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
