The Case Of The Unrelenting Diarrhoea Flashcards
What are the histological features of chrohn’s disease?
Patchy - Loss of crept architecture - but focal
Transmural inflammation
Neuromuscular hyperplasia
Deep fissuring ulcers - knife edge/ rose thorn
Fibrosis
Polymorphic neutrophils
Comparison of histological features of IBD
How do we tell the difference between Crohn’s/UC?
Clinical history Location of biopsies Endoscopic findings Imaging Ancillary tests - microbiology, serology Can have indeterminate colitis - only a diagnosis that can be made at resection Usually behaves more like UC
Upper GI causes of diarrhoea
Plain radiography - advantages vs disadvantages
Cheap, readily available, clinicians can interpret
BUT
2-D image only, ionising radiation, poor soft tissue resolution
Contrast - Gas = black - fat - fluid - calcium - metal - contrast media
Erect CXR for GI helps to find…
Shows free gas/ airspace disease
AXR - coffee bean sign
AXR - riglers sign?
… studies:
Upper GI - OGD
Lower GI - Colonoscopy/flexi sig or CT colonography
Small bowel enteroclysis - MR Enterography
Contrast studies:
Upper GI - OGD
Lower GI - Colonoscopy/flexi sig or CT colonography
Small bowel enteroclysis - MR Enterography
Barium swallow is used for looking at…
Often post-OGD
Functional
Benign e.g. achalasia
Cancer
Birds beak appearance on barium swallow?
Achalasia
Why is ultrasound not commonly used for bowel assessment?
Due to gas
CT advantages vs disadvantages
How to diagnose a small bowel obstruction and cause of it?
CT
CT Colonography: good for imaging …
Good for polyps (esp small ones) good detail
MR enteropraphy:
Imaging of Crohn’s … acute inflammation shows evidence of …
Hyperaemia/prominence of the vasa recta
‘Comb sign’
Mural hyper-enhancement is seen in …
Crohn’s
