GI Flashcards
Mean age of onset for Chron’s?
26
Mean age of onset for UC?
34
Where does Chron’s affect?
Any part of gut, commonly terminal ileum
Where does UC affect?
Below the ileo caecal valve, if it goes above the caecum it’s called backwash ileitis
What antibody does UC test positive for?
pANCA (Perinuclear Anti-Neutrophil Cytoplasmic Antibodies), Chron’s tests negative
Which disease is smoking protective for and which is it a RF for?
UC - protective
Chron’s - RF
What is a distinguishing common symtom of Chron’s?
Mouth ulcers
Chron’s symptoms?
Right iliac fossa (LQ) mass/pain Diarrhoea Blood in stool Malabsorption- B12, iron def anaemia (sign - acutely can sound like appendicitis)
UC symtoms?
Diarrhoea due to excess mucus
Bloating
If it says finger up the bum with blood on it think UC
May have weight loss and malaise
Extraintestinal symptoms of UC and Chron’s?
Large joint arthritis Irisitis, Episcleritis erythema nodosum (on shins most common in UC) mouth ulcers (mouth and vagina? Pyoderma gangrenosum
PRIMARY SCLEROSING CHOLANGITIS AND UVEITIS = MORE COMMON IN UC
What would a barium swallow for Chron’s and UC show?
Chron’s - cobblestone appearance
UC - loss of haustrations, drain pipe colon
What is diagnostic for UC and Chron’s?
Chron’s - colonoscopy
UC- sigmoidoscopy
(+biopsy)
Histology of Chron’s?
- Skip lesions
- Transmural inflammation
- Non caseating Granulomas
- Increase in goblet cells
Histology of UC?
- Superficial inflam - mucosal
- Continous
- Crypt abscesses
- Goblet cell depletion
- Ulcers
Complications of Chron’s
Obstruction (due to fibrosis)
Fistulas
Adenocarcinoma of the distal ileum
Osteoporosis
Complications of UC
Perforation, Toxic Megacolon
COMPLICATIONS RARE WITH UC – more common in crohns
What is the severity staging criteria for UC called?
True Love and Witts severity index
What investigations will you do for UC and Chron’s?
- Colonoscopy and biopsy
- Barium swallow
- FBC - anaemia of chronic disease, iron deficient anaemia (B12 often ileum), ESR and CRP raised, low albumin (severe)
Chron’s drug treatment?
- initiate remission 1. oral prednisolone
- maintenance - azathioprine/ mercaptopurine
- 2nd line methotrexate
- unresponsive - influximab (anti TNF)
UC drug treatment?
Initiate remission
- 1st line- Mild: Mesalazine/alamine (5-aminosalicylic acid)
- Moderate: steroids (pred) then 5ASA
- Severe: IV hydrocortisone
- 2nd line: azathioprine, methotrexate (immunosuppressants)
Maintenance
- 1st line: 5-ASA
- 2nd Line: immunosuppressant e.g. azathioprine, methotrexate.
UC and Chron’s non drug treatment
Chron’s stop smoking
B12 and iron supplementation
80% will require surgery – the two surgical options – Ileocaecal resection, Stricturoplasty
Define Coeliac’s?
T Cell mediated Autoimmune disease caused by an abnormal reaction to GLUTEN resulting in damage and inflammation of intestinal tract
Symptoms of coeliac’s?
Malabsorption – Weight loss (buttock wasting in children)
Diarrhoea and steatorrhea
Bloating and Indigestion
Iron deficiency Anaemia (Often initial diagnosis)
Coeliac antibodies
Anti-gliadin
Anti-transglutaminase
Anti-endomysial
Ix for coeliac’s
Blood tests
Small bowel biopsy (4-6 diagnostic)
Antibodies
Tx for coeliac’s
Gluten free diet (lactose free if necessary)
Supplementation
Pneumococcal vaccine (Due to decreased spleen function in some)
Manage Anaemia
Histology of coeliac’s
Villous atrophy
Crypt hyperplasia
Increased lymphocytic infiltration
Complications of coeliac’s
- Malabsorptive problems e.g. osteopenia, iron deficiency anaemia
And - Increases risk of Colon cancer
Appendicitis symptoms
Starts central pain (visceral all over) then moves to lower R quadrant when peritoneum involved Pain radiate to shoulder Pyrexia Pain on Walking Nausea Loss of appetite Testicular pain in men
Appendicitis signs
Rovsing’s sign - press on the left lower quadrant and pain is felt in the right lower quadrant
Dunphy’s sign - coughing causes pain in mcburney’s point
Mcburney’s sign (do on both sides) - rebound tenderness, press in, when take away - pain
Complications of appendicitis
Ischaemia as a result of exudate build up and toxic damage to the blood vessels
This leads to Gangrene – And eventually perforation causing peritonitis, septicaemia and ultimately a gruesome death.
Dx appendicitis
Generic inflammatory/infection markers (CRP, ESR, WCC)
US and CT
laparatomy
Mx appendicitis
Metronidazole
IV abx
Appendectomy
What do you use to know the likelihood of surgery in appendicitis?
Alvarado score
> 7 operate
< 4 unlikely
Cause of acute peritonitis?
Infection or irritation due to:
Perforation
Appendicitis
Cholecystitis