowel ischaemia
incr age
men
htn
t2dm
obesity
smoking
all the same for cardiac ischaemia
what is mainly affected in chronic mesenteric ischameia
mesenteric vessels
what is mainly affected in acute mesenteric ischamia
superior mesenteric artery
what are the signs and symptoms for acute mesenteric ischaemia
severe colicky abdo pain
abdo bruit - noise
N+V
hypovolaemia- shock
melanea and haematochezia
signs and symptoms for chronic mesenteric ischaemia
abdo pain - constant
abdo bruit
wt loss
what is ischamic colitis
type of bowel ischaemia mainly affecting watershed areas of the bowel- far away from blood supply
- mainly splenic flexure of colon
signs ans symptoms of ischamic colitis
left abdo pain
abdo bruit
n+v
investigations for bowel ischaemia
ct angiography and gold - colonoscopy for acute mesenteric
treatment for bowel ischaemia
- anticoagulants - heparin
- abs - prophylactic
- surgery
complications of bowel ischaemia
necrosis and sepsis
what is pseudomembranous colitis
bowel inflammation due to clostridium difficile and recent ab use
characterised by owl eye inclusion bodies
signs and symptoms of pseudomembranous colitis
abdo pain
n+v
diarrhoea
investigations
- stool sample and culture
- bloods - esr, crp
- abdo ct
- histology - owl eye inclusion bodies
what are owl eye inclusion bodies characteristic of
pseudomembranous colitis
treatment for psuedomembranous colitis
ab eg oral vancomycin
what is a divertcula
mucosal outpouching of bowel wall typically near perforating vessels, in sigmoid colon
what is diverticulosis
presence of diverticula
what is diverticular disease
symptomatic diverticulum
what is diverticulitis
inflammation of diverticulum, commonly due to bacteria from faeces
where are diverticulum commonly found
near perforating vessels
sigmoid colon
what are the risk factors for diverticular disease
low fibre diet -> constipation
smoking
obesity
NSAIDS
brief pathophysiology for diverticular disease
high colonic pressure causes mucosal outpouches into mucularis
signs and symptoms of diverticular disease
- left lower quadrant abdo pain
- bowel habits changed
- bloating
signs and symptoms for diverticulitis
LLQ abdo pain
bloating
bowel habits changed
fever
blood in stool
investigations for diverticular disease
colonoscopy
GS - ct abdo
treatment for diverticular disease
ASx- monitor - incr fibre
Sx- monitor, analgesic, antispasmodics
diverticulitis- AB , analgesic, antispasmodics
what is merkles diverticulum
- congenital diverticulum in the ileum
- ddx - acute appendicitisis
what is merkles diverticulum commonly confused with - presentation wise
acute appendicitis
complications of diverticular disease
perforation
infection/ inflammation
bleeding
