Small Intestine Disorders Flashcards
what are diverticula
diverticula are sac-like protrusions of mucosa through the muscular wall of the colon
define diverticular disease and diverticulitis
a condition where diverticula cause symptoms that can progress to diverticulitis - inflammation and infection of diverticula
causes of diverticular disease
believed to be caused as a result of deficiency of dietary fibre
risk factors of diverticular disease/diverticulitis
low fibre diet >50yrs smoking obesity use of NSAIDs, opioids and corticosteroids
clinical features of diverticular disease
intermittent abdominal pain in LLQ and tenderness
constipation or diarrhoea
bloating
rectal bleeding + passage of mucous
clinical features of diverticulitis
constant abdominal pain from hypogastrium to LLQ pyrexia bowel changes rectal bleeding anorexia vomiting + nausea
differentials of diverticular disease/diverticulitis
IBS appendicitis crohns disease colorectal cancer ruptured ovarian cyst ectopic pregnancy UTI
investigations for symptomatic diverticular disease
colonoscopy
bloods - ⬆️ WCC, platelets and ⬇️ Hb
investigations for diverticulitis
barium enema (if no complications) abdominal US sigmoidoscopy bloods - FBC, U+E, ESR + CRP
management of diverticular disease
advise high fibre diet with adequate fluid intake
consider prescription of bulk-forming laxatives
recommend paracetamol for pain
management of diverticulitis (at home)
oral antibiotics (if systemically unwell) paracetamol for pain clear liquids only for 48-72hrs with gradual solids reintroduction
management of diverticulitis (hospital)
IV antibiotics
Harmann’s procedure (resect sigmoid colon)
common complications of diverticular disease/diverticular disease
fibrosis
perforations
ruptured abscess
obstruction
define coeliac disease
a chronic immune-mediated systemic disorder that is triggered by exposure to dietary gluten
describe genetics of coeliacs disease
multigenetic disorder associated with HLA types HLA-DQ2 or HLA-DQ8
risk factors of coeliac disease
familial history
genetics (HLA allele)
diabetes (type 1)
autoimmune thyroid disease
clinical features of coeliacs disease
persistent, unexplained GI symptoms faltering growth dermatitis herpetiformis prolonged fatigue/lethargy 1st degree relative with disease
differentials of coeliacs disease
infective gastroenteritis non-coeliac gluten sensitivity food allergy IBS crohns disease
investigations of coeliacs disease
clinical examination (height, weight, abdominal pain/distension)
coeliac serology testing (IgA, tTGA)
bloods - FBC, LFTs
gold standard investigation for coeliacs disease and indication
if serology and blood indicate coeliac, refer for distal duodenal biopsy