Other GI Flashcards
Prevalence of IBD and smoking protective in which one
100/100,000 for each, Crohn’s more common
Smoking protective in UC
Macroscopic features in UC and crohn’s
UC - rectum, colon, backwash ileitis, continous, no strictures
Crohns - mouth to anus, skip lesions, strictures
Microscopic UC features
Crypt abscesses, non-granulomatous
Shallow ulcers
Pseudopolyps
Microscopic Crohn’s features
(Tranny Granny Crohn’s skipping down rosey cobblestone lane)
Transmural
Cobblestone mucosa
Fibrosis, granulomas, fistulae
Systemic symptoms in IBD
Fever, malaise, anorexia
Abdo symptoms in IBD
Diarrhoea Blood + mucous (more in UC) Abdo pain Tenesmus, urgency (UC) Weight loss (crohns)
Abdo signs
Fever, tender abdo - UC
Mouth ulcers, RIF mass, perianal abscess/tags, strictures - crohn’s
Skin and eye features in IBD
Skin -Clubbing -Erythema nodosum -Pyoderma gangrenosum (UC) Eyes -Iritis, uveitis -Episcleritis (more in crohns) -Conjunctivitis
Joint, HPB and other IBD features
Joint -Arthritis - most common extra abdo IBD features -Sacroilitis, ank spond HPB -PSC + cholangiocarcinoma (UC) -Gallstones (crohns) -Fatty liver Other -Amyloidosis -Renal stones
Complications in UC
Toxic megacolon
Bleeding, venous thrombosis
Malignancy
Complications in Crohns
Fistula
Strictures/obstructions, abscess
Malabsorpion
Ix UC:
Blood, stool, imaging
Ba/gastrograffin enema - lead pipe, thumbprinting
Ix Crohns and diagnose
Blood, stool, imaging
Small bowel follow-through/enteroclysis - skip lesions, rose thorn ulcers, string kantor sign (narrow terminal ileum)
Diagnose - ileocolonoscopy + regional biopsy
Rx acute UC
NBM, IV hydrocortisone, LMWH
Then oral pred + 5-ASA
No improvement - ciclosporin, infliximab
Induce remission in UC
Oral: 5-ASA (1st line), pred (2nd line)
Topical - suppositorie/enemas of 5-ASA + steroids
Steroid sparing agents (azathioprine, mercaptopurine, not methotrexate)
Maintain remission in UC
- 5-ASA PO
- azathioprine or 6-mercaptopurine
- Infliximab/adalimumab
Acute Rx of crohns
IV hydrocrotisone, LMWH
Metronidazole, NBM
Then oral pred
No improvement - methotrexate + infliximab
Induce remission in crohns
- budesonide (ileocaecal), sulfasalazine (colitis)
- pred
- methotrexate/azathioprine/mercaptopurine
- infliximab
Maintain remission in crohns
- Azathioprine/mercaptopurine
- methotrexate
- Infliximab
Coeliac prevalence and pathohys
0.5-1%
HLA-DQ2, DQ8
CD8+ mediated response to gliadin in gluten
Presentation of coeliac
GLIAD
GI malabsorption
-Abdo distension/colic, steatorrhoea, renal stones, anaemia, vit D/K/B2/B6 deficiency
-Lymphoma + carcinoma (T cell lymphoma, adenocarcinoma of small bowel)
-Immune associations (IgA deficiency, T1DM, PBC)
-Anaemia (hyposplenism - target cells, Howell-Jolly bodies)
-Dermatological (dermatitis herpetiformis, aphthous ulcers)
Antibodies in coeliac and OGD/biopsy finding
Anti-endomysial IgA (95% specific)
Anti TTG (transglutiminase) IgA
Anti-gliadin IgG
Biopsy - subtotal villous atrophy, crypt hyperplasia
Rx coeliac disease
Gluten free diet
Dapsone - dermatitis herpetiformis
Whipple’s disease gender and cause and biopsy finding
M:F 10:1
Tropheryma whippelii
PAS+ve macrophages
Features in whipple’s disease
Arthralgia GI - diarrhoea (malabsorption, colic) Systemic - lymphadenopathy, cough, fever, sweats Cardiac - endocarditis CNS - behaviour change, ophthalmoplegia
Rx whipples disease
Ceftriaxone
Risk factors for pancreatic cancer
SINED Smoking Inflammation - chronic pancreatitis Nutrition - fatty diet EtOH DM
Pancreatic cancer presentation
Male >60yrs
Head - painless obstructive jaundice
Body/tail - epigastric pain
Anorexia and weight loss
Signs of pancreatic cancer
Epigastric mass, splenomegaly, ascites
Painless jaundice + palpable gallbladder - Courvoiser’s law (not gallstones)
Trousseau sign - Thrombophlebitis migrans
Ix in pancreatic cancer
Bloods - cholestatic LFTs, raised CA-19-9
EUS - best
Rx pancreatic cancer
Whipple’s pancreatoduodenectomy
Cause of chronic pancreatitis
AGITS - Alcohol Genetic (CF, HH) Immune tryglycerides raised Structural (obstruction by tumour, pancreas divisum)
Presentation of chronic pancreatitis
Epigastric pain radiate to back, better when sitting forward
Steatorrhoea, weight loss, DM
Ix in chronic pancreatic cancer
raised glucose, low faecal elastase
US - psuedocyst
AXR/CT - calcification
Complications of chronic pancreatitis
Pseudocyst, DM, pancreatic cancer, biliary obstruction, splenomegaly
Hormone and location of carcinoid tumour
5HT (VIP, gastrin, glucagon)
Appendix 45%, ileum
Carcinoid syndrome features
FIVE HT Flushing Intestinal - diarrhoea Valve fibrosis - TR, PS whEEze - bronchoscontriction Hepatic involvement - bypass 1st pass metabolism Tryptophan deficiency - pellagra
Ix in carcinoid
Raised urine 5-HA
Raised plasma chromogranin A
Rx carcinoid
Symptoms - octreotide/loperamide
Resect
Vit A deficiency
Xerophthalmia
Dry conjunctivae
Night blindness–>total blindnesss
Thiamine/B1 deficiency
Beriberi
Wet - Heart failure + oedema
Dry - polyneuropathy
Wernicke’s - COA
Pellagra/nicotinic acid/B3 deificiency
Diarrhoea + Dermatitis + Dementia
Cause: dietary,isonizid, carcinoid syndrome
Pyridoxine, B6 deficiency
Peripheral sensory neuropathy
Vit B12/cyanocobalamin deficiency
Glossitis, peripheral neuropahty
Subacute combined degeneration of spinal cord - dorsal columns and corticospinal tract
Vitamin C deficiency, scurvy
Gingivitis, bleeding (gums, nose, hair follicles)
muscle pain/weakness
Oedema
Vit D deficiency - osteomalacia
Bone pain
