GI week: IBD, GORD, bowel obstruction, diverticulitis, GI cancer Flashcards
Among the following diseases, which would give transudate/exudate
- Liver failure (cirrhosis)
- Heart failure
- Kidney failure
- Pancreatitis
- Infection
- Neoplasm
- TB
Transudate: liver, heart, kidney failure
Exudate: Pancreatitis, Infx, Neoplasm, TB
What are some extra-intestinal manifestations of IBD?
Which ones are more common in UC?
- Pyoderma gangrenosum
- Iritis
- Erythema nodosum
- Sclerosing cholangitis
- Ankylosing spondylitis
- Clubbing
More common in UC: Pyoderma gangrenosum, sclerosing cholangitis, ankylosing spondylitis
Is UC or Crohn’s more common
UC
but incidence of Crohn’s now rising due to everything being disinfected so immune systems nowadays are weaker
Crohn’s/UC tend to cause pain more commonly in RIF/LIF
Crohn’s: RIF
UC: LIF
Crohn’s/UC have:
- skip lesions/uniform
- superficial inflammation/transmural damage
Crohn’s: skip lesions, transmural damage
UC: uniform, superficial inflammation
Crohn’s/UC have more blood/mucus in stool
Crohn’s: more mucus
UC: more blood
Most common type of upper GI cancer
Adenocarcinoma
If someone has no stool found in a DRE, but is not passing stool, what should be suspected?
Bowel obstruction
Systematic approach to AXR
- Projection
- Patient Details
- Technical Adequacy (should include hemidiaphragms down to symphysis pubis & hernia orifices)
- Obvious Abnormalities
- Systematic Review (easiest to start from rectum and go backwards)
- Large and small bowel
- Diameter of the bowel
- Bowel Wall Thickness - Other – foreign bodies, bones etc
Maximum diameter of small bowel
3cm
Maximum diameter of large bowel
6cm (except caecum which can be up to 9cm)
Difference between valvula conniventes and haustra
Which is in small/large bowel
- Valvula conniventes (goes all the way across) - SMALL BOWEL
- Haustra (doesn’t go all the way across) LARGE BOWEL
Presentation of bowel obstruction
- Pain (crampy)
- Distension
- Vomiting
- Constipation
- Lack of bowel sounds/tinkling bowel sounds
What normal condition may cause dilation and radiological appearance of small bowel obstruction?
Post-operative ileus (disruption of normal movement of intestines)
Is small or large bowel obstruction more common
Small bowel obstruction more common
What features may be found in AXR of patient with IBD
- Often normal
- May have signs of inflammation
Signs of bowel inflammation on AXR
- thickened bowel wall
- thumbprinting (from thickening of haustral folds
- mucosal islands (white patches on black bowel)
Where does pain from diverticulitis normally occur
LIF
Symptoms of diverticulitis
- LIF pain
- fever
- nausea
- constipation or diarrhoea
- bleeding in stools
Complications of diverticulitis
- peritonitis (from perforation)
- abscess formation (from perforation)
- fistula in bladder/ vagina (affected colon adheres to other organs in pelvic cavity)
- bowel obstruction
Risk factors for chronic mesenteric ischaemia
PVD/IHD risk factors
- smoking
- hypertension
- high cholesterol
- diabetes
- family history
Risk factors for acute mesenteric ischaemia
Sources of emboli
- a fib
- recent MI
- cardiac valvular disease
Most common cause of lower GI bleeding
Diverticular disease
Which type of IBD is highly associated with primary sclerosing cholangitis
UC
Which cancer is associated with H pylori?
How to treat this cancer
Gastric MALT lymphoma
Treat with H pylori eradication
