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Gastrointestinal > Small Bowel Pathology > Flashcards

Small Bowel Pathology Flashcards

1
Q

What is Irritable Bowel Syndrome?

A

Chronic functional bowel disorder in the absence of identifiable structural pathology

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2
Q

What is the difference between structural and functional disease?

A

Structural GI disease is when there is detectable pathology, whereas functional is no detectable pathology

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3
Q

How common is IBS?

A

Common, affecting 20% of the population

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4
Q

What group does IBS affect more?

A

F>M

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5
Q

What are the causes of IBS?

A

Idiopathic

Post-infective

Stress

Adverse life events

Anxiety

Depression

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6
Q

How does IBS present?

A

Diarrhoea

Constipation

Fluctuating bowel habit

Frequent stools

Mucus

Abdominal pain, relieved by defaecation

Bloating/distention

Belching

Symptoms are made worse by eating and improved by opening bowels

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7
Q

What inestigations are used in IBS diagnosis?

A

Colposcopy, to exclude other pathology

FIT, to exclude bowel cancer

Anti-TTG, to exclude coeliac

Stool culture, to exclude infective cause

Rectal examination

Calprotectin, to exclude IBD

FBC, CRP, ESR normal

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8
Q

What is the non-pharmacological management of IBS?

A

Low FODMAP diet

Regular small meals

Limit caffeine and alcohol

Reduced processed foods

CBT

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9
Q

What is the first line pharmacological management of IBS?

A

Probiotics, for bloating, trial for 4 weeks

Laxatives, for constipation

Antimotility agents, for diarrhoea

Anti-spasmodic agents, for cramps

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10
Q

What is the first line anti-motility agent in IBS?

A

Loperamide

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11
Q

What laxative should be avoided in IBS?

A

Lactulose, as can cause bloating

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12
Q

What laxative is used for IBS patients not responding to convential laxatives?

A

Linaclotide

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13
Q

What is the first line anti-spasmodic in IBS?

A

Buscopan

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14
Q

What is the second line pharmacological management for IBS?

A

TCA

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15
Q

What is the third line pharmacological management for IBS?

A

SSRI

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16
Q

What is Coeliac disease?

A

Autoimmune condition characterised by sensitivity to the gliadin fraction of gluten, found in wheat, rye, barley and contaminated oats

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17
Q

Where does coeliac mainly occur and why?

A

Occurs mainly in the duodenum, perhaps as first to be exposed to gluten

But affects the jejunum the most

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18
Q

Describe the pathophysiology of coeliac disease

A

Anti-TTG and anti-EMA antibodies are created in response to gluten, that target epithelial cells of the intestine, leading to inflammation and villious atrophy

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19
Q

What age does coeliac disease tend to peak?

A

Usually develops in childhood but can begin at any age

20
Q

How does coeliac disease present?

A

Chronic diarrhoea

Bloating/abdominal distention

Weight loss, due to malabsorption

Fatigue and anaemia

Dermatitis Herpetiformis

Clubbing

Mouth ulceration

Reduced fertility

Rarely can present with neurological symptoms

21
Q

What is dermatitis herpetiformis?

A

Chronic skin condition characterised by blistering and itchiness typically on the abdomen

22
Q

What condition is also tested for in new cases of coeliac?

A

DM1 as conditions are often linked

23
Q

What investigations are used in coeliac diagnosis?

A

Distal duodenal biopsy

  • Villious atrophy/collapsed villi
  • Crypt hypertrophy

Antibodies

  • Raised anti-TTG
  • Raised anti-EMA

Total IgA levels

24
Q

Why does plasma IgA have to be tested before testing coeliac antibodies?

A

As anti-TTG and anti-EMA antibodies are a type of IgA, if total IgA is low/patient is deficient in IgA, coeliac test will be negative even if they have coeliac

For these patients, use IgG version of antibodies instead

25
Q

What should a patient do before confirming a diagnosis of coeliac?

A

Patient must be eating gluten in more than 1 meal a day for 6 weeks, otherwise serology and biopsy may be negative

26
Q

What is the management for coeliac?

A

Lifelong guten free diet

Coeliac antibody monitoring

Pneumococcal immunisation, due to hyposplenism

27
Q

What conditions are associated with coeliac?

A

DM1

Thyroid disease

Autoimmune hepatitis

Primary biliary cirrhosis

Primary sclerosing cholangitis

28
Q

Name some complications of coeliac disease

A

Refractory coeliac disease

Anaemia (Folate, iron and B12 deficiency)

Osteoporosis

Small bowel adenocarcinoma

Lymphoma

Functional hyposplenism

29
Q

Give features of angiodysplasia

A

Vascular malformation of the gut

Occasional rectal bleeding

Fatigue

Dyspnoea

Colonoscopy shows scattered bright lesions with branching appearance of vessels from central vessel

30
Q

How is angiodysplasia managed?

A

Interventional endoscopy

  • Adrenalin injection
  • Photocoagulation
  • Clipping
31
Q

What is acute mesenteric ischaemia?

A

Acute disruption of blood supply to small bowel

32
Q

How is acute mesenteric ischaemia managed?

A

Emergency laparotomy

33
Q

What causes small bowel obstruction?

A

Intra-abdominal adhesions, due to previous surgery

Incarceration of hernias

Malignancy

IBD

34
Q

How does small bowel obstruction present?

A

Central abdominal pain

N&V, early

Constipation, late

Abdominal distention

Tinkling/high pitched bowel sounds

35
Q

How is small bowel obstruction managed?

A

IV fluids

NG tube

Emergency laparotomy

36
Q

Differentiate between small and large bowel obstruction

A

In small, there is early onset N&V

In large, there is late onset N&V

37
Q

What investigations are used in small bowel obstruction?

A

AXR, first initial investigation

  • Dilated bowel loops

CT, diagnostic investigation

Erect CXR

  • Pneumoperitoneum, if perforation
38
Q

What is the most common cause of small bowel obstruction?

A

Adhesions

39
Q

What is Peutz-Jeghers syndrome?

A

Autosomal dominant condition characterised by numerous hamartomatous polyps within the gastrointestinal tract, along with pigmented freckles on the lips, face, palms and soles

40
Q

What is the most appropriate initial investigation to assess presence of free fluid within the abdomen?

A

FAST scan

CT is useful in the assessment

41
Q

Give features of carcinoid tumours

A

Appendix and small bowel are common origins

Serotonin secretion

Abdominal pain and diarrhoea

Flushing

Wheeze

Pulmonary stenosis

42
Q

What investigations are used in carcinoid tumours?

A

Raised urinary 5-HIAA

43
Q

How are carcinoid tumours managed?

A

Octreotide/somatostatin analogue that blocks serotonin release and counters its peripheral effects

44
Q

Give features of whipples disease

A

Systemic condition caused by Tropheryma whipplei

Diarrhoea and weight loss

Joint pain

Memory loss

Acid-Schiff (PAS)-positive macrophages on duodenal biopsy

45
Q

How is whipples disease managed?

A

Co-trimoxazole

Gastrointestinal (14 decks)

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