Lower GI Flashcards
Describe the pathophysiology of coeliac disease
Autoimmune disease: antibodies to gliadin (gluten) cause inflammation in the small bowel
- > villous atrophy, crypt hyperplasia, lymphocyte infiltration
- > diarrhoea, malabsorption, anaemia
Describe the presentation of coeliac disease
GI upset: diarrhoea, pain, bloating, wind
Anaemia: fatigue, SOB
Weight loss
Common in children: rash, N+V, FTT
Describe the investigations for coeliac disease
- History and examination
- Bloods: FBC, LFTs, anti-TTG and IgA level, TFTs, consider Ca-125 in older F
- Endoscopy + biopsy to confirm diagnosis
Describe the management of coeliac disease
Conservative:
- Dietary modification: lifelong gluten free diet, dietician referral at Dx
- Supplementation if needed
Describe the epidemiology of Crohn’s disease
Affects young adults
White, esp Ashkenazi Jews
Describe the pathophysiology of Crohn’s disease
Inflammatory disease affecting any part of the GI tract from mouth to anus
-> patchy transmural inflammation (skip lesions), ulcers, granulomas, stricturing, fistulas etc
Describe the presentation of Crohn’s disease
- GI upset: pain, diarrhoea, bloody stools, bloating
- Rash, arthralgia, eye symptoms (ant uveitis)
- Weight loss, fatigue, fever
Describe the signs of Crohn’s disease on examination
General: pallor, low BMI, rashes
Oral ulcers
Abdominal tenderness
Perianal: skin tags, fistulas, abscess
Describe the investigations for Crohn’s disease
- History and examination
- Stool sample: MCS, faecal calprotectin
- Bloods: FBC, CRP + ESR, U+Es, TFTs, anti-tTG and IgA, iron studies, B12 and folate
- Imaging: AXR, CT/MRI
- Endoscopy (typically ileocolonoscopy)
Describe the management of Crohn’s disease
Conservative:
- Lifestyle: avoid smoking
- Dietician and supplements
Medical: Inducing remission: -Steroids/ aminosalicylates -> + Immunomodulators eg. azathioprine, mercaptopurine, methotrexate -> biologics eg. infliximab, adalimumab Maintenance: -Immunomodulators
Surgical:
- For complications eg. dilatation for strictures
- Resection of diseased bowel
Describe the complications of Crohn’s disease
- Obstruction
- Sepsis
- Toxic megacolon
- Fistulas, abscesses
- Anaemia
- B12 deficiency
- Malignancy
- Complications from drug treatment
Describe the pathophysiology of ulcerative colitis
Inflammatory disease affecting the distal colon
- Continuous mucosal inflammation
- Crypt abscesses, pseudopolyps
Describe the presentation of ulcerative colitis
GI upset: diarrhoea, PR bleeding, mucus, pain, tenesmus
Arthritis, uveitis, rash (EN)
Weight loss, fatigue, fevers
Describe the investigations for ulcerative colitis
- History and examination
- Stool sample: MCS, calprotectin
- Bloods: FBC, CRP + ESR, anti-tTG, LFTs, U+Es
- AXR
- Flexi sigmoidoscopy or full if ?extensive disease
Describe the management of ulcerative colitis
Conservative:
-Dietician
Medical: Induce remission: -Aminosalicylates (5-ASA): topical or oral or combo -> Steroids: topical or oral or IV -> biologics Maintenance: -Aminosalicylates -Immunomodulators: azathioprine, mercaptopurine
Surgical:
-For acute complications eg. resection
Describe the complications of ulcerative colitis
- Toxic megacolon
- Perforation
- Malignancy
- PSC
Describe the epidemiology of diverticular disease
Common in developed countries
Increases with age
Assoc w low fibre diets
*Right sided more common in Asians
Define diverticulosis, diverticular disease, diverticulitis, etc
Diverticula: herniation of the submucosa and mucosa through the muscular wall of the bowel
Diverticular disease: symptoms as a result of diverticulosis eg. intermittent pain, PR bleeding
Diverticulitis: inflammation of diverticula
Describe the presentation of diverticular disease
Typically LLQ severe pain: may be colicky or constant in -itis.
N+V, anorexia, fever
PR bleeding
Constipation or diarrhoea
Describe the signs of diverticular disease on examination
General: tachycardia, pyrexia
Abdo: LLQ/RLQ tenderness, PR bleeding
+/- RLQ mass
Peritonitis if perforated
Describe the investigations for diverticular disease
Complicated acute diverticulitis:
- Bloods: FBC, CRP, U+Es. +ABG and culture if required
- Contrast CT
- CXR if suspected perf
- Flexisig if unclear Dx/suspected malignancy
Describe the management of diverticular disease
Conservative:
- For all: lifestyle advice re: diet (fibre), weight loss
- For uncomplicated diverticulitis: paracetamol and come back if worse/no improvement
Medical:
- For unwell diverticulitis: antibiotics (co-amox)
- For complicated: sepsis 6, IV antibiotics etc
Surgical:
- For perf/obstruction/abscess drainage
- Consider resection w/ 1˚ anastomosis or Hartmann’s
Describe the presentation of common vitamin deficiencies
A: night blindness
B1 (thiamine): Wernicke’s, Korsakoff dementia, Beri-Beri (wet or dry)
B3 (niacin): pellagra- dementia, dermatitis, diarrhoea
B6 (pyridoxine): anaemia, dermatitis, glossitis
B12 (cobalamin): megaloblastic anaemia, neuropathy
C: scurvy
D: osteomalacia/Rickets
Describe the causes of vitamin A/E/K deficiency
- Malnutrition
- Malabsorption: pancreatic insufficiency (CF, chronic pancreatitis), biliary tree obstruction
