GI Flashcards
Crohn’s disease
Type of IBD
Inflammation of digestive tract- mouth to anus
Sx: pain (often R lower quad), diarrhoea, blood in stool, fatigue, weight loss, malnutrition.
Immune related, not autoimmune. Triggered by foreign pathogen- mycobacterium paratuberculosis, pseudomonas - large immune response = destruction
Cousin: ulcerative colitis- large intestine
Risk factor: Genetics - NOD2 frameshift
Make granulomas -> ulcers beyond submucosa layer / transmural
Scattered areas of inflammation - cobblestone
1. Ileum and colon most common
2. Ileum
3. Colon
Tx: anti inflammatorys
Antibiotics - control bacterial levels, control Sx
Immunosuppressants first severe
Surgery to remove
Destination from ulcerative colitis: surgery doesn’t cure crohns, can happen anywhere on GI track
Ulcerative colitis
IBD with crohns Specifically in large intestine Ulcers in lumen - in mucosa and submucosa Flares and remission Most common type of IBD Most common in Young women teens-30’s
Cause: secondary (stress and diet), autoimmune (cytotoxic T cells), p- ANCA in blood (antibodies that target our neutrophils ), sulphide producing bacteria, all theories.
Pattern: circumferential and continuous, no normal tissue.
Sx: Pain in left lower quad, diarrhoea and blood, dehydration
Diagnosis: colonoscopy plus biopsy
CT, MRI, barium enema, X-ray
Tx: anti inflammatories - sulfasalazine, mesalamine
Immunosuppressors- corticosteroids, azathioprine, cyclosporine
Biological - infliximab, adalimumab
Colectomy- removal large intestine
Commonest cause of travellers diarrhoea
ETEC enterotoxigenic escherichia coli
Post course of antibiotics for chest infection
Abdo pain, watery diarrhoea, temperature, other family fine
C diff Associated with antibiotic use Gram positive anaerobe , spore forming Causes colitis Toxin producing- damage lining of bowel Diagnosis: stool sample , serious complications if not treated Report to public health
Giardiasis
Infection of small intestine
Parasite
Drinking contaminated water
Flatulent, bloating, burping
Mallory Weiss tear
Tissue tear in lower oesophagus
Present: heamatemesis
Associated with violent coughing or vomiting
Mostly self limiting so supportive Tx.
Endoscopy - rule out other causes of upper GI bleeds
Often right border near gastro oesophageal junction
Oesophageal varices
From portal hypertension, complication of cirrhosis
Hepatic venous pressure gradient >12 mmHg = decompensated cirrhosis
Significant mortality and morbidity
Tx : preventative - non selective B blockers
Acute haemorrhage- resus, vasopressin / octreotide IV if suspected
Variceal ligation when confirmed on endoscopy
Balloon tamponade
TIPS - early trans-jugular intrahepatic Porto- systemic stunt - if other Tx fails.
Pain causes
BIDI Blockage Inflammation Damage, dysfunction Ischemia
Colicky central abdo pain migrating to Sharp right iliac fossa pain.
Appendicitis
McBurney’s point -1/3 distance from asis to umbilicus
Deep tenderness here.
AAA
Pulsating mass the pain radiating to back
Contrast CT gold standard
Gastric ulcers
Caused by : NSAIDs and alcohol H pylori colonises exposed area Converts urea to ammonia and CO2 Tx: clarithromycin and inject adrenaline to stop bleeding Gastric : pain on eating Duodenal: pain relived by eating Painful 2-5h after
Iron absorption: duodenum
Folate : jejunum
B12 : ileum
C.diff infection
Opportunistic, blood in diarrhoea usually after amoxicillin
1st Tx: metronidazole
2nd vancomycin
Ulcer damage through entire intestinal wall - transmural
Vs
Only through mucosa and submucosa
Crohns
UC