Lower GI diseases - medical Flashcards
coeliac disease
inflammation of the mucosa of the upper small bowel when exposed to gluten
immune response causes inflammation which leads to villous atrophy and crypt hyperplasia - malabsorption
coeliac disease associated diseases
thyroid disease type 1 diabetes Sjogren syndrome IBD IgA deficiency
coeliac disease signs and symptoms
abdo pain weight loss diarrhoea/steatorrhoea angular stomatitis on corners of mouth dermatitis herpetiformis on extensor surface of elbows anaemia, malnutrition
coeliac disease long-term problems
iron/folate deficiency
osteoporosis
ceoliac disease investigations
1st line - serology
tTG antibodies (IgA tissue transglutaminase antibodies)
EMA (IgA endomysial antibodies)
2nd line - biopsy
taken endoscopically may see scalloping of mucosal folds
coeliac disease management
gluten free diet vitamin supplement pneumococcal vaccines for pts with splenic atrophy annual blood tests screen for other autoimmune conditions
coeliac disease differentials
IBS
IBD
GI malabsorption
defective mucosal absorption
digestive system does not have the function and/or enzymes to break down the substances from the diet
causes of malabsorption
coeliac, lactose intolerance, Crohn’s, post infective, chronic pancreatitis, biliary obstruction, liver cirrhosis
Whipple’s disease, drugs, PSC, short bowel
malabsorption symptoms and signs
diarrhoea, weight loss, bloating, abdo pain
anaemia, oedema, steatorrhea, bleeding disorders, neuropathy
lactose malabsorption
patient produces little or no lactase so they will not break down the lactose into glucose and galactose
undigested molecule will cause digestive problem such as diarrhoea and abdominal pain
tropical sprue
rare digestive disease of unknown cause that affects the small bowel’s ability to absorb nutrients especially vitamin B12 and folic acid
atrophy of villi of digestive wall
symptoms - fatigue, diarrhoea, anorexia
treat with antibiotics and supplements
vitamin C deficiency
scurvy
gum disease, anorexia, weakness
vitamin D deficiency
osteomalacia, rickets
malnutrition
state of nutrition in which a deficiency or imbalance of energy and nutrients leads to adverse effects on body tissue, function and clinical outcome food first oral supplements enteral feeding tube parenteral nutrition
adenocarcinoma of small bowel
most often found in duodenum and jejunum
most common primary tumour found in small bowel
Crohn’s disease is a predisposing factor
surgical resection + radio + chemo
lymphoma of small bowel
mot often found in ileum
most common lymphoma type is B cell arising from MALT
surgical resection + radio + chemo
carcinoid tumours of small bowel
a type of slow growing neuroendocrine tumour
originate fro enterochromaffin cells of intestine
most common in appendix and terminal ileum
common metastasis to liver
neuroendocrine cells secrete hormones
mainly asymptomatic
carcinoid syndrome
only occur if tumour has metastasised spontaneous flushing diarrhoea SOB pulmonary stenosis or tricuspid incompetence
carinoid tumour investigation and management
serum chromagranin A
24hr urine secretion of 5 hydroxyindoleacetic acid
imaging to check for mets
surgical resection
octreotide/lanreotide inhibit the release of hormones, alleviating symptoms
IBS
functional bowel disorder in which abdo pain is associated with change in bowel habit in the absence of structural pathology
anxiety/stress/depression
more common in women
IBS history
SOCRATES symptoms impact of daily activities diet/exercise/mental well being improvement with defecation change in frequency of stool change in appearance of stool
IBS exam
check BMI for unexplained weight loss
abdo exam to check for tenderness/masses
PR exam to check for rectal pathology
IBS investigations
FBC
ESR/CRP - raised in infection/inflammation
coeliac serology
IBS management
identify dietary/mental triggers dietary advice FODMAP recommended increased probiotic intake consider anti-diarrhoeals consider laxatives antispasmodic if pain not resolving
FoDMAP
fermentable oligo, di, momo-saccharides and polyps
fructose, lactose, polyps, fructans, galactans
IBD aetiology
genetic - family history, involved with coding immune cells, NOD2/CARD15 protein for bacterial recognition
environmental triggers - smoking, NSAID, hygiene, diet and nutrition, stress
mucosal immune system
gut flora - altered in IBD
IBD due to an overactive mucosal immunological response to luminal antigens
IBD leaky epithelium increases chance of detection of antigen by immune cells
Crohn’s - TH1 mediated
UC - Th1/Th2
extra-GI manifestations of IBD
increases risk of developing coln cancer, toxic megacolon, bowel obstruction and sclerosing cholangitis
eyes - uveitis, episcleritis, conjunctivitis
skin - erythema nodosum, pyoderma gangrenosum
joints - arthralgia, ankylosing, spondylitis
liver and biliary tree - sclerosing cholangitis, fatty liver, chronic hepatitis, cirrhosis, gallstones
Crohn’s disease signs and symptoms
abdominal pain diarrhoea weight loss and reduced growth fatigue malaise fever mouth ulcers angular stomitis peri-anal disease - pain, abscesses, fistulas and strictures
Crohn’s disease risk factors and social history
family history
present in young people
smoking
Crohn’s disease investigations
exam - weight loss, right iliac fossa mass, peri-anal signs
bloods - CRP, ESR, Ferritin, B12, faecal calprotection
endoscopy - cobble-stoning, skip lesions
biopsy - patchy, granuloma, loss of villi
bowel imaging - MRI, CT, barium follow through
