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
