GI problems 1 Flashcards
What things do we want to know about bowel habits?
- how regular
- diahorrea, constipation
- colour pale - jaundice, red - blood, black - from upper GI tract
- blood - normally inflammatory
- fatty
- pain
- what time of day
What are common causes for diahorrhea with blood
- inflammation - crohns, UC, infection
- cancer
Blood in diahorrhea, and weight loss differntials
-what to figure out enxt
- inflammation - crohns, UC, infection
- cancer
- weight loss - coeliac (not normally blood)
- full blood count
- want to know if there is malnutriton - coeliac, test b12, folate, iron ect
- want to know how long - iron low - blood for a while
-also do stool sample to see if infection
Infection
- diahorrhea for a couple of weeks
- may be immune compromsied or taken antibitoics - c.difficle
- not normally blood
- check if recent travel
- normally self limiting
IBS
- dont normally get irregular bowel habits at night
- no bleeding
HOW CAN we tell if it is acute or prolonged blood loss?
microcytic anaemia - lots of iron lost so would be chronci
-if normal - then short term bledeign
What are inflammatory markers?
- WBC, neutrophils, CRP, platelet
- normocytic anaemia
- low albumin, high ferritin - acute phase reaction
** Differences between Crohns and ulcerative colitis
-other complications of crohns disease
Crohns - any part of GI tract
- discontinuous inflammation
- fistulisin, stricturing, perianal, anal fissure, deep ulcers
UC - colon only
- continuous inflammation starting at rectum
- shallow ulcers
*** differences beteen colitis, ileitis, gastritis/duodentiits
– Colitis – diarrhoea, bleeding
– Ileitis – abdominal pain, typically at least an hour or so post-prandial
– Gastritis/duodenitis – dypepsia
** symptoms of stricural disease
-if get obstruction - can get abdominal pain and distentsion, vomiting, bowels not opening
*** UC symptoms
- diarrhoea, bleeding
- frequent bowel motions and urgency
- abdominal discomfort
- fever, malaise, weight loss
- raised CRP, ESR
Other complicaitons of UC
Toxic megacolon
- occurs in severe UC and doesnt repsosd to teratment
- release NO, dont get contraction, and have dilated colon
- complications - perforation
-can get damage to other body organs
Cause for weight loss with crohns
- reduced intake because of pain
- malabsroption
- chornci infalmmation inrease energy exependiture
*** Treatment for IBD
- anti-inflamatorys - 5-aminosalicylates
- steroids e.g prednisone
- immunosupression
Surgery - does not treat this, but can remove parts of severe inflamamtion or stricures, absesses ect.
UC - can get colectomy is curative
** what is consequence of resection of terminal ileum
- b12 is absorbed here
- bile salts are also absorbed here - reduced fat malabsorption - steatorrhoea
- bile salts in colon - irritant to colon, can get secretory diahorreha
If person has microcytic anaemia what else do we need to fnd out?
- cause of iron deficicencey
- due to vegeterian or low iron intake?
- chronic blod loss
- abnormal absorption? (e.g coeliac)
- menstural loss
Causes of abnormal blood loss?
-overat and occult bleeding, inflammation, ulcers, diverticulosis, polyps, cancer, angiodysplasia
Diverticulitis
- increased muscle contractions
- causing high pressure causing branch out and form diverticular
- mainly in sigmoid colon
- get bleeding
- can get this will decreased fiber diets - constipation
- colonoscopy or CT scan
** Rectal bleeding - colour
-Black - melena - upper GI tract ,small intestine
-Brigh red- outer bleedign - perianal
Bright red - left colon - mixed with stools
Dark red - proximal colon, distal smal intestine
*** Commonest causes of GI bleeding in stomach
- Peptic ulcer - NSAIDS, H. pylori - stool test to check for bacterial antigen
- oesophagitis
Coeliac Serology
- colonoscopy
- coelaic antibodies - elevated - need biopsy to confirm
- gluten causes an autoimmune response - get an increase in antibodies - cause damage to villi - cannot get absorption of nutrient and minerals
- igA tissue transglutaminase antibodies is most common
- before testing need to hav gluten in diet 2 pieces of bread
- can see damaged villi
- genetics - HLA-DQ2 or HLA-DQ8 - however 50% of population has this
- so if have other symptoms tehn may be case
*** 3 conditions associated with coeliac disease
- skin conditions - dermatitis
- 1s degree relative with coeliac disease
- type 1 diabetes
