GI Pathology 2 Flashcards
Gastritis
This is inflamation of the stomach lining. Gastritis may be acute or chronic.
Causes of acute gastritis.
- Stress
- Uraemia
- Alcohol
- NSAIDs
- Burns: Curling’s ulcer
Chronic gastritis
- Type A
- Autoimmune: autoantibodies are present to parietal cells
- Presents with perncious anaemia
- Occurs in the fundus or the body of the stomach
- Type B
- Most common
- Associatedwith Helicobacter pylori infection
Investigations for H. pylori infection
- bloods: anaemia and H. pylori (antibodies)
- Urinalysis
- Carbon isotope - urea breath test
- Endoscopy with biopsy of stomach lining
- Stool microscopy and culture - may detect trace amounts of H. pylori
Treatment for H. pylori
Triple therapy to erradicate H. pylori:
- proton pump inhibitor
- ammoxicillin 1g and clarithromycin 500mg
or
- metronidazole 400mg and clarithromycin 250mg
(Medications twice daily)
Treatment of gastritis
Mild - antacids or H2 receptor antagonists
Moderate/severe - PPI
Gastritis complications
- Peptic ulcers
- Anaemia (from bleeding ulcers)
- Stricture formation
- Mucoal-associated lmphoid tissue (MALT) lymphoma
What is irritable bowel syndrome?
This is a common functional disorder of the bowel.
Signs and symptoms of IBS
- Recurrent abdominal pain
- which improves on defecation
- Change in bowel habit
- increased or decreased frequency
Treatment for IBS
Conservative:
- education and avoidance of triggering factors
Medical - depends on symptoms :
- antimuscarinics
- laxatives
- stool softners
- antispasmotics
- antidepressants
Complications of IBS
Depression and anxiety
What is appendicitis?
This is inflammation of the appendix that presents with pain that can origionate in the umbilical area before migrating to the right iliac fossa.
Appendicitis investigations
- Bloods: FBC, U&Es, CRP
- Ultrasound
- Pregnancy test in females of child-bearing age to rule out ectopic pregnancy
Appendicitis complications
Peritonitis
What is ulcerative colitis (UC)?
UC is a relapsing remitting inflamatory disorder of the colonic mucosa.
Which part of the bowel does UC affect?
It may just affect the rectum (30%) or extend to involve part of the colon (40%) or the entire colon (30%).
It ‘never’ spreads proximal to the ileocaecal valve (except for backwash ileitis).
What feature differentiates UC from Crohns disease?
Continuous inflamation limited to the mucosa.
Ulcerative colitis epidemiology.
- typically presents around 20-40 years
- UC is 3 fold as common in non-smokers
- symptoms may relapse on stopping smoking
Symptoms of UC
- episodic or chronic diarrhoea (± blood and mucus)
- crampy abdominal discomfort
- bowel frequency relates to severity
- tenesmus
Systemic symptoms in attacks:
- fever
- malaise
- anorexia
- ↓weight
Extraintestinal signs of UC
- Clubbing
- Aphthous oral ulcers
- Erythema nodusum
- Pyoderma gangrenosum
- Conjunctivitis
- Episceritis
- Iritis
- Large joint arthritis
- Scroiliitis
- Ankolysing spondylitis
- Primary sclerosing cholangitis
Investigations for UC
- Blood - FBC, ESR, CRP, U&E, LFT, blood culture
- Stool - MC&S
- to exclude Campylobacter, Salmonella, Shigella, E.coli, amoebae
- Faecal calprotectin
- a simple non-invasive test for GI inflamation with high sensitivity
- AXR
- mucosal thickening, colonic dilation
- Lower GI endoscopy
- limted flexible sigmoidoscopy if acute to assess and biopsy
- full coloonoscopy once controlled to define disease extent
Complications from UC
- Toxic megacolon
- Increased incidence of colon cancer
- Primary sclerosing cholangitis
- Osteoporosis (from steroid use)
Treatment for mild UC
- 5-ASA eg mesalazine
- PR for distal disease
- PO for more extensive disease
- Topical steroid foams PR or prednisolone 20mg retention enemas
- Less effectve than PR 5-ASA but ay be needed in addition
Treatment for moderate UC.
If 4-6 motions per day but otherwise well:
- oral prednisolone
- 40mg/d for 1wk, then taper by 5mg/wk over following 7 weeks
- then maintain on oral 5-ASA
