Lower GI Inflammatory Disorders and GI Malabsorption Flashcards
What is appendicitis?
Inflammation of the appendix due to obstruction of the opening of the appendix
What are the signs and symptoms of appendicitis?
Periumbilical pain shifting to the lower right quadrant
- Guarding
- Tenderness/rebound tenderness
Anorexia
Nausea and vomiting
What tests can be used to diagnose appendicitis?
Gold standard: CT/Ultrasound
Physical examination
Increased white blood cell count
Urinalysis
What is the treatment for appendicitis?
Laparoscopic appendectomy
NO LAXATIVES
What are the complications of appendicitis?
Rupture –> Peritonitis
Abscesses
What is diverticulosis?
What is the main cause of diverticulosis?
What is diverticulitis?
Diverticulosis is the formation of multiple, non-inflamed pockets in the bowel (diverticula)
Diverticulitis is the inflammation of these diverticuli
Diverticulosis is caused by low fibre intake
What are the signs and symptoms of diverticulitis?
Acture lower left quadrant pain
Palpable masses
- Diverticula becomes swollen and can be felt on the abdominal surface
Systemic infection symptoms
Altered bowel movements
- Change in size
- Presence of mucus and/or blood
What are some diagnostic tests for diverticulitis?
CT with contrast
Blood tests
Physical exam
History
What is the treatment for diverticulitis?
General:
- High-fibre diet
- Increase activity and weight management
- Stool softeners
- Clear liquid diet
Acute:
- Rest colon
- Inflammation management
- Oral antibiotics
- NBM
- Nasogastric suction
- Surgery if abscess or obstruction
What are the complications of diverticulitis?
Diverticular bleeding
Abscess
Perforation into peritoneum
- Peritonitis if uncontained
What is peritonitis?
What are the primary and secondary causes of peritonitis?
Inflammation of the peritoneum
Primary cause: Organisms invading the abdomen (Uncommon - intact gut)
Secondary cause: Rupture/perforations/Trauma (Most common)
What are the signs and symptoms of peritonitis?
Severe abdominal pain
- Tenderness over-involved area
- Rebound tenderness
Distension
Spasm
Fever
What are some diagnostic tests for peritonitis?
Abdominal X-ray and ultrasound
Blood tests
Peritoneoscopy
Aspiration if ascites present (less common)
What is the treatment for peritonitis?
Antibiotics
Pain relief
IV Fluids
Nasogastric suction
- Remove the bowel contents so they don’t leak into the peritoneum
Surgery
- Flush antibiotics into the peritoneum and leave antibiotics in the peritoneal space (Peritoneal lavage)
What are the complications of peritonitis?
Sepsis
Hypovoloaemic shock
What are two examples of inflammatory bowel diseases?
Two examples of inflammatory bowel diseases are Chron’s disease and Ulcerative colitis
What is Chron’s disease?
What causes Chron’s disease?
A chronic inflammatory bowel disease that usually affects the ileum and the colon but can affect all parts of the GI tract
Chron’s disease is of unknown origin
What are the signs and symptoms of Chron’s disease?
Diarrhea
Weight loss
Abdominal pain
Fever
Fatigue
What is ulcerative colitis?
What causes ulcerative colitis?
Inflammation of the colon with the development of mucosal and sub-mucosal ulcers
Ulcerative colitis is of unknown origin
What are the signs and symptoms of ulcerative colitis?
Blood in stool
- Brown blood = Old
- Red/Large amount of blood = Invasion or erosion of a blood vessel into the bowel
Diarrhea
Rectal bleeding
Abdominal pain
What is the treatment for inflammatory bowel diseases?
Medication
Nutritional management/Dietary adjustments
- Ensure adequate caloric intake
Inflammation management
- Steroids
- Antibiotics if infected
Stress management
Smoking cessation
Surgery depending on the type of inflammatory bowel disease
What are the complications of inflammatory bowel diseases?
Haemorrhage
Strictures
- Tightening bands around bowels
Perforation
Dilatation
Fissures
- Crack
Fistulae
- A tract from one lumen to another
- Increased risk of rectal and intestinal cancers
How is Chron’s disease diagnosed?
Often through biopsy
What is the surgical intervention for Ulcerative colitis?
Total or partial colectomy with the formation of an ileal pouch or ileostomy (AKA proctocolectomy)
When is surgery advocated for in managing Chron’s disease?
What is the usual management for Chron’s disease without surgery?
Conservative surgery to repair strictures, obstructions and fissures/fistulas without bowel removal
Conservative management with medication and diet
What is coeliac disease?
What causes coeliac disease?
Coeliac disease is an immune-mediated response to gluten ingestion
It is caused by genetic predisposition
What are some diagnostic tests for coeliac disease?
Gold standard: Small intestine biopsy before and after gluten
Serology for Immunoglobulin A
Genotyping for antigens
What is the treatment/management of coeliac disease?
Gluten-free diet
Corticosteroids
What is GI Malabsorption syndrome?
Impaired absorption of fats, carbs, proteins, minerals and vitamins
What are some causes of GI malabsorption syndrome?
Biochemical & Enzymatic
- e.g. Lactase deficiency
Lymphatic/vascular
- e.g. Ischaemia, heart failure
Infectious
- e.g. parasites
Small intestine mucosal disruption/surface area loss
- e.g. Inflammatory bowel diseases, coeliac disease
What are some gastrointestinal signs and symptoms of GI malabsorption?
Diarrhoea
Flatulence
Weight loss
Fatty stools
What are some haematological symptoms of GI malabsorption?
Anaemia
Tendency to haemorrhage
What are some musculoskeletal symptoms of GI malabsorption?
Bone pain
Osteoporosis
Weakness
Wasting
What are some neurological symptoms of GI malabsorption?
Altered mental state
Paraesthesia
Peripheral neuropathy
Night blindness
What are some skin-related symptoms of GI malabsorption?
Bruising
Dermatitis
Brittle Nails
Hair thinning
What are some cardiovascular symptoms of GI malabsorption?
Hypotension
Tachycardia
Peripheral oedema
What are some tests that can help diagnose GI malabsorption syndrome?
Stool tests
Blood tests
Hydrogen breath tests
CT scans
Endoscopy with small bowel biopsy
What is the treatment on GI malabsorption based on?
The treatment for GI malabsorption is based on the cause, but early identification can help prevent complications
What is the cause of irritable bowel syndrome?
It is unknown. May be related to food allergies? May be related to stress?
What are the signs and symptoms of irritable bowel syndrome?
Abdominal pain
Altered bowel patterns
- Diarrhoea
- Constipation
Distension
Flatulence
Urgency
Fatigue
Sleep disturbances
What are some tests for irritable bowel syndrome?
Patient history and description of symptoms
Tests aimed at differential diagnoses
What is the treatment for irritable bowel syndrome?
Dietary management
Psychological
Medication
