let's get the bowel rolling Flashcards
what is inflammatory bowel disease
umbrella term for ulcerative colitis and chron’s disease
chronic relapsing and remitting disease
dysbiosis in microbes
what are the risk factors for inflammatory bowel disease
autoimmune conditions NSAIDS SSRIs diet history of gastroenteritis genetics + environment
how may inflammatory bowel disease present
watery diarrhoea frequency and urgency abdominal pain passing blood weight loss 20-40yrs extra-intestinal - primary biliary cholangitis, skin rashes, mouth ulcers, arthritis
what are the main features of chron’s disease
chron’s nests
cobblestone ulcerations
No/less blood or mucous
Entire GI tract - inc perianal chrons disease
Skip lesions on endoscopy
Terminal ilium most effected, Transmural
Smoking is a risk factor
vitamin deficiency
anaemia
wrapping mesenteric fat, thick mesentery
what are the main features of ulcerative colitis
U C CLOSEUP continuous inflammation limited to colon and rectum - proctitis only superficial mucosa effected smoking is protective excrete blood and mucous use aminosalicylates primary sclerosing cholangitis (strong association) + pseudopolyps
can present with acute severe colitis
what investigations could you do for inflammatory bowel disease
faecal calprotectin - good marker of intestinal inflammation >200 endoscopy colonoscopy biopsy bloods - anaemia, infection, thyroid function CRP, WCC, platelets raised albumin low CT MRI stool culture pANCA - positive in 75% of UC sexual health history
how would you manage chron’s disease
for relapse - steroids, prednisolone or IV hydrocortisone infliximab methotrexate surgery to remove strictures manage any malabsorption
how would you manage ulcerative colitis
aminosalicylates/5 ASA analogues - mesalazine
corticosteroids - IV if severe
immunosuppressants - azathioprine
panproctocolectomy - colon + rectum removed leaving permanent ilieostomy or J-pouch
what are complications of ulcerative colitis
toxic megacolon colon cancer risk osteoporosis due to steroids block bile flow (paucities) perforation haemorrhage
what are complications of chron’s disease
small bowel obstruction fistula strictures anaemia osteoporosis
what is irritable bowel syndrome
functional bowel disorder - cause is not clear
diagnosis made by excluding other pathologies
what are risk factors for IBS
female age stress hypermotility visceral sensitivity
how does IBS present
abdominal pain/discomfort relieved by opening bowels/associated with change in bowel habit 2 of: abnormal stool passage bloating worse after eating PR mucous
what investigations can you do for IBS
stool culture bloods - CRP faecal calprotectin sigmoidoscopy, colonoscopy rectal examination
how could you treat IBS
laxatives loperamide for diarrhoea antispasmodics tricyclic antidepressants SSRIs dietician
what is coeliac disease
when gluten causes an immune response in the gut (usually duodenum) resulting in the gut walls getting destroyed - villi are damaged, crypts can atrophy etc
what are symptoms of coeliac disease
distention abdominal pain steatorrhea vomiting weight loss clubbing
what investigations can you do for coeliac disease
duodenal biopsy
bloods
anti-TTG IgA
how do you manage coeliac disease
gluten free diet
what is diverticulosis
when the walls of the colon form an outpouching (like an aneurysm)
outpouching is usually where the blood vessels transverse the muscular layer because the tissue is weaker here
all layers dilated = true diverticulum
what causes diverticulosis
abnormal contractions cause increased pressure so the walls balloon out
connective tissue disorders like marfan’s syndrome are risk factors
how may diverticulosis present
usually asymptomatic
can cause painless rectal bleeding due to blood vessel rupture at the diverticulum
what is diverticulitis
inflammation of diverticulum
what can cause diverticulitis
faecal matter becoming lodged in the pouch
erosion of the wall due to high pressures
how may diverticulitis present
pain in LLQ
not associated with bleeding
what are complications of diverticulitis
can burst and form a fistula with the bladder
how could you treat diverticulitis
antibiotics in case of bacterial involvement
high fibre diet after recovery
surgical removal in severe cases
what is appendicitis
inflammation of the appendix
what can cause appendicitis
faecal matter blocking the appendix - traps the gut bacteria in and the bacteria multiply and build pressure, WBCs become involved and the whole thing goes to shit, ischaemia
lypmhoid hyperplasia - the lymph nodes enlarge and block off the appendix, common in children
how may appendicitis present
RLQ pain fever mcburney's sign nausea vomiting
what tests could you do for appendicitis
FBC
US
pregnancy test to rule out ectopic pregnancy
how would you treat appendicitis
remove the appendix and give antibiotics
what is ischaemic enteritis
inflammation and injury of the large intestine result from inadequate blood supply - acute occlusion of coeliac, inferior and superior mesenteric arteries
mucosa becomes damaged and gangrenous can cause dehydration and shock
what can cause ischaemic enteritis
hypoperfusion - hypotension, shock, dehydration
thrombus
inflammation
ulceration
what are risks for ischaemic enteritis
atherosclerosis vasculitis aneurysm oral contraceptives cardiac failure shock vasoconstrictors
what part of the bowel is vulnerable to ischaemia
splenic flexure
how can ischaemic enteritis present
abdominal pain, cramping, tenderness
what are complications of colonic ischaemia
mucosal inflammation ulceration submucosal inflammation fibrosis stricture
radiation colitis
abdominal irradiation can impair the normal proliferative activity
usually rectum-pelvic radiotherapy
damage depends on dose
what are symptoms of radiation colitis
anorexia
abdominal cramps
diarrhoea
malabsorption
what is acute severe colitis
inflammation effecting entire colon
how does ASC present
pain diarrhoea bleeding fever inability to eat
how do you manage ASC
bloods
4 stool cultures for c diff
XR
IV glucocorticoids
rehydration therapy
stop problem drugs
GI review by specialist
low molecular weight heparin if thrombus
surgery if it is not responding - colectomy or rectal preserving ileostomy
what is coeliac disease
autoimmune condition where gluten causes an immune response in the small bowel - mostly jejunum
causes atrophy of villi - malabsorption
anti-TTG and anti-EMA antibodies
how does coeliac disease present
failure to thrive diarrhoea fatigue weight loss mouth ulcers anaemia Dermatitis herpetiformis can cause peripheral neuropathy, cerebellar ataxia, epilepsy
what investigations could you do in coeliac disease
exclude IgA deficiency - total plasma IgA
endoscopy with biopsy - crypt hypertrophy, villi atrophy
HLA
how do you manage coeliac disease
life long gluten free diet
refer to dietician
