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Colon + Rectum year3 -K > IBD+ IBS > Flashcards

IBD+ IBS Flashcards

1
Q

What are the diff b/w IBD + IBS?

A 
IBS
Women, young, unclear, psychosomatic, tx-> sx - depression, anxiety, 
Harm- psychological- no long term
Antispasmotics
Alvarin, meleverin- antispaspotic, 
Coffee upsets it

IBD
Young, women,
GI inflammation, harm- psych + physical
UC-> cancer - pancolitis, tx- infl, lifelong.

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2
Q

IBD + Fe relationship

A

IBD= ⬆️ ferritin due to inflammation (cz acute phase protein)
It is not lost to Bacteria in inflamation and infex.
Even tho iron defi = ⬇️ ferritin.

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3
Q

IBD inv

A
  1. Colonoscopy + multiple biopsies
  2. OGD
  3. Barium follow through

USS- thickened loops maybe

Small bowel- capsule endoscopy

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4
Q

Coeliac histology?

A

Crypt hypertrophy proximal small bowel

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5
Q

14Y F , Diarrhoea and abdo Cramps. 6w sx
Cut down extracaricular activities.
What else?

A 
What Cfs could imdicate serious cause?
Wt loss, blood + mucus, 
NIGHT SX 🌙✨ = PATHOLOGY‼️ 
Bowel hanits change
Steatorrhoea 
Tenesmus
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6
Q

RED FLAGS FOR ABDO PAIN AND DIARRHOEA

A 
Bloody D
Anaemia
Wt loss
Abdo mass
FHx of bowel or ovarian cancer 
>60 + change of bowel h >6 w
Diarrhoea + ⬆️ infl markers, abdo mass, anaemia, rectal bleed, rectal mass.
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7
Q

Characteristic sx of IBS

A 
Bloating
Discomfort + relief on defecation ✔️
Tenesmus (sensation of fullness) 
IBS- ⬆️ frequency, small motions, 
IBD- always ⬆️F + change in consistency
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8
Q

Whats thenexception with wt loss?

A

Hypothyroidism

Cz diarrhoea + lose wt due to high metabolism

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9
Q

IBS inv if u suspect it

A

FBC- anaemia
CRP- IBD
3. Coeliac serology- anti- tTG -ve, then duodenal endoscopy + biopsy
4. Faecal calprotectin

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10
Q

Whats the gold standard inv for coeliac?

A

Gluten free diet + +ve biopsy to confirm

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11
Q

Whats the faecal calprotectin?

A

Measured neutrophils produced indirectly as inflammatory markers

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12
Q

Whats abnormal in inflammation?

A 
Thick blood- leukocytosis- ⬆️ ESR
⬆️CRP,
Usually anaemia- normocytic- chronic disease
(Microcytic- Fe def, macro) 
⬆️ferritin
⬇️HB
FBC-> ⬆️WCC- neutrophils 
Platelets- thrombocyto
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13
Q

Inv for IBd

A
  1. OGD endoscopy- rule out coeliac and crohns
  2. Colonoscopy- Ulcers
  3. Barium follow through

IBD- ⬇️ ferritin cz iron def- tranferritin
B12 + terminal ileum- macrocytic-
Folate- jejunum + absorb Fe
Microcytic- IBD- jejunum- Fe abs, blood loss,
Chronic disease- normocytoc- ongoing inflm

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14
Q

IBS CF

A
  1. Abscence of red flags
  2. Abdo painw/ discomfort w/ defecaetion.
  3. Passage of mucus.
    Young women especially
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15
Q

Crohns

A 
145 per 100,000
Site- anywhere 
Skip lesions
Transmural 
F:M--> 3:1 
Histology: transmiral ulcerations 
Inflammation driven by smoking
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16
Q

UC

A 
240 per 100,000
Rectum starts
Continuous 
Mucosa + submucosa
F=M
2 peaks - 30's + 60-70s 
Smoking is protective 
Histology: crypt abcess
17
Q

ExtraGI manifestations of IBD

A
  1. Eye disease -> uveitis - scleritis/ iritis
  2. Large joint disease- arthritis- spine, axial skeleton- shoulder/hips
  3. PSC-> obstruction- ⬆️ risk for cholangiocarcinoma esp w/ UC
    4 pyoderma gangrenosum
    Clubbing
    Anaemia
    HLA-B27+ ve- ankylosing spondilotis. + UC
    Erythema nodosum
18
Q

Whats the special diet for Crohns?

A

Adults less acceptable- somNG tube x4 day
1st line in kids
Special drink- diet replecement- mixwd w/ H2O
Elemental and polymeric
Bowel rest
As effective as steroids
Avoid drugs in kids like 14

19
Q

Crohns getting worse, 15Y girl
Mouth ulcers, painful.
What tablets are tried next?

A
  1. Prednisolone 1mg/kg 7 a day for 2w
  2. Chew twice a day- chalk taste- Ca2+ supplement
  3. Special enzyme blood test before taking it + reg blood tests every 2w: Aziothiaprine (TPNT) - liver + kidney fx monitored. + mone marrow deficient.
    TPNT metabolised..

5ASA for UC.

20
Q

Paediatric and adult care of Cronhs

A

Dosage based on weight- adult doses are standard
Schl and lofe addected- mums get in touch
Adults focused on social life
17-25 fully. Neurocognitive development
Transitiom-> impact-> lost in follow up.

21
Q 
Becky got worse, bloody stools and flare pain. 
Fainted. She was admitted. 
IV steroids + fluids. 
Dangerously dilated colon.
What ate some complications of IBD?
A 
Toxic megacolon
Tachycardic
Perforation
Obstruction- crohns
Strictures- crohns
Fistulas- leak
Perianal sepsis
Constipation

UC- commonest- c. Diffic- pseudomembraneous colitis- due to immunosupression by steroids. So SE.
VTE risk when admitted, anaemia, abcess- microheal..m

Volvulus
Malabsorption/malnutrition
TPN
Dehydration

22
Q

Diarrhoea- drugs

+ what after steroids?

A

Codeine

Methotraxate- vomiting- then infliximab infusions

Colon + Rectum year3 -K (6 decks)

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