UGI/CR - The Colon Flashcards
CAuse of Meckels diverticulum
Remnant of embryological vitellointestinal duct
RUle of 2’s Meckel’s
2% pop
2% develop Sx
2cm long
20 inches from ileocecal valve
PS Meckels diverticulum
Usually asymp or can mimic other conditions
What other conditions can Meckels mimic? (4)
Caecal volvulus
Intussusception
Appendicits
Peptic ulceration
Why can Meckels mimic a caecal volvulus
Because if tethered to umbilicus, diverticulum may act as apex of volvulus
Why can Meckels mimic peptic ulceration
Ulceration of gastric acid secreting epithelium
Ix Meckels
Technetium scan
CT
Def of IBS
12 months previously, at least 12 consecutive weeks of abdo pain/discomfort w/ 2-3 of:
Relieved by defacation
Onset assoc w/ change freq stool
Assoc w/ change form of stool
Other Sx IBS
Bloating Passage mucus Stool passage Sx Gynae Sx Urinary Sx back pain Headaches Bad breath Poor sleep fatigue
Stool passage Sx assoc w/ IBS (2)
Tenesmus
Feeling of incomplete evacuation
Gynae Sx assoc w/ IBS (3)
Dysmenorrhoea
Dysparenuia
Premenstrual tension
Urinary Sx assoc w/ IBS (3)
Frequency
Urgency
Nocturia
Prevalnce IBS
10-20%
M:F IBS
1:2
Factors triggering onset IBS (7)
Affecting disorders Psychological stress + trauma GI infection ABx Sexual/physical/verbal abuse Pelvic surgery Eating disorders
Ix IBS (3)
Hx - ensure no red flag Sx
O/E - anaemia/masses
Ix to rule out coeliac (CRP/ESR, foecal calprotectin) (TTG/anti-endomysial), (FBC)
Success rate IBS Mx
50%
Mx IBS
Advice - exercise/relaxation/diet Can try low FODMAP diet Antispasmodics Laxatives avoid constipation Antimotility Dx
What is 1st line antispasmodic for Mx IBS
Mebeverine
Which laxative should not be used in Mx of IBS and why
Lactulose
1st line antimotility Dx IBS
Loperamide
2nd line Mx IBS
TCA once nightly
3rd line Mx IBS
SSRIs
Def Refractory IBS + Mx
Sx persisting after 12 months of anti-depressant meds - Rx to CBT
M:F Chrons
=
RF chrons (4)
Poor diet
FHx
Smoking
Altered immune state
WHere in the GIT is Chron’s most common (2)
Terminal ileum
Ascending colon
Chrons appearance XR
Rose thorn ulcers
Chrons appearance CT
Cobblestone appearance
Which layers of the bowel are affected in chrons
ALl layers
Clinical features Chrons (6)
Abdo pain Diarrhoea W loss Severe aphthous ulcers mouth Anal complications Extra GI manifestations
Peak ages UC
15-30
60
Which RF for Chrons is protective in UC?
Smoking
Pathology UC
Inflammation starts in rectum and ascends into colon
What is UC called if in rectum alone
Proctitis
What layers of the bowel does UC affect
Mucosa only
PS UC (3)
Crampy lower abdo discomfort
Gradual onset diarrhoea (bloody)
Extra GI Sx
XR appearance UC
Thumb indents along colon Mucosal islands (necrosis)
Specific Sx: Proctitis + proctosigmoiditis (4)
Fresh bleeding
Mucus
Urgency
Tenesmus
Specific Sx - extensive pancolitis (2)
Abdo pain
Blood diarrhoea
Histology Chrons (3)
Transmural inflammation
Lymphoid hyperplasia
Granulomas
Histology UC (3)
Mucosal inflammation
Crypt abscesses
Goblet cell depletion
Chrons vs UC: Location
C: Mouth –> anus
UC: Colon only
Chrons vs UC - anal involvement?
C: Often
UC: Seldomn
Chrons vs UC - Continuity
C: Discontinuous ‘skip lesions’
UC; Continuous from rectum
Chrons vs UC - Fistulae
C: Common
UC: uncommon
Chrons vs UC - smoking
C: Increases risk
UC: protective
Chrons vs UC - cure
C: surgery to help Sx
UC: surgery is cure
Ix - Chrons/UC - bloods (5)
FBC U+E ESR CRP LFT
FBC findings Chrons
Hypoalbuminaemia - severe Chrons
Se Fe/B12/folate anaemia common
Stool studies - Chrons/UC (3)
Stool chart
MCS x 3
Calprotectin
Use of endoscopy in UC/Chrons
Rigid/flexi sigmoidoscopy UC
Colonoscopy
Endoscopic rectal biopsy may be taken
mx acute chrons flare - Mild
PO prednisolone
mx acute chrons flare - severe (3)
IV HC 100mg//6h
NBM + parental nutrition
Once improved - PO pred
What warrants admission - acute chrons flare (4)
Raised temp
Raised pulse
CRP/ESR raised
Low albumin
2nd line Mx Severe acute chrons flare
Thiopurines
What must be checked before prescribing thiopurines
TMPT
Refractory disease Chrons acute flare up Mx
Biologics
Chrons maintenance - 1st line
Thiopurines
Chrons maintenance - 2nd line
methotrexate
Which med is specifically useful for Chrons w/ anal disease
PO metronidazole
Mx - mild mod acute UC flare up - proctitis/proctosigmoiditis
TO aminosalicylate +/- PO mesalazine
Mx mild/mod acute UC flare up - paancolitis
PO mesalazine +/- PO beclomethasone
+ TO mesalazine
2nd line mild/mod acute UC flare up
Add PO prednisolone
If not successful after 4 w
3rd line mild/mod acute UC flare up
After another 2-4w
Add tacrolimus
4th line mild/mod acute UC flare up
Biologics
Acute severe/fulminating UC flare up Mx (4)
MDT
Start IV CCS
SC heparin
Avoid anti-motility Dx
2nd line x - acute severe UC flare up Mx
IV ciclosporin
3rd line Mx - acute severe UC flare up
biologics
UC maintenance Mx - 1st line
5ASA derivatives
TO if proctosigmoiditis
PO if L sided
E.g.s of 5ASA derivatives (2)
Sulfasalazine
Mesalazine
2nd line Mx UC maintenance
PO thiopurines
General IBD complications (4)
bowel perforation
Lower GI haemorrhage
Toxic dilatation
Colonic carcinoma
20y risk of colon cancer - UC
115%
PS toxic dilation (3)
Persistent fever
TachyC
Loose blood-stained stool
Ix results toxic dilation (2)
Falling albumin + potassium
AXR - dilated >6cm colon w/ mucosal ilsands
Mx toxic dilation
ER SURGERY
Chrons specific complications (4)
SBO
Fistulae
Abscess formation
B12/folate/Fe deficiencies
Extracolonic manifesations duing active phase IBD (6)
Conjunctivitis/episcleritis/iritis Arthralgia large joints Erythema nodosum Pyoderma gangrenosum Venous thrombosis Fatty liver
Extracolonic manifesations at any time IBD (6)
Autoimmune hepatitis Gallstones Renal calculi 1SC Cholangiocarcinoma AS
