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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
IBS management
``` identify dietary/mental triggers dietary advice FODMAP recommended increased probiotic intake consider anti-diarrhoeals consider laxatives antispasmodic if pain not resolving ```
26
FoDMAP
fermentable oligo, di, momo-saccharides and polyps | fructose, lactose, polyps, fructans, galactans
27
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
28
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
29
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
30
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 ```
31
Crohn's disease risk factors and social history
family history present in young people smoking
32
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
33
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
34
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
35
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
36
UC macroscopic changes
``` mucosa looks red and inflamed very friable continuous appearance pseudo-polyps present thin wall ```
37
UC microscopic changes
inflammation limited to mucosa superficial goblet cells depleted crypt abscesses
38
UC risk factors
not smoking family history no appendectomy NSAIDs
39
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 ```
40
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 ```
41
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 ```
42
UC surgical management
elective colectomy with/without ileostomy or colostomy stoma
43
anorexia nervosa
a low BMI <18.5 because of a reduction in food intake due to fear of weight gain
44
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 ```
45
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
46
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
47
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
48
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
49
diarrhoea history
``` acute < 2 weeks chronic frequency, urgency, nature of stool blood, mucus, pus explosive pain, fever, weight loss, appetite constipation social history ```
50
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
51
constipation
< bowel movements per week | often involves - straining, hard stools, incomplete emptying, abdominal pain, perianal pain and bleeding
52
constipation causes
poor diet, poor fluid intake obstruction - stricture, colorectal cancer, diverticulitis IBS anorectal disease - stricture, prolapse, fissure functional/idiopathic metabolic drugs
53
constipation treatment
``` treat underlying diet, exercise, fluid bulking agents stool softeners osmotic laxative stimulant laxative ```
54
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
55
peritonitis
inflammation of the peritoneum
56
peritonitis causes
``` underlying GI condition perforated organ peritoneal dialysis ascites related to liver disease TB ```
57
localised peritonitis
seen with acute inflammation paiain and localised tenderness, more gradual onset treat underlying cause
58
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
59
peritonitis signs and symptoms
``` abdo pain and tenderness rigid abdomen rebound tenderness distended abdomen high temp tachycardia ```
60
peritonitis investigations
erect CXR - air under diaphragm if due to perforation | abdominal paracentesis
61
peritonitis management
``` resuscitate pt (NG tube, IV fluids, antibiotic) surgical - peritonea lavage, treat underlying cause ```
62
peritonitis complications
sepsis multiorgan failure abscess formation - may need drained
63
Peutz-Jeghers syndrome
autosomal dominant condition characterised by hamartomatous GI polyps and mucocutaneous hyperpigmentation

GI (10 decks)

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