Lower GI Flashcards
abdo pain mimicking appendicitis in kids + rectal bleeding
meckels diverticulum
dx meckels diverticulum
radio nucleotide scan - t99
tx meckels diverticulum
surgical excision - wedge or small bowel resection with anastomosis
3 main causes of malabsorption
bowel disease
pancreatic - CF or cancer
infection - giardiasis
ix for malabsorption
- Stool sample microscopy.
- Bloods: FBC, B12, folate, iron, calcium, anti TTG.
- Hydrogen breath test. (bacterial overgrowth, intolerances)
- OGD + biopsy.
skin condition associated with coeliac
dermatitis herpetiformis
1st line ix coeliac
serum anti TTG (IgA) after eating gluten for 6 weeks
gold standard ix for coeliac
OGD + duodenal/jujenal biopsy - villous atrophy, crypt hyperplasia, lymphocytes
deficiencies in coeliac
iron deficiency anaemia
B12 and folate
osteoporosis
osteomalacia
cancer linked to coeliac
T cell lymphoma
small bowel cancer
if patient with ? coeliac has low total IgA what can you measure
IgG TTG
assocaited with HLA DQ2 and 8
vaccines in coealic
pneumococcal with 5 yearly booster
due to hyposplenism
ix for lactose intolerance
hydrogen breath test
ix for bacterial overgrowth
hydrogen breath test
who is at risk of bacterial overgrowth
elderly
post gastric surgery
tx bacterial overgrowth
abx e.g. trimethoprim
tx tropical sprue
tetracycline + folic acid
ix tropical sprue
OGD + biopsy
what is whipples disease
infection with tropheryma whipplei
associated with HLA B27
ix of whipples disease
OGD + jejunal biopsy –> PAS (periodic acid-schiff) positive macrophages and saggy mucosa
tx whipples disease
LT antibiotics - oral co trim 1 year
2 main RF for diverticular disease
low fibre
age
tx diverticulosis
high fibre diet
ix diverticular disease
colonoscopy
ix diverticulitis
erect CXR - rule out perforation
AXR - assess for obstruction
abdo CT with contrast to identify cause/local comps e.g. abscess
NOT colonoscopy due to risk of perforation in acute disease
mild diverticulitis tx
oral abx
severe diverticulitis tx
IV abx and IV fluids - cephalosporin and metronidazole
tx diverticular abscess
USS guided percutaneous drainage
diverticulitis + perforation/obstruction
probably hartmanns
AF predisposes to what bowel problem
acute mesenteric ischaemia
ischaemic colitis in young person
cocaine possibly
ischaemic colitis ix of choice
CT
where is ischaemic colitis most likely to occur
splenic flexure
AXR of ischaemic colitis
mucosal thumb printing
diagnostic ix of ischaemic colitis
sigmoidoscopy + biopsy - withering crypts
screening for ischaemic colitis
AXR
presentation of large bowel ischaemia / ischaemic colitis
intermittent LLQ pain
rectal bleeding
diarrhoea
hx of CVD/risk factors
tx ischaemic colitis
conservative
fresh intermittent PR bleeding in elderly
IDA on FBC
no mass
angiodysplasia
ix for angiodysplasia
rule out cancer - FIT, colonscopy
diagnostic - mesenteric angiography is acutely bleeding
tx angiodysplasia
embolisation, endoscopic lazer cautery
2nd line - resection
dx and tx of colorectal polyp
colonscopy + polypectomy
how often are people with FAP screened
sigmoidoscopy annually from 15
inheritance of FAP
AD
what cancer does HNPCC predispose to
colorectal
ovarian
endometrial
screening in HNPCC
colonoscopy every 1-2 years from age 25
inheritance of HNPCC
AD
inheritance of gardners
AD
describe DUKES staging of colorectal cancer
A Tumour confined to mucosa.
B Tumour invaded through bowel wall.
C Involvement of local lymph nodes.
D Distant metastasis.
describe the bowel cancer screening
every 2 years to people aged 60-74 (england) and 50-74 (scotland) using FIT
gold standard ix for bowel cancer if FIT positive
colonoscopy + biopsy
what is used to detect lynch syndrome (HNPCC) if colonoscopy diagnoses bowel cancer
CT colonography
staging of rectal cancer
MRI
staging of colonic cancer
CTCAP
monitoring of bowel cancer
CEA
tx bowel cancer
surgical 1st line - most with curative intent
surgery for Ceacal, ascending, proximal transverse
right hemicolectomy
surgery for Distal transverse or descending
left hemicolectomy
surgery for sigmoid
high anterior resection
surgery for upper or lower rectum
anterior resection
surgery for anal verge
abdomino-perineal excision of rectum
who gets chemo for colorectal cancer
Dukes C and above
chemo used in colonic cancer
5FU and oxaliplatin
is radiotherapy used in rectal cancer
yes - post op reduces local recurrence
monoclonal AB used in stage 4 colonic or metastatic disease
cetuximab
diagnostic criteria for IBS
3 month history of abdo pain/discomfort for 3 days/week that is relieved by defacation, associated with change in stool frequency and consistency with 2 + additional symptoms
diagnosis of exclusion - suspect ovarian/bowel cancer
tx diarrhoea in IBS
loperamide
tx constipation in IBS
bulking agents - fybogel, hyocine, avoid lactulose
tx bloating in IBS
meveberine
tx IBS if failed symptomatic control
psychotherapy, amitriptyline
eye problems in
- UC
- crohns
UC - uveitis
crohns episcleritis
(both can occur in both)
PSC is associated more with which IBD
UC
describe distribution of UC
rectum to ileoceacal valve
continuous
superficial inflammation
histology of UC
o Goblet cell depletion.
