GI CBL Flashcards
Differential dx of diarrhoea
Coeliac
Small bowel chrons
Ulcerative colitis
Infective gastroenteritis
What does steatorrhoea point to?
Fat malabsorption due to pancreatic insufficiency
What is the relevance of family hx in a GI history?
Relevance of autoimmune diseases - possibility of another disease causing symptoms e.g. thyrotoxicosis, addisons disease, coeliac disease
Relevance of itchy rash in GI hx
May point towards dermatitis herpetiformis - coeliac disease
What does faecal calprotectin show?
Protein produced in the gut as a result of inflammation. Can be used to differentiate between functional and organic GI disorders. It is non specific and may be raised due to any cause of underlying inflammation
What does faecal elastase show?
It is a pancreatic enzyme which doesn’t undergo degradation. Useful marker of pancreatic activity. Low faecal elastase (<500) may point to pancreatic exocrine insufficiency.
Genetic basis of coeliac disease
HLADQ2/8 (95% patients)
Investigations in GI
Haematology - Hb, MCV, B12, Folate, Ferritin Biochemistry Faecal calprotectin Faecal elastase Immunology - TTG, anti-endomysial CXR - excludes malignancy/TB
What classification system is used in coeliac disease?
Marsh classification
Potential complications of coeliac disease
Osteoporosis
Iron deficiency anaemia
Small bowel malignancy
How would a patient be seen as non compliant with gluten free diet?
TTG stays positive with ongoing exposure to gluten. Patients may be compliant with GFD but have ongoing villous atrophy - refractory coeliac disease
Investigations in coeliac for pathology
OGD (gastroscopy) with duodenal biopsy
Why may people with coeliac be more prone to infections?
Functional hyposplenism - indicated by howell-jolly bodies on blood film
A patient has been compliant with GFD, however is not getting any better. What are alternative diagnoses?
IBS
lymphocytic colitis
autonomic neuropathy
refractory coeliac disease
Risk factors for viral hepatitis to ask for in hx
IVDU
Historical transfusion
Which over the counter drug can derange LFTs?
Paracetamol
Important questions in hx for hepatitis?
Sexual history
IVDU
Historical transfusion
Flu like symptoms - viral hepatitis
Differential diagnosis for deranged LFTs
Hepatitis: drug induced, viral hepatitis, autoimmune
NAFLD
Haemochromatosis
Obstructive jaundice secondar to cholelithiasis
Pancreatic malignancy
Liver investigations
Biochemistry - LFTs, U/E
Haematology - FBC, Coag profile
Liver screen - Liver autoantibodies, Ferritin, Immunoglobulins, viral hepatitis serology
USS abdomen
Define autoimmune hepatitis (AIH)
Chronic inflammatory liver disease which if untreated leads to cirrhosis, liver failure and death. Women are affected 3-4x more than men.
Key findings in investigations that point towards AIH
Elevated ALT and AST
Raised serum immunoglobulins
Negative hepatitis serum
High titres of circulating autoantibodies (IgG)
Once AIH is suspected, what would be the next step?
Liver biopsy - grade of inflammation and fibrosis can be described using validated pathological index
Treatment for AIH
Immunosuppresive glucocorticoids
with or without azathioprine
Important investigations in strong clinical suspicion of colorectal cancer?
CT to detect liver or lung metastases
MRI for staging within the pelvis
PET Scan
Treatment of colorectal cancer
Surgery - site dependent, right hemi-colectomy, excision of ascending/transverse/descending/sigmoid dependent on tumour location
Colostomy may be needed
Chemotherapy
Radiotherapy
A resection specimen of a colorectal tumour is sent to pathology. What info can the pathologist provide?
Confirmation of dx
Evaluation of whether complete resection had been achieved
Quality of surgery
Evaluation of response by carcinoma to chemo
What staging is used in colorectal adenocarcinomas?
Dukes staging - ABCD
Risk factors for colorectal adenocarcinoma?
Size and number of adenomas
Ulcerative colitis
Crohn’s
Cancer syndromes (especially APC and Lynch syndrome)
