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Gastrology > Infection, Inflammation and the Gut > Flashcards

Infection, Inflammation and the Gut Flashcards

1
Q

Infective causes in the Gut

A

Giardiasis
Whipples disease
Psuedomembrane colitis

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2
Q

Giardisis

A

Protozoa
Waterbourne infection
Rare in Glasgow
Usually a chronic infection

Symptoms- diarrhoea, malabsorption, weight loss but often asymptomatic

RFs- immunodeficiency

Tbx - metronidazole

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3
Q

Whipples disease

A

Tropheryma whipplei

Patients have lack of immmunity to ogansim . Absorption of digested food in the intestine is reduced.

Rfs- Middle aged men

Symptoms- Abdominal pain, skin pigmentation, arthrlagia (joint pain), diarrhoea

Diagnosis - Biopsy of dudoenum - PAS positive macrophages

Tbx- antibiotics

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4
Q

Psuedomembrane colitis

A

Clostridium difficile

Overgrowth with toxin producing clostridium difficile after abx therapy with clindimycin

Symptoms- Feverm abdominal pain, diarrhoea, necrosis

Diagnosis - toxin in stool

Treatment - Vancomycin

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5
Q

Non infective causes of gut inflammation

A

Acute appendicitis

Coeliac disease

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6
Q

Coeliac disease Definition

A

A condition where there is inflammation of the jejunum mucosa that improves when the patient is treated with a glten free diet and relapses when gluten is introduced

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7
Q

Clinical featues of coeliac

A
  • fatty diarrhoea: bulky, pale, greasy and offensive
  • Weight loss
  • Reduced bone density with increased risk of fracture (osteomalacia)
  • iron deficiency aneamia (can digest but not absorb)
  • oral apthous ulcers
  • Dermatitis herpetiforms
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8
Q

Investigations for coeliac disease

A

a. Duodenal/jejunual biopsy
b. Endomysial (EMA) Ab
c. Haematology
d. Biochemistry

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9
Q

Risk factors of coeliac disease

A

RFs - genetic predispostiion (HLA-Dq)

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10
Q

Epidemiology of coeliac

A

Epideimiology - commonest cause of villous atrophy in UK (1in 200)

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11
Q

Pathophysiology of coeliac disease

A

Cause - triggered by ingestion of gluten

  1. Prolamins (gliadin from wheat, Hordeins from barley, seclans from rye) are damaging factors
  2. Gluten is fractioned to give alpha, beta and gamma-gliadin peptides (alpha-gliagin is main damaging factor)
  3. gliadin peptides pass through the epithelium
  4. deaminated by tissue transglutamase
  5. Gliadin peptides then bind to APC and presented to CD4 T cells in lamina propria via HLA Dq2/8
  6. T cells produce pro-inflammatory cytokines
  7. T cells also interact with B cells to produce autoantibodies (transglutaminase + antiendomysial autoantibodies) against self tissue
  8. Leads to:
    a. Villous atrophy - normally cells created at the pit of tge crypt and regenerate
    b. Crypt hyperplasisa - proliferative component increased
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12
Q

Classification used in coeliac

A

Marsh classification

0- Normal mucosa
1- Increase number of intra-epithelial lymphocytes >20 per 100 enterocytes)
2- Proliferation of the crypts of liberkuhn
3 - Variable villous atrophy
3a- Partial villous atrophy
3b- Subtotal villous atrophy
3c - total villous atrophy
4. hypoplasia of the small bowel architecture

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13
Q

Treatment of coeliac disease

A

Treatments with gluten free diet - recovery of villous atrophy in three months

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14
Q

Complications of coeliac disease

A

-TTG antibodies are a good measure of compliance. If the diet is good they will stay low.

They are at risk of enteropathy associated T cell lymphoma

They are prone to osteoporosis – therefore bone should be screened regularly. Would not use bisphosphonates at such a young age – save them for later in life.

Can have side effect of causing spontaneous mid shaft femur fractures.

