GI Flashcards
What is meant by the term inflammatory bowel disease?
Umbrella term:
- Crohn’s disease
- Ulcerative colitis
What is Crohn’s disease?
Transmural, granulomatous inflammation affecting any part of the gut (mouth to anus)
Describe the macroscopic and microscopic features of Crohn’s disease
Macroscopic:
- Skip lesions (‘cobblestone’ appearance)
Microscopic:
- Transmural
- Granulomas
- Goblet cells present
What are the symptoms and signs of Crohn’s disease?
Symptoms:
- Diarrhoea
- RLQ abdominal pain
- Weight loss
- Fatigue
Signs:
- Mouth ulcers
- Anaemia
Describe the investigation of Crohn’s disease
Bloods:
- FBC may show anaemia
- ESR/CRP raised
Stool sample to rule out infection
Colonoscopy and biopsy = DIAGNOSTIC
Describe the pharmacological management of Crohn’s disease
- Oral corticosteroid, e.g. prednisolone
- IV hydrocortisone in severe flare-ups
- Add anti-TNF antibodies (e.g. Infliximab) or DMARD (e.g. sulfasalazine, methotrexate) in severe disease
What is ulcerative colitis?
Inflammatory condition affecting the colon mucosa ONLY!
Describe the macroscopic and microscopic features of ulcerative colitis
Macroscopic:
- Continuous lesion (no skip lesions)
- Ulcers
Microscopic:
- Mucosa ONLY
- No granulomas
- Goblet cell depletion
- Crypt abscesses
Describe the symptoms and signs of ulcerative colitis
Symptoms:
- Diarrhoea WITH BLOOD/MUCUS
- LLQ abdominal pain
Signs:
- Fever
- Erythema nodusum
Describe the investigation of ulcerative colitis
Bloods:
- ESR/CRP raised
- Autoantibody screen for pANCA (perinuclear anti-neutrophil cytoplasmic antibodies)
Stool sample to rule out infection
Colonoscopy and biopsy = DIAGNOSTIC
Describe the pharmacological management of ulcerative colitis
- DMARD, e.g. Sulfasalazine
- Add oral prednisolone if necessary
Describe the interventional management of ulcerative colitis
Colectomy
What is irritable bowel syndrome?
A group of abdominal symptoms for which no organic cause can be found
Describe the symptoms of irritable bowel syndrome
- Abdominal pain relieved by defecating
- Bloating
- Alternating bowel habits (constipation, diarrhoea)
Describe the investigation of irritable bowel syndrome
Diagnosis is made after ruling out differentials (i.e. Crohn’s disease, ulcerative colitis, Coeliac disease etc.)
Describe the pharmacological management of irritable bowel syndrome
- For pain/bloating: anti-spasmodic, e.g. buscopan
- For diarrhoea: anti-motility agent, e.g. loperamide
- For constipation: laxative, e.g. senna
What is GORD? Describe its pathophysiology
GORD = gastro-oesophageal reflux disease
Reflux of gastric contents into the oesophagus due to relaxation of the lower oesophageal sphincter independently of swallowing
What are the risk factors for GORD?
- Male
- Increased abdominal pressure, e.g.obesity, pregnancy
- Smoking
- Hiatus hernia
What is the main symptom of GORD?
Heartburn
Describe the pharmacological management of GORD
- Anatacids, e.g. gaviscon
- H2 blockers, e.g. ranitidine
- PPIs, e.g. lansoprazole
How do PPIs work?
PPIs inhibit release of hydrogen ions into the stomach, so inhibit production of gastric acid
What is a peptic ulcer?
A break in the epithelial lining penetrating down to the mucosa (in the stomach/first part of the duodenum)
What are the causes of peptic ulcers?
Helicobacter pylori infection
NSAID use
Describe the investigation of helicobacter pylori infection
- Urea breath test
- Stool antigen test
- Serology
Describe the pharmacological management of helicobacter pylori infection
- PPI, e.g. lansoprazole
- 2 Abx (clarithromycin and metronidazole)
How do NSAIDs cause peptic ulcers?
NSAIDs inhibit cylooxygenase 1, which inhibits the production of prostaglandins which are needed for mucus production (this leads to mucosal damage)
What is Coeliac disease?
Gluten intolerance
Describe the investigation of Coeliac disease
Bloods:
Autoantibody screen for IgA tissue transglutaminase (tTG) antibody and IgA anti-endomysial antibody (anti-EMA) - MUST HAVE GLUTEN IN DIET WHEN TESTING FOR ANTIBODIES
Duodenal biopsy is diagnostic
What are the symptoms and signs of Coeliac disease?