Crohn’s disease management medica
lifestyle - quit smoking, avoid foods that aggravate symptoms
1st - steroids, prednisolone, budenoside, 6-8 weeks induce remission, weight gain, osteoprosis, thinning pf skin, hypertension
2nd - immunosuppressants, azathioprine, methotrexate, maintenance therapy
3rd - anti-TNF, imab, promote apoptosis of T cells
Crohn’s disease management surgery
not curative
emergency or elective
often involves resection of affected area
risk of short gut syndrome and parenteral nutrition
may need stoma
complications - strictures, fistulas, obstruction, flare ups and remission, malnutrition, short gut syndrome, low quality of life, colon cancer
ulcerative colitis
chronic, remitting condition affecting just the colon
peak incidence in late adolesence
affects males and females equall
proctitis, proctosigmoiditis, left-sided colitis, extensive colitis
UC macroscopic changes
mucosa looks red and inflamed very friable continuous appearance pseudo-polyps present thin wall
UC microscopic changes
inflammation limited to mucosa superficial
goblet cells depleted
crypt abscesses
UC risk factors
not smoking
family history
no appendectomy
NSAIDs
UC signs and symptoms
aphthous ulcers finger clubbing pallor - anaemia abdo tenderness in LIF history of bloody diarrhoea faecal urgency/incontinence tenesmus pain before defication, relieved once stool passed malaise fatigue fever anorexia anaemia
UC investigations
p-ANCA positive FBC - anaemia, high platelets CRP - raised LFTs - may be deranged U&Es - may be deranged coeliac serology - to exclude coeliac stool culture - to exclude infective casues faecal calprotectin - raised suggests active inflammation colonoscopy diagnostic
UC medical management
1st - topical aminosalicylate 2nd - oral aminosalicylate 3rd - add on topical/oral steroid 4th - biologics, anti-TNF acute exacerbations - IV steroids azathioprine also used lifestyle support groups bone health assessment colonic cancer surveillance monitor nutrition status flu and pneumococcal vaccines
UC surgical management
elective colectomy with/without ileostomy or colostomy stoma
anorexia nervosa
a low BMI <18.5 because of a reduction in food intake due to fear of weight gain
anorexia nervosa signs and symptoms
distortion of body image fear of gaining weight amenorrhoea history of fad diets sensitivity to cold, constipation, low BP, bradycardia
bulimia nervosa
uncontrolled eating the large quantities of food over short periods of time followed by compensatory behaviour
self induced vomiting
laxative abuse
excessive exercise
fluctuation in body weight within normal limits
irregular periods
osmotic diarrhoea
large quantities of non-absorbable substances in the bowel cause water to move into the lumen
resolved by avoiding the substances and an increased absorption by the bowel
eg certain purgatives, malabsorption condition
secretory diarrhoea
secretion of electrolytes into the lumen in response to a signal. followed by the movement of water
resolved by replacing the electrolytes and fluids
eg E.coli, C.diff and cholera
inflammatory diarrhoea
damage to mucosal cells leads to loss of blood and fluid. decrease in absorptive function causes a build up in malabsorbed substances
treat underlying
eg IBD
diarrhoea history
acute < 2 weeks chronic frequency, urgency, nature of stool blood, mucus, pus explosive pain, fever, weight loss, appetite constipation social history
diarrhoea causes
infenctive - sudden onset, crampy abdo pain, fever
IBD - loose, blood stained stools, chronic history, extra GI symptoms
IBS - no blood, triggering events, alternating diarrhoea/constipation
pancreatic - steatorrhea
colorectal cancer - blood, mass
malabsorption
constipation
< bowel movements per week
often involves - straining, hard stools, incomplete emptying, abdominal pain, perianal pain and bleeding
constipation causes
poor diet, poor fluid intake
obstruction - stricture, colorectal cancer, diverticulitis
IBS
anorectal disease - stricture, prolapse, fissure
functional/idiopathic
metabolic
drugs
constipation treatment
treat underlying diet, exercise, fluid bulking agents stool softeners osmotic laxative stimulant laxative
necrotising enterocolitis
affects premature babies when the GI wall is invaded by bacteria
bowel becomes inflamed and leads to the necrosis of the tissue
bowel contents leak into peritoneal cavity and cause peritonitis
symptoms - poor feeding, abdo distention, bile stained vomit, sepsis
peritonitis
inflammation of the peritoneum
peritonitis causes
underlying GI condition perforated organ peritoneal dialysis ascites related to liver disease TB
localised peritonitis
seen with acute inflammation
paiain and localised tenderness, more gradual onset
treat underlying cause
generalised peritonitis
inflammation of peritoneal cavity
due to irritation of peritoneum because of infection or chemical irritation due to leakage of intestinal contents
there may be a superimposed e.coli infection
peritonitis signs and symptoms
abdo pain and tenderness rigid abdomen rebound tenderness distended abdomen high temp tachycardia
peritonitis investigations
erect CXR - air under diaphragm if due to perforation
abdominal paracentesis
peritonitis management
resuscitate pt (NG tube, IV fluids, antibiotic) surgical - peritonea lavage, treat underlying cause
peritonitis complications
sepsis
multiorgan failure
abscess formation - may need drained
Peutz-Jeghers syndrome
autosomal dominant condition characterised by hamartomatous GI polyps and mucocutaneous hyperpigmentation
