GI 3 Flashcards
what is coeliac disease associated
HLA DQ2, HLA DQ8, derm hepetiformis, AI disease
dx of coeliac disease
histology
what other ix should be done
anti TTG and IgA and jejunal biopsy
villous atrophy, crypt hyperplasia, increase in epithelial lymphocytes, lamina proper infiltration w lymphocytes
DEXA scan for osteoporosis
treatment for coeliac
complications
gluten free diet
pneumococcal vaccine for functional hyposplenism
anaemia, hyposplenism, osteoporosis, osteomalacia, lactose intolerance, enteropathy T cell lymphoma, subferility, cancer
intestinal failure cause
treatment
complication of line
surgery, obstruction, congenital, malabsorption
parental nutrition via central/peripheral vein
incorrect placement - pneumothorax, atrial puncture-, sepsis, SVC obstruction, like fracture, line leak, line migration
small bowel obstruction causes
symp
ix
treatment
luminal (gallstone ileas, food, bezoar) wall (tumours corns), arteries occlusion, adhesions post op, hernias
distention, V/N, dia/cons, pain
bloods, erect CXR, AXR>2.5cm, CT, gastrogaffin swallow
trial of NBM, laprotomy and ABs (amox and met), anti embolism
meckels diverticulum is what when should is disappear rule of two symp ix treatmtne t
congenital diverticulum of small intestine, remnant omphalomesenteric duct/vitellointestinal duct
should disappear by w6
2% of population 2feet prox from IC valve 2 inches long
barium follow through, laparoscopy
wedge excision or formal SB resection and anastomosis if symptomatic
appendicits cause symp ix treatment cx
inflammation, irritation, obstruction
mcburneys, irritation, N/V, rovings, fever, abd pain
increased inflam markers, urinalysis - exclude other dx
appendectomy, open/laproscopic. cefoxtin/metro to decrease wound infection. broad spec ABs to those without peritonitis but and mass
perf mass
carcinoid tumour originates from where commonly where symp carcinoid syndrome ix treatment
enterochromaffen cells commonly appendix and terminal ileum most common neuroendocrine tumour appendicitis/obstruction carcinoid syndrome - liver mets urine for 5-HI AA, CT/US of liver surgery
IBS diagnosis
otehr ix
abdominal pain relieved by defamation or associated with altered bowel frequency/stool form and 2 of: alternate stool passage, abdominal bloating distention hard, symp worse on eating, passage of mucous
faecal calciprotectin for IBD, FBC, ESR, CRP, coeliac rule out
red flags for IBS
PR bleeding, decreased weight, FH bowel/ovarian, >=60
treatment of IBS
diet FODMAP, physical activity, antispasmodics: mebevorine, hyoscine. anti motility loperimide
constipation laxatives not lactulose
if not responding to laxatives or constipation >=12m -> linaclotide
second line or further of IBS
TCA amitrip
SSRIs
Eluxodoline for diarrhoea
crohns commonly affects where
ix
cx
terminal ileum and colon
transmural process
increased faecal calcoprotectin, increased ESR/CRP, decreased Hb/B12/Vit D
colonoscopy, histology small bowel enema for terminal ileum
strictures, obstruction, perforation, SB cancer, colorectal cancer, osteoporosis
induce remission for crohns
Pre/methyl/IV hydro. Budesonide as alternative
Enteral feeding for kids
Mesalazine not ass effective
Add on azithro/mercap
metho treat alt
biologic
maintaining remission for crohns
azithro/merca
metho
5ASA if previous surgery
UC severe mild
ix
> 6 bloody stools per day and 1 of: fever, tacky, decreased Hb, decreased alb, increased ESR
Mild <4 stools per day little blood
increased faecal calciprotectin, increased inflam markers, panca and anca pos, AXR shows led pipe
induce remission for US
rectal topical aminocalcylate oral amino topical steroid oral steroid severe IV steroid
maintain remission for UC
cx
oral aminosalicylate
azithro/merca
probiotics
toxic megacolon >6cm in traverse colon
PSC
colorctal cancer
large bowel obstruction cause
symp
ix
rx
cancer, volvulus
distended abdomen, tinkling bowel sounds
bloods, erect CXR, AXR >5cm, gastrgraffen enema, CT
NBM, surgery
colitis symp
ix
infective causes
ischaemic causes
diarrhoea plus minus blood, cramps, dehydration, decreased weight
AXR, stool culture, sigmoidoscopy/coloscopy, Ba swallow
infective: CDiff, camp, shigella, Coli 0157
ischaemia: obstruction, atherosclerosis or mesenteric vessels
diverticular disease symp
ix
treatment
cx
LS pain, change in bowel habit
colonoscopy, CT/Ba enema. if unwell check for cx- erect CXR, abd CT with contrast
high fibre diet, acute ABs, pericolonic abscess drained
Hartmenns for resection
itis, haemorrhage, fistula, perforation, abscess, diverticular phlegman, abscess, peritonitis, obstruction, perf
acute diverticulitis uncomplicated
severe
PO metro and PO co tramox
IV ceftriaxone and IV metro or
IV piptaz
risk factors for colorectal cancer
LS symptoms
RS symptoms
screening
enviro, diet, IBD, FAP/HNPCC
change in bowel habit, bleeding, obstruction, pain
anaemia, weight loss
60-74 every 2 years
ix for colorectal cancer
Dukes ABCD
FOBT. colonoscopy. CT CAP. CEA. CA19-9 A tumour confined to mucosa B invading bowel wal C LN mets D distant mets
palliative treatment
other treatment colorectal cancer
stents, sugircla bypass, diversion stomas
hemicolectomy, resections, colectomy
FAP genetics
how many polyps by what age
rx
ADom disorder of tumour suppressor gene APC
>100 by 30-40yo
prophylactic total colectomy
HNPCC genetics
how many polyps
what type of cancer
ADOM disorder of DNA mismatch repair system
<100 polyps
endom
SBP what
cirrhosis with ascites develop peritonitis
