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1
Q

what is coelic dieseas

A

autoimmuen t4 hypersensitivity due to gluten intolerance causing abdo pain and malabsorption

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2
Q

what type of hypersensitivity is coeliacs disease

A

t4

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3
Q

pathophysiology coeliacs disease

A

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

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4
Q

AB involved in coeliac disease

A

anti tTG (tissue transglutaminase)
anti EMA (endomysial antibodies)

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5
Q

signs and symptoms coeliac disease

A
  • anaemia (fe/ folate/ b12 deficiency)
  • wt loss
  • abdo pain
  • bloating
  • diarrhoea
  • dermatitis herpeformis
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6
Q

diagnosis of coeliac disease

A

1st anti tTG
2nd anti EMA
gold. duodenal biopsy

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7
Q

what si seen on duodenal biopsy for coeliacs disease

A

complete villous atrophy
crypt hyperplasia
intraluminal lymphocytes

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8
Q

managment of coeliacs disease

A

stop eating gluten
folate, iron, n12 supplements

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9
Q

common vit/ mineral def w coeliac disease

A

iron, b12, folate

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10
Q

what is IBS

A

functional chronic bowel condition with changed bowel habits and abdo pain with no structural abnormalities

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11
Q

who is commonly affected with IBS

A

women with stress/ anxiety/ depression/ recent gastroenteritis

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12
Q

risk factors/ exacerbating factors for iBS

A

recent gastroenteritis
anxiety
stress
depression
food triggers

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13
Q

what si seen on duodenal biopsy for coeliacs disease

A

complete villous atrophy
crypt hyperplasia
intraluminal lymphocytes

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14
Q

signs and symptoms for IBS

A
  • abdo pain - worse on eating and better on defecation
  • bloating
  • change in bowel habits - constipation, diarrhoea, mucus in stool
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15
Q

3 classes of ibs

A

ibs-c constipation
ibs-d diarrhoea
ibs-m mixed

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16
Q

diagnosis of ibs

A

diagnosis of exclusion
- esr/crp for inflam
- faecal calprotectin for ibd
- colonoscopy for colorectal cancer
- anti tTG and EMA for coeliac d

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17
Q

differentials for ibs

A

ibd
lactose intolerance
coeliacs
colorectal cancer

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18
Q

management for ibs

A
  • education
  • avoid triggers
  • cbt for anxiety/ depression
  • lactatives for constipation
  • loperamide (immodium) for diarrhoea
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19
Q

whats anti tTG and EMA associated with

A

coelaics disease

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20
Q

what is tropical sprue

A

chronic inflammation due to travel to the tropics eg SEA, india, caribbeans

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21
Q

what is the diagnosis of tropical sprue

A

jejunal biopsy-> partial villous atrophy

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22
Q

treatment for tropical sprue

A

AB - tetracycline for 6 months and folate supplements

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23
Q

what is ulcerative colitis

A

autoimmune mucosal inflammation of the rectum, variably spreading proximally to the colon stopping before the ileum
type of IBD

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24
Q

GI signs and symptoms of ulcerative colitis

A

left lower quadrant abdo pain
blood and mucus in stool
diarrhoea
urgency

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25
non GI signs of ulcerative colitis
arthritis ankylosing spondolitis amyloidosis primary sclerosing cholangits clubbing erythema nodusum iritis
26
investigations for ulcerative colitis
1st. +ve faecal calprotectin 2nd. +ve pANCA gold: colonoscopy and biopsy
27
results colonscopy and biopsy for ulcerative colitis
colonoscopy: continuous 'leadpipe' inflammation biopsy: crypt abscesses, mucosal inflammation pseudopolyps
28
treatment for mild ulcerative colitis
- aminosalicylate (mesalazine) - then add prednisolone - with azathioprine for remission
29
treatment for severe/ moderate ulcerative colitis
- IV hydrocortisone (steroids) - then add TNFa inhib (infliximab) - azathioprine for remission
30
layers affected by ulecerative colitis
mucosal
31
featuresof ulcerative colitis
continuous mucosal inflammation mucosal ulceration and psuedopolyps rectal -> ileocaecal valve LLQ pain
32
smoking and ulcerative colitis
a protective factor
33
what is crohns
type of IBD with transmural inflammation with non caseating granuloma formation n occur anywhere in the GIT
34
what are the 3 types of bowel ischaemia
acute mesenteric chronic mesenteric ischaemic colitis
35
what is the main cause of bowel ischaemia
thromboembolism also vasospasm
36
what are the risk factors for bowel ischaemia
incr age men htn t2dm obesity smoking all the same for cardiac ischaemia
37
what is mainly affected in chronic mesenteric ischameia
mesenteric vessels
38
what is mainly affected in acute mesenteric ischamia
superior mesenteric artery
39
what are the signs and symptoms for acute mesenteric ischaemia
severe colicky abdo pain abdo bruit - noise N+V hypovolaemia- shock melanea and haematochezia
40
signs and symptoms for chronic mesenteric ischaemia
abdo pain - constant abdo bruit wt loss
41
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
42
signs ans symptoms of ischamic colitis
left abdo pain abdo bruit n+v
43
investigations for bowel ischaemia
ct angiography and gold - colonoscopy for acute mesenteric
44
treatment for bowel ischaemia
- anticoagulants - heparin - abs - prophylactic - surgery
45
complications of bowel ischaemia
necrosis and sepsis
46
what is pseudomembranous colitis
bowel inflammation due to clostridium difficile and recent ab use characterised by owl eye inclusion bodies
47
signs and symptoms of pseudomembranous colitis
abdo pain n+v diarrhoea
48
investigations
- stool sample and culture - bloods - esr, crp - abdo ct - histology - owl eye inclusion bodies
49
what are owl eye inclusion bodies characteristic of
pseudomembranous colitis
50
treatment for psuedomembranous colitis
ab eg oral vancomycin
51
what is a divertcula
mucosal outpouching of bowel wall typically near perforating vessels, in sigmoid colon
52
what is diverticulosis
presence of diverticula
53
what is diverticular disease
symptomatic diverticulum
54
what is diverticulitis
inflammation of diverticulum, commonly due to bacteria from faeces
55
where are diverticulum commonly found
near perforating vessels sigmoid colon
56
what are the risk factors for diverticular disease
low fibre diet -> constipation smoking obesity NSAIDS
57
brief pathophysiology for diverticular disease
high colonic pressure causes mucosal outpouches into mucularis
58
signs and symptoms of diverticular disease
- left lower quadrant abdo pain - bowel habits changed - bloating
59
signs and symptoms for diverticulitis
LLQ abdo pain bloating bowel habits changed fever blood in stool
60
investigations for diverticular disease
colonoscopy GS - ct abdo
61
treatment for diverticular disease
ASx- monitor - incr fibre Sx- monitor, analgesic, antispasmodics diverticulitis- AB , analgesic, antispasmodics
62
what is merkles diverticulum
- congenital diverticulum in the ileum - ddx - acute appendicitisis
63
what is merkles diverticulum commonly confused with - presentation wise
acute appendicitis
64
complications of diverticular disease
perforation infection/ inflammation bleeding

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