GI Flashcards
Who does inflammatory bowel disease effect the most?
White + young adults
What is the cause of IBD + the associations?
Idiopathic but suggested associations with: Genetics (Crohn’s), the environment (smoking), and immune response (increased response to bacteria/Ag in both UC + CD)
What is the effect of smoking on the chance of getting IBD?
Increased risk in Crohn’s and decreased risk in UC
What is the cancer risk in IBD?
Increased (+ a bigger increase in UC compared to Crohn’s)
Describe the distribution of UC lesions in the GI system compared to CD (Crohn’s)?
UC: continuous from rectum (but only affects the large intestine)
CD: patchy distribution (mouth to anus)
What layers of the GI system are affected in UC compared to Crohn’s?
UC: Mucosa
CD: All layers (mucosa –> muscularis propria + adventitia)
What is the macroscopic intestinal of UC compared to Crohn’s?
UC: inflamed colon w/ polyps
Crohn’s: cobblestone appearance
What is the microscopic appearance of UC compared to Crohn’s?
UC: ulcers, no granuloma, crypt abscesses, depleted goblet cells
CD: Granuloma (non-caseating), goblet cells
What is the big symptom in Crohn’s?
Weight loss + diarrhoea
What is the big symptom in UC?
Bloody diarrhoea w/ mucus
Give 4 symptoms of UC
Malaise/lethargy, proctitis, diarrhoea, lower abdo pain
Give 3 symptoms of Crohn’s
Diarrhoea, WEIGHT LOSS, pain on defacation
What MSK conditions are Crohn’s and UC linked to?
HLA B27 +ve seronegative spondyloarthropathies
Give 3 signs of UC
Mouth ulcers, rectal bleeding, signs of malnutrition
Give 3 signs of Crohn’s
Perianal disease (anal tags, haemorrhoids…), signs of malnutrition, mouth ulcers
What are some examples of extraintestinal manifestations of IBD
Erythema nodosum, clubbing, uveitis, IBD ARTHRITIS, ankylosing spondylitis (seronegative spondyloarthropathy), anaemia
What are the general Ix’s you would carry out for a patient presenting with IBD? What will the tests show?
Blood cultures + stool sample (exclude infective cause of diarrhoea), bloods (anaemia, ^ inflammatory markers, ^WCC)
What is the gold standard Ix for UC?
Colonoscopy
What might you do to Ix Crohn’s?
barium swallow small bowel imaging
What would you do to diagnose UC?
Colonoscopy + rectal biopsy
What would you do to diagnose Crohn’s?
Sigmoidoscopy + rectal biopsy
What area of the GI tract does Crohn’s favour?
Terminal ileum
What disease is erythema nodosum a classical feature in?
Sarcoidosis (red lesions on shins)
What is the 1st line of the treatment for UC and Crohn’s?
Induce and maintain remission
What is the general conservative management for UC?
treat anaemia + diarrhoea (codeine phosphate or loperamide)
What is the 1st line Rx to induce remission for UC?
1st: corticosteroid (prednisolone) or 5-ASA (sulfasalazine)
What is the 2nd line Rx to induce remission for UC?
Use BOTH corticosteroid + 5-ASA
Whatis the 3rd line Rx to induce remission for UC?
Admit the pt
How do you maintain remission in UC?
5-ASA (sulfasalazine)
What is the 2nd line curative treatment for UC? What is this based on?
Surgery (colectomy w/ iliostomy). Based on the idea that there is a clear distinction in healthy and pathological bowel
What is the conservative management for Crohn’s?
SMOKING CESSATION, Rx anaemia + diarrhoea
How do you induce remission for Crohn’s?
Corticosteroid + anti-TNFalpha
Give an example of anti-TNF treatment?
Infliximab, adalimumab, etanercept (TNF receptor)
How would you maintain remission in Crohn’s?
5-ASA (sulfasalazine)
What does 5-ASA stand for?
5-aminosalicylic Acid
What are SEs of 5-ASA?
GI upset (abdominal pain, nausea, cramping…etc)
Give an example of an anti-emetic. How does it work?
Ondasetron. A serotonin 5-ht3 receptor antagonist
Who is commonly affected by Coeliac disease?
White, IRISH, N. Europe
What is Coeliac disease?
A gluten sensitive enteropathy - an autoimmune disease
What contains gluten?
Wheat, barley and rye
What is the toxic protein in gluten?
Gliadin
What diseases give you increased risk of getting coeliac?
T1DM, thyroid diseases, atopy
Describe the pathology of coeliac disease
Gliadin crosses damaged intestinal epithelium –> MHC binds to gliadin and presents it on HLA DQ2 or DQ8 to a Th cell –> Th cell releases inflammatory cytokines
What do the inflammatory cytokines Th cells release in response to binding to an APC presenting gliadin?
Villous atrophy, crypt hyperplasia, B cell activation, increased expression of HLA DQ8/DQ2 on intestinal epithelium
What antibodies to activated B cells produce?
IgA tTG (tissue transglutaminase), EMA (anti-endomysial antibody), IgA + IgG to gliadin
In terms of symptoms/signs, what effects does villous atrophy have?
Malabsorption (weight loss), anaemia (reduced Fe + B12 absorption), diarrhoea (reduced water absorption), steatorrhoea (reduced fat absorption)
What are the symptoms of anaemia
Fatigue, lethargy, malaise…etc
What are some other symptoms of Coeliac disease?
Infertility, abdominal pain, bloating
What is a unique sign found in Coeliac disease?
Dermatitis herpetiformis
What other sign can be found in Coeliac disease?
Distension, weight loss..etc
What are the two risks associated with Coeliac disease?
Increased risk of cancer (particularly lymphoma), osteoporosis
What Ix’s might you carry out in someone with Coeliac disease?
Serology, 4 or more duodenal biopsies, DEXA scan
What are you looking for in serology to Ix Coeliac disease?
tTG, EMA, IgG/IgA to gliadin
How many duodenal biopsies do you need to diagnose Coeliac disease and how long must a person keep gluten in their diet for?
4 or more + 6weeks
What does a duodenal biopsy demonstrate in coeliac disease?
Villous atrophy, crypt hyperplasia, ^ intraepithelial lymphocytes
What is the classic presentation of a Mallory Weiss tear?
A history of persistent vomiting + retching before haematemesis
What must you do before doing an oesophageal endoscopy?
Stop NSAIDs + give PPI (omeprazole)
What do peptic ulcers encompass?
Gastric and duodenal ulcers
When do those with duodenal ulcers get epigastric pain?
At night and when hungry (relieved by eating)
How would you eradicate H. pylori?
Triple therapy: omeprazole, amoxicillin + metronidazole
How would you treat peptic ulcer not caused by H. pylori?
Stop NSAIDs (use COX-2 inhibitors instead), PPI (omeprazole), treat complications
What are the complications of a peptic ulcer?
Perforation (causing peritonitis), gastric outlet obstruction (fibrosis/scarring), haemorrhage
What positions are direct and indirect inguinal hernias to the inferior epigastric artery?
Direct: medial
Indirect: lateral
