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GI > Lower GI diseases - medical > Flashcards

Lower GI diseases - medical Flashcards

1
Q

coeliac disease

A

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

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2
Q

coeliac disease associated diseases

A 
thyroid disease 
type 1 diabetes 
Sjogren syndrome 
IBD
IgA deficiency
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3
Q

coeliac disease signs and symptoms

A 
abdo pain 
weight loss
diarrhoea/steatorrhoea 
angular stomatitis on corners of mouth 
dermatitis herpetiformis on extensor surface of elbows 
anaemia, malnutrition
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4
Q

coeliac disease long-term problems

A

iron/folate deficiency

osteoporosis

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5
Q

ceoliac disease investigations

A

1st line - serology
tTG antibodies (IgA tissue transglutaminase antibodies)
EMA (IgA endomysial antibodies)
2nd line - biopsy
taken endoscopically may see scalloping of mucosal folds

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6
Q

coeliac disease management

A 
gluten free diet
vitamin supplement 
pneumococcal vaccines for pts with splenic atrophy
annual blood tests 
screen for other autoimmune conditions
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7
Q

coeliac disease differentials

A

IBS

IBD

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8
Q

GI malabsorption

A

defective mucosal absorption

digestive system does not have the function and/or enzymes to break down the substances from the diet

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9
Q

causes of malabsorption

A

coeliac, lactose intolerance, Crohn’s, post infective, chronic pancreatitis, biliary obstruction, liver cirrhosis
Whipple’s disease, drugs, PSC, short bowel

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10
Q

malabsorption symptoms and signs

A

diarrhoea, weight loss, bloating, abdo pain

anaemia, oedema, steatorrhea, bleeding disorders, neuropathy

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11
Q

lactose malabsorption

A

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

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12
Q

tropical sprue

A

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

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13
Q

vitamin C deficiency

A

scurvy

gum disease, anorexia, weakness

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14
Q

vitamin D deficiency

A

osteomalacia, rickets

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15
Q

malnutrition

A 
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
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16
Q

adenocarcinoma of small bowel

A

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

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17
Q

lymphoma of small bowel

A

mot often found in ileum
most common lymphoma type is B cell arising from MALT
surgical resection + radio + chemo

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18
Q

carcinoid tumours of small bowel

A

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

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19
Q

carcinoid syndrome

A 
only occur if tumour has metastasised 
spontaneous flushing 
diarrhoea
SOB
pulmonary stenosis or tricuspid incompetence
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20
Q

carinoid tumour investigation and management

A

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

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21
Q

IBS

A

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

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22
Q

IBS history

A 
SOCRATES symptoms 
impact of daily activities 
diet/exercise/mental well being 
improvement with defecation 
change in frequency of stool
change in appearance of stool
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23
Q

IBS exam

A

check BMI for unexplained weight loss
abdo exam to check for tenderness/masses
PR exam to check for rectal pathology

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24
Q

IBS investigations

A

FBC
ESR/CRP - raised in infection/inflammation
coeliac serology

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25
Q

IBS management

A 
identify dietary/mental triggers 
dietary advice FODMAP
recommended increased probiotic intake 
consider anti-diarrhoeals 
consider laxatives 
antispasmodic if pain not resolving
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26
Q

FoDMAP

A

fermentable oligo, di, momo-saccharides and polyps

fructose, lactose, polyps, fructans, galactans

27
Q

IBD aetiology

A

genetic - family history, involved with coding immune cells, NOD2/CARD15 protein for bacterial recognition
environmental triggers - smoking, NSAID, hygiene, diet and nutrition, stress

28
Q

mucosal immune system

A

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

29
Q

extra-GI manifestations of IBD

A

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

30
Q

Crohn’s disease signs and symptoms

A 
abdominal pain 
diarrhoea 
weight loss and reduced growth 
fatigue 
malaise 
fever 
mouth ulcers 
angular stomitis 
peri-anal disease - pain, abscesses, fistulas and strictures
31
Q

Crohn’s disease risk factors and social history

A

family history
present in young people
smoking

32
Q

Crohn’s disease investigations

A

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

33
Q

Crohn’s disease management medica

A

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

34
Q

Crohn’s disease management surgery

A

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

35
Q

ulcerative colitis

A

chronic, remitting condition affecting just the colon
peak incidence in late adolesence
affects males and females equall
proctitis, proctosigmoiditis, left-sided colitis, extensive colitis

36
Q

UC macroscopic changes

A 
mucosa looks red and inflamed 
very friable 
continuous appearance 
pseudo-polyps present 
thin wall
37
Q

UC microscopic changes

A

inflammation limited to mucosa superficial
goblet cells depleted
crypt abscesses

38
Q

UC risk factors

A

not smoking
family history
no appendectomy
NSAIDs

39
Q

UC signs and symptoms

A 
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
40
Q

UC investigations

A 
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
41
Q

UC medical management

A 
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
42
Q

UC surgical management

A

elective colectomy with/without ileostomy or colostomy stoma

43
Q

anorexia nervosa

A

a low BMI <18.5 because of a reduction in food intake due to fear of weight gain

44
Q

anorexia nervosa signs and symptoms

A 
distortion of body image 
fear of gaining weight 
amenorrhoea 
history of fad diets 
sensitivity to cold, constipation, low BP, bradycardia
45
Q

bulimia nervosa

A

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

46
Q

osmotic diarrhoea

A

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

47
Q

secretory diarrhoea

A

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

48
Q

inflammatory diarrhoea

A

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

49
Q

diarrhoea history

A 
acute < 2 weeks 
chronic 
frequency, urgency, nature of stool 
blood, mucus, pus
explosive
pain, fever, weight loss, appetite
constipation 
social history
50
Q

diarrhoea causes

A

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

51
Q

constipation

A

< bowel movements per week

often involves - straining, hard stools, incomplete emptying, abdominal pain, perianal pain and bleeding

52
Q

constipation causes

A

poor diet, poor fluid intake
obstruction - stricture, colorectal cancer, diverticulitis
IBS
anorectal disease - stricture, prolapse, fissure
functional/idiopathic
metabolic
drugs

53
Q

constipation treatment

A 
treat underlying 
diet, exercise, fluid
bulking agents
stool softeners
osmotic laxative 
stimulant laxative
54
Q

necrotising enterocolitis

A

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

55
Q

peritonitis

A

inflammation of the peritoneum

56
Q

peritonitis causes

A 
underlying GI condition 
perforated organ 
peritoneal dialysis
ascites related to liver disease 
TB
57
Q

localised peritonitis

A

seen with acute inflammation
paiain and localised tenderness, more gradual onset
treat underlying cause

58
Q

generalised peritonitis

A

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

59
Q

peritonitis signs and symptoms

A 
abdo pain and tenderness
rigid abdomen 
rebound tenderness
distended abdomen 
high temp
tachycardia
60
Q

peritonitis investigations

A

erect CXR - air under diaphragm if due to perforation

abdominal paracentesis

61
Q

peritonitis management

A 
resuscitate pt (NG tube, IV fluids, antibiotic)
surgical - peritonea lavage, treat underlying cause
62
Q

peritonitis complications

A

sepsis
multiorgan failure
abscess formation - may need drained

63
Q

Peutz-Jeghers syndrome

A

autosomal dominant condition characterised by hamartomatous GI polyps and mucocutaneous hyperpigmentation

GI (10 decks)

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