Use regular biopsies to monitor bowel

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15
Q

Acute appendicitis

A

Bacterial infection of blocked appendix
Right iliac fossa pain!!!
Chi;dren

Histo- acute inflammation followed by ulceration and trasnmural inflammation

Complications - transmural gangrene leading to perforation, generalised peritonitis

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16
Q

Chronic inflammatory bowel disease consists of

A

Ulcerative collitis

Crohns disease

17
Q

Ulcerative collitis vs Crohns

Position, incidence and age of onset

A

Ulcerative collitis:

  • rectum and extends confluently into to colon only
  • 10-20/100,000
  • Age of onset 35
  • Not common in non-smokers -Smoking protective

Crohns

  • affects any part of the gastrointestinal wall from mouth to anus (usually terminal ileum)
  • 5-10/100,000
  • 26
  • common in smokers
18
Q

Ulcerative collitis vs crohns

Endoscopic findings

A

Ulcerative collitis

  • con fluent inflammation
  • pseudo polyps
  • thin bowel wall
  • erythema, odema, abnormal vascular pattern

Crohns

  • skip lesions (normal mucosa between affected areas)!
  • coblblestoning
  • aphthous and linear ulcerations
  • strictures
  • thickened bowel wall
19
Q

Ulcerative collitis vs crohns

Clinical features

A

Ulcerative collitis

  • L sided abdominal cramping
  • Diarrhoea, often with blood and mucus (haemotochezia)
  • Tenesmus (a continual or recurrent inclination to evacuate the bowels)

Crohns

  • RLQ colicy pain
  • Diarrhoea + blood PR (less blood)
  • Fistula (communication between one lumen to another)
  • apothlous ulcers - canker sores-
  • Crohns ileitus -inflammation/ulceration of terminal ileum )
  • anaemia
20
Q

General inflammatory bowel disease (IBD) extra-colonic manifestations

A

Msk: arthritis - ankylosis get spondylitis, clubbing

Dermo and oral -
reactive lesions: pyoderma gangrenosa, aphthous ulcers
Specific: fissures, fistulas and oral Crohns

Hepatobilary: PSC, chronic acute hepatitis

Ocular: iritis

Renal: calcium - oxalate stones

21
Q

Ulcerative colitis vs inflammatory bowel disease

Serological markers

A

ulcerative collitis
- ANCA (anti cytoplasmic antibodies)

Crohns
-ASCA (anti- saccharides cerevisae)

22
Q

Complications of inflammatory bowel disease

A
  1. colon cancer
  2. Toxic megacolon
  3. strictures
    4/ fistula
23
Q

Diverticular disease

A

“mucosal outpouchings through muscle coat of colon”
Common-
>40
Sigmoid colon
causes - low roughage diet causes constipation and high sigmoid luminal pressure-herniation of mucosal through wekaness in muscle coat of sigmoid
-Left iliac fossa pain

Complicaitions:

  • perforation
  • fistula –> bladder or bowel
  • bleed
  • obstruct bowel
24
Q

Microscopic colitis

A

Middle aged persons with profuse watery diarrhoea- 10 motions per fay

Colonscopy entirely norma

Abnormal histology

Two types:
lymphocytic –> increased lymphocytes

Collagenous –> increased collage

Tbx - eliminate drug cause then treat with 5aminosalicyclic acid

25
Q

Ichaemic gut

A

Acute- sudden onset abdominal pain with blood per rectum

Chronic- abdominal angina
pain assoc with eating -weight loss (reduced absorption)

Causes- 
-mesenteric artery or vein thrombosis. 
-Mesenteric artery embolus. Hypotension(causing watershed infarction) (splenic flexure). 
- strangulated hernia. 
Volvulus

Pathology: Mucosa and transmural infacrtion. Coagulative necrosis. Gangrene. Surgical resection may be needed if severe.

26
Q

Ulcerative colitis definition

A

A relapsing and remitting inflammatory disease of the colon, arising in the anus and spreading proximally, not beyond ileocecal valve

27
Q

Crohn’s disease definition

A

Chronic relapsing non-cheating granulomatous transmural inflammatory condition can affect any part of GI tract from mouth to Anus

28
Q

Investigations of IBD

A 
FBC - macrocytic or microcytic 
WCC - increases infection and chronic inflammation 
U&es may be dehydrated in diarrhoea 
LFTs primary sclerosising cholangitis 
ESR and CRP raised 
Stool culture - to exclude C.DIFF 
Radio 
- abdo ultrasound 
-AXR - obstruction mucosal thickening 
Contrast studies (barium meal, barium follow through, barium enema)

CXR- air under diaphragm
PR for blood

Gastrology (19 decks)

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