o Acute cryptitis and crypt abscesses.
o Superficial inflammation involving only the mucosa and submucosa.
is UC associated with bloody stool
yes
where is pain in UC typically felt
Left
diagnosis of UC
colonoscopy + biopsy
XR appearance of UC
lead pipe colon - short and narrow
ix of UC with severe colitis
flexible sigmoidoscopy
assessing extent of UC
colonoscopy
risks of UC
colorectal cancer
toxic megacolon
dx toxic megacolon
AXR - thumb printing and colon > 6cm in diameter
remission induction:
Tx UC proctitis
topical ASA
remission induction:
Tx UC proctitis if remission not achieved in 4 weeks with topical ASA
add oral ASA
remission induction:
Tx UC if remission not achieved with topical and oral ASA
add topical or oral steroid
remission induction:
Tx UC proctosigmoiditis/left sided UC
topical ASA
remission induction:
Tx UC proctosigmoiditis/left sided UC if not resolved in 4 weeks on topical ASA
add high dose oral ASA or switch to high dose oral ASA and topical steroid
remission induction:
Tx UC proctosigmoiditis/left sided UC if not resolved in 4 weeks on topical ASA/steroid and oral ASA
stop topical treatments
offer oral ASA and oral corticosteroid
remission induction:
Tx UC extensive disease
topical ASA and high dose oral ASA
remission induction:
Tx UC extensive disease if remission not achieved in 4 weeks with topical ASA and oral ASA
stop topical treatments and offer high dose oral ASA and oral steroid
tx severe UC
IV steroids in hospital - IV methylprednisolone
tx severe UC if no improvement in 72 hours with IV steroids
add IV ciclosporin
tx UC maintaining remission mild/moderate flare up proctitis/proctosigmoiditis
topical ASA
oral and topical ASA
or low dose oral ASA alone
tx UC maintaining remission if left sided UC/ extensive disease
low dose oral ASA
Tx UC severe relapse or > 2 exacerbations in a year
oral azathioprine or mercaptopurine
first line treatment of UC and mainstay for remission
5 ASA (mesalazine)
what is a risk of using mesalazine
acute pancreatitis
describe the distribution of crohns
any part of alimentary canal from mouth to anus
transmural inflammation
skip lesions (cobblestone)
where is pain typically felt in crohns
right hand side - most commonly affects terminal ileum
histology of crohns
o Non caseating granuloma.
o Deep, transmural (extends from mucosa to serosa) inflammation that can cause fissures and gives the mucosa a cobblestone appearance.
o Goblet cells
deficiency common in crohns
B12 - macrocytic anaemia
is crohns associated with blood
not as much as UC
yes if crohns colitis
does UC or crohns get perianal disease
crohns
anaemia seen in crohns
macrocytic
what inflammatory marker correlates with disease activity in crohns
CRP
ix of crohns
colonoscopy and biopsy
what feacal marker is rasied in crohns
faecal calprotectin
dx of crohns
flexible sigmoidoscopy
treatment crohns - remission induction
glucocorticoids - oral topical or IV
enteral feeding with elemental diet
what can be used as an add on medication to induce remission in crohns but not as a monotherapy
azathioprine or mercaptopurine
methotrexate is alternative
drug used in treatment crohns in refractory disease and fistulating disease
infliximab
isolated perianal disease in treatment crohns
metronidazole
1st line treatment crohns maintaining remission
azathioprine or mercaptopurine
2nd line treatment crohns maintaining remission
methotrexate
what needs to be measured before starting azatioprine
TMPT activity
ix for suspected perianal fistula
MRI
tx complex fistula
draining seton
tx perianal abscess
incision and drainage and antibiotics
tx severe flares in crohns
IV steroids
azathioprine and mercaptopurine can be added on
most important advice in crohns
STOP SMOKING
where are ileostomies found
RIF
where are colostomys found
LIF
5ASA side effect that patients need to be aware of
agranulocytosis - if get a cold sore throat etc need to check FBC
