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Inflammation > GI disease > Flashcards

GI disease Flashcards

1
Q

How does coeliac disease present?

A

Non-specific GI problems: bloating, diarrhoea, malabsorption so may be diagnosed with anaemia and consequential osteoporosis

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2
Q

What can inflammation of the small bowel in coeliac disease lead to?

A

Small bowel lymphoma and other cancers

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3
Q

What conditions is coeliac disease associated with?

A

Other AI conditions e.g. thyroid problems and T1DM

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4
Q

Pathology of coeliac disease:

A

Ingesting gluten causes mucosal inflammation, crypt hyperplasia and villous atrophy (VA can reverse in rare refractory cases)

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5
Q

Coeliac genes:

A

All carry HLA DQ2 or DQ8

30-50% of population are just carriers though

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6
Q

Diagnosis of coeliac:

A

OGD + duodenal biopsy

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7
Q

Marsh 1 classification of coeliac:

A

Increased intraepithelial lymphocytes (IEL>30)

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8
Q

Marsh 2 classification of coeliac:

A

Increased IEL and crypt hyperplasia

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9
Q

Marsh 3 classification of coeliac:

A

Increased IEL and crypt hyperplasia and villous atrophy

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10
Q

Marsh 4 classification of coeliac:

A

Total mucosal hyperplasia

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11
Q

Deficiencies with coeliac:

A

B12, Iron, Folate (anaemia)
Vitamin D
Calcium
Others

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12
Q

Haematological issues from coeliac:

A

Anaemia
Hyposplenism
Bleeding

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13
Q

Musculoskeletal issues form coeliac:

A

Osteopaenia and osteoporosis
Stunted growth in children
Vitamin D deficiency and hypocalcaemia

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14
Q

Skin issues from coeliac:

A

Dermatitis
H
Vesicular herpetiforms (intensely blistering, itchy rash)

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15
Q

Neurological issues from coeliac:

A

Muscle weakness, paraesthesia and ataxia
Memory loss
Seizures secondary to cerebral calcification

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16
Q

Hormonal issues from coeliac:

A

Amenorrhoea

Infertility

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17
Q

Risk of hyposplenism?

A

Bacterial pneumonia (offer pneumonia vaccine)

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18
Q

Differentials for coeliac:

A 
Viral/bacterial enteritis
Crohn's (commonest)
Small bowel bacterial overgrowth
IBS
Microscopic colitis (diarrhoea)
Protein losing enteropathy
Malabsorption
Immunodeficiency (can have villous atrophy)
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19
Q

Management of varices

A

Antibiotics due to increased risk of bacteraemia

Terlipressin which causes splanchnic vasoconstriction

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20
Q

Immediate management of GI bleed:

A

Take bloods and give blood
Insert catheter and measure hourly urine output
Antibiotics if varices/aspiration risk
Complete exposure + examination + PR exam

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21
Q

What are Mallory-Weiss tears?

A

Tears of the oesophago-gatric junction caused by prolonged vomiting

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22
Q

What are the drug causes of GI bleeds?

A

NSAIDs and aspirin
Anticoagulants
Steroids

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23
Q

Signs of portal hypertension:

A

Varices
Distended abdomen
Spider naevi
Encephalopathy

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24
Q

PPI treatment for GI bleeds:

A

Pantoprazole infusion 80mg IV stat then 8mg/hour for 72 hours

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25
Q

What does a Blatchford score of 6 or over indicate?

A

There is a greater than 50% risk of needing intervention

26
Q

What is high urea a marker for?

A

Blood being broken down in the upper GIT

27
Q

Management of a severe bleed (Blatchford 6 or over/haemodynamic instability):

A

Urgent OGD once resuscitated

Will need protected airway

28
Q

Management of a mild/moderate bleed:

A

OGD within 24 hours of admission

250mg IV erythromycin 30 minutes before procedure

29
Q

Rockall score <3?

A

Good prognosis

30
Q

Rockall score >8?

A

High risk mortality

31
Q

Modalities to stop bleeding?

A

Bands, APC (burning), clips and adrenaline

32
Q

How do you tell if a peptic ulcer is malignant?

