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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
What does a Blatchford score of 6 or over indicate?
There is a greater than 50% risk of needing intervention
26
What is high urea a marker for?
Blood being broken down in the upper GIT
27
Management of a severe bleed (Blatchford 6 or over/haemodynamic instability):
Urgent OGD once resuscitated | Will need protected airway
28
Management of a mild/moderate bleed:
OGD within 24 hours of admission | 250mg IV erythromycin 30 minutes before procedure
29
Rockall score <3?
Good prognosis
30
Rockall score >8?
High risk mortality
31
Modalities to stop bleeding?
Bands, APC (burning), clips and adrenaline
32
How do you tell if a peptic ulcer is malignant?
Malignant = rolled up edges
33
Treatments for varices after OGD:
Propanolol or carvedilol to lower BP | Endoscopic banding every 2-4 weeks
34
How to test for H. Pylori:
CLO Urea breath test Stool antigen
35
Treatment of H. Pylori?
7 day triple therapy: PPI + amoxicillin + metronidazole
36
What causes oesophageal varices?
Portal hypertension commonly due to chronic liver disease
37
What is TIPSS?
Transjugular intrahepatic portosystemic shunt | Treatment for varices
38
Signs of UC:
Bloods: raised CRP/ESR, anaemia, low albumin Faecal calprotectin Low albumin
39
Diagnosis of UC?
Gold standard is endoscopy - white ulcers and red inflammation
40
Classification of UC:
``` Proctitis - rectum Left-sided colitis Pancolitis Distally progressive Settles after 5 years ```
41
Medications for UC:
Prednisolone Aminosalicydates - mesavant, octasa Immunosuppressants - azathioprine, methotrexate Biologics
42
Anti-TNF medications for UC:
Infliximab Adalimumab Golimumab
43
Anti-integrin medication for UC:
Vedolizumab
44
Surgeries for UC:
Subtotal colectomy/total colectomy Ileostomy J-pouch (complications of urgency, infertility in women and pouchitis)
45
What is Truelove and Witt criteria used for?
Assessing the severity of UC
46
What qualifies as severe UC (T+W)?
``` Over 6 motions a day that are bloody Temp >37.8 Pulse >90 Haemoglobin <10.5 Raised CRP ```
47
Use of sigmoidoscopy in UC?
Exclude CMV
48
Increased risk in UC of...
C. diff
49
Features of toxic megacolon/leadpipe colon:
No rural folds Pattern not tortured High risk of perforation >6cm
50
Management of toxic megacolon/leadpipe colon:
Hydrocortisone 100mg QDS Dalteparin 500 units Daily review due to high risk of DVTs (despite bleeding) Then ciclosporin/infliximab
51
Day 3 of admission of UC, CRP >45 and bowels open >8 times in one day...
Chance of colectomy 85%
52
Where is Crohn's mainly found?
Terminal ileum
53
Symptoms of Crohn's:
``` Diarrhoea Rectal bleeding Abdominal pain Weight loss Perianal abscess Oral ulceration ```
54
Differentials between UC and Crohn's:
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
Signs of Crohn's:
``` Cachexia Scars Overweight as easy to digest junk food Stomas (2-3) Parenteral nutrition ```
56
Tests in Crohn's:
Anaemia: low B12, folate Ferritin Low albumin Faecal calprotectin
57
Diagnosis of Crohn's:
Endoscopy - Ulcers are deeper and patchier than in UC with more visible blood vessels
58
Imaging in Crohn's:
Small bowel US Small bowel MRI (white inflammation, strictures) MRI of pelvis
59
Medications for Crohn's:
Steroids: prednisone + budeconide (short term and local) Abx: ciprofloxacin + metronidazole Immunosuppressants: azathioprine, mercaptopurina, methotrexate Biologics Modulen drink
60
Biologics for Crohn's:
Anti-TNFs: infliximab, adalimumab, golimumab | 2nd line: vedolizumab (anti-integrin), ustekinumab (IL-12,23)
61
Surgery for Crohn's:
Exam under anaesthesia of perianal disease Stricturopathy Colectomy Diverting colectomy

Inflammation (9 decks)

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