IBD, IBS and Coeliac Flashcards
Diagnosis of IBS
Considered if patient has one of the following for 6 months (ABC)
Abdo pain
Bloating
Change in bowel habit
Positive if
Abdo pain relieved by defacation
Altered bowel frequency stool form
IBS investigations
FBC, ESR/CRP, coeliac screen (tissue transglutimase antibodies)
IBS management
First line
pain:mebeverine
constipation: laxatives, avoid lactulose
diarrhoea: loperamide
Second line
low dose tricyclic antidepressant
Risk of relapse of Chrohn’s disease is increased by
Smoking
Gold standard for coeliac diagnosis
Endoscopic intestinal biopsy (must continue to eat gluten otherwise villous atrophy may not be present)
Endoscopic intestinal biopsy findings in coeliac
Villous atrophy
Crypt hyperplasia
Increased intraepithelial lymphocytes
Lamina propria infiltration with lymphocytes
Malnutrition is defined as BMI >
18.5 OR
unintentional weight loss >10% over 3-6 months OR
BMI >20 and 5% weightloss over 3-6 months
what is ERCP
endoscopic retrograde colangeopancreatrography
uses x ray and an endoscope to treat liver, gallbladder, bile ducts and pancreas
achalasia pathophys
ganglion cell degeneration causing failure of relaxation of the lower oesophageal sphincter and loss of peristalsis in distal oesophagus
key X-ray achalasia finding
bird beak appearance at lower oesophageal sphincter
achalasia investigations
oesophageal manometry: excessive LOS tone doesn’t relax on swallowing
barium swallow: grossly expanded oesophagus and bird beak
xray: bird beak and fluid level
ulcerative colitis symptoms
bloody diarrhoea
urgency
tenesmus
LLQ abdo pain
ulcerative colitis age occurence
15-25
55-65
ulcerative colitis diagnosis
colonoscopy and biopsy finding red, raw mucosa that bleeds easily
about ___ of people with IBD have anaemia
2/3rds
risk of colorectal cancer higher in ulcerative colitis or chrons disease?
ulcerative colitis
most appropriate investigation for h pylori
13c urea breath test
deranged LFTs and secondary amenorrhoea
autoimmune hepatitis
what medication may increase the risk of Chrohn’s disease relapse
NSAIDS
H Pylori management
PPI + amoxicillin (or metronidazole) + clarithomycin
What indicates a worse prognosis of Chrohns?
perianal disease
what percentage of people with Chrohns also have osteoporosis?
30%
is psoriasis in Chrohns related to disease activity?
No
What laxative should be avoided in IBS?
Lactulose
Red flag symptoms in IBS
1/ rectal bleeding
2/ unexplained weight loss
3/ family history bowel or ovarian cancer
4/ onset after 60
What laxative can be used in IBS if other laxatives have not worked for 12 month?
?
What foods should be avoided in IBS?
Insoluble fibres: bran and wholemeal bread
Mild flare of UC criteria
> 4 stools daily
no systemic disturbance
normal ERS and CRP
Moderate flare of UC criteria
4-6 stools a day
miminal systemic disturbance
Severe flare of UC criteria
> 6 stools a day containing blood
systemic disturbance
A family history of Chrohns disease is present in around ___% of all patients
25%-40%
The risk of Chrohns is increased __x after a bout of gasteroenteritis
4
what drug is used to maintain remission in left sided or extensive ulcerative colitis
Oral and reactal aminosalicylate: mesalazine
treatment of severe flare of ulcerative colitis
admit to hospital
IV corticosteroids
mild/moderate distal (proctitis) UC flare treatment
topical (rectal) aminosalicylate
mild/moderate extensive UC flare treatment
oral and rectal aminosalicylates
severe relapse or >2 in past year treatment
oral thiopurines: azathioprine or oral mercaptopurine
2nd line mild/moderate flare UC treatment
add oral corticosteroids (prednisolone)
,Chrohns vs UC differences
1. bloody diarrhoea
2. weight loss
3. abdo pain
4. colorectal cancer
- UC
- Chrohns
- Chrohns
- UC
Coeliac investigations
low ferritin and folate
Oral aminosalycisate side effects
acute pancreatitis
diarrhoea
nausea
vomiting