A

Malignant = rolled up edges

33
Q

Treatments for varices after OGD:

A

Propanolol or carvedilol to lower BP

Endoscopic banding every 2-4 weeks

34
Q

How to test for H. Pylori:

A

CLO
Urea breath test
Stool antigen

35
Q

Treatment of H. Pylori?

A

7 day triple therapy: PPI + amoxicillin + metronidazole

36
Q

What causes oesophageal varices?

A

Portal hypertension commonly due to chronic liver disease

37
Q

What is TIPSS?

A

Transjugular intrahepatic portosystemic shunt

Treatment for varices

38
Q

Signs of UC:

A

Bloods: raised CRP/ESR, anaemia, low albumin
Faecal calprotectin
Low albumin

39
Q

Diagnosis of UC?

A

Gold standard is endoscopy - white ulcers and red inflammation

40
Q

Classification of UC:

A 
Proctitis - rectum
Left-sided colitis
Pancolitis
Distally progressive
Settles after 5 years
41
Q

Medications for UC:

A

Prednisolone
Aminosalicydates - mesavant, octasa
Immunosuppressants - azathioprine, methotrexate
Biologics

42
Q

Anti-TNF medications for UC:

A

Infliximab
Adalimumab
Golimumab

43
Q

Anti-integrin medication for UC:

A

Vedolizumab

44
Q

Surgeries for UC:

A

Subtotal colectomy/total colectomy
Ileostomy
J-pouch (complications of urgency, infertility in women and pouchitis)

45
Q

What is Truelove and Witt criteria used for?

A

Assessing the severity of UC

46
Q

What qualifies as severe UC (T+W)?

A 
Over 6 motions a day that are bloody
Temp >37.8
Pulse >90
Haemoglobin <10.5
Raised CRP
47
Q

Use of sigmoidoscopy in UC?

A

Exclude CMV

48
Q

Increased risk in UC of…

A

C. diff

49
Q

Features of toxic megacolon/leadpipe colon:

A

No rural folds
Pattern not tortured
High risk of perforation >6cm

50
Q

Management of toxic megacolon/leadpipe colon:

A

Hydrocortisone 100mg QDS
Dalteparin 500 units
Daily review due to high risk of DVTs (despite bleeding)
Then ciclosporin/infliximab

51
Q

Day 3 of admission of UC, CRP >45 and bowels open >8 times in one day…

A

Chance of colectomy 85%

52
Q

Where is Crohn’s mainly found?

A

Terminal ileum

53
Q

Symptoms of Crohn’s:

A 
Diarrhoea
Rectal bleeding
Abdominal pain
Weight loss
Perianal abscess
Oral ulceration
54
Q

Differentials between UC and Crohn’s:

A

UC is colon whereas Crohn’s is mouth to anus
Crohn’s is full thickness whereas UC is not past crypts
UC is bloody diarrhoea, Crohn’s is non-bloody
Crohn’s can have bowel obstruction and fistulae
UC can have primary sclerosis cholangitis
UC more associated with colorectal cancer

55
Q

Signs of Crohn’s:

A 
Cachexia
Scars
Overweight as easy to digest junk food
Stomas (2-3)
Parenteral nutrition
56
Q

Tests in Crohn’s:

A

Anaemia: low B12, folate
Ferritin
Low albumin
Faecal calprotectin

57
Q

Diagnosis of Crohn’s:

A

Endoscopy - Ulcers are deeper and patchier than in UC with more visible blood vessels

58
Q

Imaging in Crohn’s:

A

Small bowel US
Small bowel MRI (white inflammation, strictures)
MRI of pelvis

59
Q

Medications for Crohn’s:

A

Steroids: prednisone + budeconide (short term and local)
Abx: ciprofloxacin + metronidazole
Immunosuppressants: azathioprine, mercaptopurina, methotrexate
Biologics
Modulen drink

60
Q

Biologics for Crohn’s:

A

Anti-TNFs: infliximab, adalimumab, golimumab

2nd line: vedolizumab (anti-integrin), ustekinumab (IL-12,23)

61
Q

Surgery for Crohn’s:

A

Exam under anaesthesia of perianal disease
Stricturopathy
Colectomy
Diverting colectomy

Inflammation (9 decks)

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