gi3 Flashcards
chronic inflammatory bowel disease overview and investigations + findings.
ulcerative colitis and chrons disease.
both chronic, relapsing remitting conditions.
peak in late adolescence and early adulthood.
Caucasians
genetically susceptible individuals with epithelial dysfunction and then get an infection.
Ix:
no specific test for either of them
biopsy/ imaging are the best modes.
Chrons:
cobblestone appearance, knife clefts through bowel wall.
adhesions + strictures, comb sign(alternating black and white)
UC:
thumbprinting- protrusions into the lumen
lead pipe colon- absence of haustra
polyps
can also use faecal calprotectin –> occurs when neutrophils degranulate. when bowel inflames- increaced levels of this. distinguishes between inflammatory and irritable.
similarities and differences between crohns and UC- ulceration differences, location etc.
crohns: any part of tract- terminal ileum + prox colon the most.
smoking is predisposing
all layers of bowel involved in inflammation.
discontinuous lesions
wt loss, diarrhoea, abdo pain.
UC:
colon and rectum affected
extends proximally from rectum
extensive diffuse ulceration with crypts
bloody diarrhoea
discuss flares in inflammatory bowel disease
UC:
mild- <4 motions a day, little bleeding rectally, hr<70 hb<11
moderate: 4-6 a day, moderate bleeding, mod temp, hr 70-90. 10.5 hb.
severe: >6 motions, tons of bleeding, >37.8 temp. hr>90.
manage inflammatory bowel diseases
induce + maintain remission
UC: mild- mesalazine (PR for smol disease, oral for more)
mod: oral pred + maintain on mesalazine
severe: IV, IV steds, monitor pulse, bp, stools freq + character
2x distention exams
consider transfusion if less than 80
infliximab
— urgent colectomy if no improvement.
Chrons: steds to induce remission
enteral feeding to rest bowel
2nd line mesalazine
infliximab(TNF alpha monoclonal antibody) for hard to treat/ fistulating.
resection is also a thing.
coeliac disease- definition and signs and symptoms
gluten (gliadin) triggered immune attack on the small intestine
damage occurs in duodenum
assoc with iron, folate and B12 deficiency
S+S:
children- abdo distention, failure to thrive, diarrhoea
adults: chronic diarrhoea, bloat, varied Sx.
pathophysiology of gluten intolerance
wheat broken down in stomach.
gliadin gets to small intestine- secretory IgA bind to it
gliadin-IgA binds to transferrin
Gliadin-IgA-transferrin diffuses through wall to propria— gets deaminated+ presented to a MHC2
Th2 mediated immmune response–> cytotoxic T cells prod
a cycle where the immune response causes enterocytes + vili- allowing more gliadin in –> more immune response.
investigations and management + diagnosis of gluten intolerance
Ix: Anti TTG + anti-EMA test.
screen for Fe def anaemia
endoscopy for biopsy- flat vili (atrophy) crypt hyperplasia
Rx: lifelong gluten free diet.( weight gain and constipation are common)
re-check anti-TTG at 3-6/12 to check levels are falling.
can get functional hyposplenism so give pneumococcal vaccc
Diagnosis-
evidence of malabsorbtion (steatorrhea, or neutrient def)
villous atrophy
weight loss
resolving symptoms on gluten free diet.
discuss infectious colitis
results in n inflammatory type of diarrhoea- majority of cases of acute diarrhoea.
purulent blood mucoid loose bowel
fever
abdominal pain
campliobacter, salmonella, shigella, e coli
discuss how you get infectious colitis
orally ingested contaminated food or water
incubation of 2-4 days
Ix: culture for infectious agent- rule out inflammatory bowel disease
fbc- esr, crp, abg aptt, albumin/ pcr for specific (e.g salmonella)
CT can help.
mild to moderate infections- don’t need abx, self limiting disease.
if they do need it for persistent then use antibiotic for the bacteria that is causing it.
discuss irritable bowel disease/ functional bowel disorders S+S, RF, patho and red flag signs
abdo pain + defecation + change in habit without organic cause
more common in women and young people
S+S: at least 6/12 of abdo pain- espesh RIF, bloat, change in bowel habit
nausea + VOM, postprandial fullness, no weight gain.
patho:
altered gastrointestinal sensitivity towards stimuli, triggered by environment, stress health.
RED flags:
B symptoms, rectal mass, Fhx ovarian/ bowel Ca.
60+ with altered bowel habit or fe def anaemia
Ix + Rx of irritable bowel syndrome
Ix: exam- pain in LIF
FBC + Iron studies
stool MX + S
coeliac serology
rectal exam, sigmoidoscopy+ colonoscopy
calprotectin
diagnosis
ROME
abdo pain. discomfort for more than 12 weeks (consecutive) with 2 or 3 of the following
relived by defaecation
assoc with change in bowel freq / form
other (need at least 2)
altered stool passage, abdo symptoms, prandial assoc, mucus discharge per rectum
Rx:
inc phys activity
diatry changes- single food avoidance diet
if persistant- loperamide
if persistant constipation- osmotic laxative (AVOID STIMULANT)
amytriptaline
CBT or psychotherapy/
define functional dyspepsia
1 or more of the following
epigastric pain/ burning
early saiety
post prandial fullness
in the absence of structural disease on imaging or endoscopy.
affects more than 20% of the population.
3 subtypes
epigastric pain syndrome
post prandial distress syndrome
overlapping disease
symptoms of epigastric pain syndrome and post prandial distress syndrome
EPS- bloating nausea, burping.does not meet biliary pain criteria.
generally no flatus
PPD- nausea, post prandial epigastric pain/ burning. epigastric bloating
excessive burping, heartburn.
Ix: bloods, metabolic panel, thyroid, inflammatory markers.
r/o H pylori
OGD, abdo ultrasound.
r/o malignancy
treatment/ management of functional dyspepsia
eradicate H pylori- - urea breath test will tell-
PPI + Clarithromycin + amox
PPI otherwise- need breaks every 6-12 months.
antidepressants- TCA. (amitryptaline)
try dietry modification, psychoterapy,
