GI problems Flashcards
describe crohn’s disease vs ulcerative colitis
Crohn’s disease
- any part of GI tract
- discontinuous inflammation
- deep ulcers, cobblestone appearance
- transmural inflammation
- inflammatory, fistulising, stricturing, perianal
- worsened by smoking, granulomas may be present
ulcerative colitis
- colon only
- continous inflammation, starting at rectum
- shallow ulcers
- mucosal inflammation
- inflammatory
- smoking is protective
four presentations of Crohn’s
inflammatory
- colitis = diarrhea, bleeding
- ileitis = abdo pain
- gastriti/duodenitis = dyspepsia
fistulising
- formation of tract between gut & other organ/vessel
stricturing
- abdo pain & distention
- vomiting
- bowels not opening
perianal
- abscess
- fistula
- anal fissure
treatment of IBD
- 5-ASA (mild anti-inflammatory)
- steroids
- immunosupression e.g. azathioprine, 6-mercaptopurine
- biologics = ABs against TNF (e.g. infliximab, adalimumab)
consequences of terminal ileum resection
B12 malabsorption
- loss of B12/IF complex receptors
bile salt malabsorption
- released by liver through bile duct, reabsorbed in terminal ileum into enterohepatic circulation
- after resection, loss of bile salts through colon -> irritant -> stimulates water & electrolyte secretion -> secretory diarrhea
- less salts -> fat malabsorption (steatorrhea)
- 25y/o woman
- 3 month history of watery diarrhoea
* 6 times a day, 3 times at night
* blood
* lower abdominal cramps
* weight loss = 5kg (important to know the duration) - usually bowel habit 1/day
- smoker: 3 cigarettes /day
- on COCP (nothing else
explain the likelihood of infection
- history too long and otherwise is fit and well
- important to exclude C. difficile in recent antibiotics
- course of infection can be longer in immunocompromise
- 25y/o woman
- 3 month history of watery diarrhoea
* 6 times a day, 3 times at night
* blood
* lower abdominal cramps
* weight loss = 5kg (important to know the duration) - usually bowel habit 1/day
- smoker: 3 cigarettes /day
- on COCP (nothing else
explain the likelihood of coeliac
unlikely due to bleeding
- 25y/o woman
- 3 month history of watery diarrhoea
* 6 times a day, 3 times at night
* blood
* lower abdominal cramps
* weight loss = 5kg (important to know the duration) - usually bowel habit 1/day
- smoker: 3 cigarettes /day
- on COCP (nothing else
explain the likelihood of irritable bowel syndrome
- unlikely as bowel habit is regular, bleeding
- nocturnal diarrhea
- 25y/o woman
- 3 month history of watery diarrhoea
* 6 times a day, 3 times at night
* blood
* lower abdominal cramps
* weight loss = 5kg (important to know the duration) - usually bowel habit 1/day
- smoker: 3 cigarettes /day
- on COCP (nothing else
explain the likelihood of inflammatory bowel disease
- possible
- bleeding and diarrhoea are common presenting symptoms
- 25y/o woman
- 3 month history of watery diarrhoea
* 6 times a day, 3 times at night
* blood
* lower abdominal cramps
* weight loss = 5kg (important to know the duration) - usually bowel habit 1/day
- smoker: 3 cigarettes /day
- on COCP (nothing else
explain the likelihood of cancer
- not usually present in a young person
- however, check family history of polyp syndrome
what does a blood test with low albumin and high ferritin indicate
acute phase reaction
extra-intestinal manifestations of IBD
- eye = uveitis (uvea layer lies between retina & sclera)
- primary sclerosing cholangitis (Crohn’s)
- joints = ankylosing spondylitis
- skin = erythema nodosum
rectal bleeding
- importance of colour and location
black/melaena = upper GI tract, small intestines
bright red, on paper = outlet (e.g. perianal)
bright red, mixed in stool = left colon
dark red = proximal colon, distal small intestines
causes of upper GI bleeding
- peptic ulcer disease (risk factors = NSAID, H. pylori)
- varices
- malignancy
- oesophageal cancer
- Mallory-Weiss tear
causes of lower GI bleeding
- angiodysplasia
- cancer
- ischemic colitis
causes of iron deficiency anaemia
- inadequate dietary intake (vegetarian)
- impaired absorption (coeliac)
- abnormal loss ( overt & occult bleeding)
how do you diagnose coeliac disease
antibodies while consuming gluten:
-TTG IgA antibody
histology (gold standard)
- intra-epithelial lymphocytosis
- crypt hyperplasia
- villous atrophy
genetics associated with coeliac
- > 99% coeliacs carry either HLA-DQ2, HLA-DQ8
- most people in general pop carry these genes, so test only useful when negative
associations with coeliac disease
- dermatitis herpertiformis
- first degree relative with coeliac
- type 1 diabetes
treatment for coeliac
- gluten-free diet (no wheat, barley, rye)
- oats = some coeliac cannot tolerate, cross-contamination with wheat possible
importance of iron deficiency anaemia in regards to age and gender
- young women w/out GI symptoms = menstrual loss
- young women w GI symptoms = needs investigations
- older women & all men = always investigate (exclude cancer)
perianal (Crohns)
- abscess
- fistula
- anal fissure
associations with stricturing (Crohns)
- abdominal pain & distention
- vomiting
- bowels opening
define fistulising
- formation of tract between gut & another vessel/organ
e. g. SI & skin, rectum & vagina