Symptoms:
- Diarrhoea
- Abdominal pain/bloating
- Fatigue
- Weight loss
Signs:
- Anaemia
- Dermatitis herpetiformis
Describe the conservative management of Coeliac disease
Remove gluten from diet
What are the 3 major symptoms/signs of malabsorption?
Weight loss, steatorrhoea and anameia
What is appendicitis?
Inflammation of the appendix
Describe the symptoms an signs of appendicitis
Symptoms:
- Acute pain starting around umbilicus migrating to RIF
- Nausea, vomiting
- Fever
Signs:
- Abdominal guarding
Describe the interventional management of appendicitis
Apendicectomy
What is peritonitis?
Inflammation of the peritoneum due to entry of blood, air, bacteria or GI contents (either faeces or bile)
What are the symptoms of peritonitis?
Symptoms:
- Dull pain that becomes sharp
- Pain worse on coughing/moving
Signs:
- Abdominal guarding
What are the causes of peritonitis?
AEIOU and P
A - appendicitis/ascites E - ectopic pregnancy I - infection with TB O - obstruction U - ulcer and P - peritoneal dialysis
Describe the investigation of peritonitis
- Ascitic tap: high neutrophil count
- AXR: dilated bowel, gas under diaphragm
Describe the pharmacological management of peritonitis
IV Cefotaxime and Metronidazole
What is ischaemic colitis?
Reduced blood supply to the colon
What is mesenteric ischaemia?
Reduced blood supply to the small bowel
What is the main cause of ischaemic colitis/mesenteric ischaemia?
Atherosclerosis
Describe the management of ischaemic colitis/mesenteric ischaemia
Conservative:
- Modification of risk factors (atherosclerosis)
Interventional:
- Resection of ischaemic/dead bowel
- Stenting
- Mesenteric artery bypass graft
What is a Mallory-Weiss syndrome?
Bleeding and other symptoms caused by a tear in the mucous membrane of part of the upper GI tract (oesophagus,stomach and first part of the duodenum)
Give the 2 most common sites for a Mallory-Weiss tear
- Gastro-oesophageal junction
- Upper part of the stomach
What causes Mallory-Weiss tear(s)?
Persistent retching/vomiting
What are the symptoms of Mallory-Weiss syndrome?
- Bringing up blood after retching/vomiting
- Epigastric abdominal pain
- Black, tarry stools
Describe the investigation of Mallory-Weiss syndrome
Gastroscopy
Describe the management of a Mallory-Weiss tear
Usually the tear heals by itself
PPIs may be given to help the tear heal
What is a hernia?
Give some examples of types of hernia
Protrusion of an organ or tissue outside of the cavity in which it normally lies
Inguinal hernia
Hiatus hernia
Umbilical hernia
Incisional hernia
What causes a hernia?
- Muscle weakness (trauma, age)
- Abdominal strain (pregnancy, chronic cough, constipation)
What is an inguinal hernia?
Protrusion of abdominal cavity contents through the inguinal canal
What is a hiatus hernia?
Protrusion of part of the stomach though the oesophageal hiatus of the diaphragm
What is gastritis?
Inflammation of the lining of the stomach
What causes gastritis?
- Helicobacter pylori infection
- NSAID use
What is diverticulitis?
- Diverticula are outpouchings which develop in the lining of the intestine as we age
- Inflammation of these diverticula = diverticulitis
Describe the investigation of diverticulitis
Colonoscopy
Describe the management of diverticulitis
Conservative:
- High fibre diet
Pharmacological:
- Paracetamol
What is pancreatitis?
Destruction of pancreas by pancreatic enzymes
What are the main causes of pancreatitis?
Gallstones
Alcohol
Steroids
Trauma, e.g. ERCP
Describe the symptoms and signs of pancreatitis
Symptoms:
- Epigastric pain radiating to back (relieved by sitting forward)
Signs:
- Cullen’s/Grey Turner’s sign (bruising around umbilicus/flanks)
Describe the investigation of pancreatitis
Bloods:
- High amylase/lipase
Describe the management of pancreatitis
Supportive - e.g. IV fluids
Analgesia
What are the causes of intestinal obstruction?
- Tumour
- Adhesions
- Volvulus
- Crohn’s
- Diverticulitis
On abdominal examination, tympanic bowel sounds suggest what?
Air/gas
