Gastroenterology Flashcards
(33 cards)
What is ulcerative colitis?
Inflammation involving any part of the large intestine ranging from the rectum only (proctitis) and projecting proximally to a varying degree to the entire colon (pancolitis). Inflammation seen is diffuse, continuous and confined to the mucosa.
What are the complications associated with UC?
- Benign strictures
- Adenocarcinoma (3-5%)
- Perforation
- Toxic megacolon
- Primary sclerosing cholangitis
- GI bleed
What are the main symptoms of UC associated with the colon?
- Rectal Bleeding
- Diarrhoea
- Blood in stool
- Abdominal Pain
- Bloating
- Tenesmus
- Urgency
- Incontinence
What drugs are used in the treatment of UC?
5-ASA derivatives (e.g. sulfasalazine, mesalazine)
Corticosteroids
Thiopurines (e.g. azothioprine, mercaptopurine)
What is the treatment goal of UC?
To induce and maintain remission
What is the role of the 5-ASA derivatives?
Usually used to maintain remission (decreases yearly relapse rate from 60% to 15%)
What is the role of corticosteroids in UC?
To remit acute disease, especially if severe or first attack, have a limited role in maintenance therapy
How should UC drugs be administered?
Dependent on the extent of disease
- Suppositories for Proctitis
- Enemas for Proctosigmoiditis
- Oral for Pancolitis
What drugs are used to induce remission of UC?
5-ASA derivatives, corticosteroids, immunosuppresive
What drugs are used to maintain remission of UC?
5-ASA and immunosuppressives (steroid sparing)
What is required for a diagnosis of UC?
Sigmoidoscopy with mucosal biopsy and negative stool cultures (to rule out infectious colitis)
What is the definitive treatment for UC?
Colectomy - will not get recurrence after surgery
What is Crohn’s disease?
Crohn’s disease (CD) is a disorder of unknown aetiology characterised by transmural inflammation of the GI tract. CD may involve any or all parts of the entire GI tract from mouth to perianal area, although it is usually seen in the terminal ileal and perianal locations. Unlike ulcerative colitis (UC), CD is characterised by skip lesions (where normal bowel mucosa is found between diseased areas).
What are the three most common causes of small bowel obstruction in order?
Adhesions
Incarcerated hernias
Malignancy
What are the three most common causes of large bowel obstruction in order?
Malignancy
Diverticulitis
Volvulus
What is intususseption?
Where part of the small bowel folds into the lumen of an adjacent part causing a bowel obstruction
What is the macroscopic appearance of Crohn’s Disease?
Distribution: Ileum ± colon
Presents in skip lesions and a cobblestone appearance
Stricture is common
Wall appears thickened
What is the macroscopic appearance of UC?
Distribution: colon only
Presents as diffuse, continuous inflammation
Rarely causes strictures
Wall appears thin
What are the 4 cell types in the stomach and what do they produce?
Mucous cells - Mucus
Parietal cells - HCl
Chief cells - Pepsinogen
Enteroendocrine cells - Gastrin
What are the three interchangable names for the circular folds in the small intestine?
Plicae circulaes or Valvulae conniventes or Kerckring folds
Barrett’s oesophagus is associated with an increased risk of what?
Oesophageal adenocarcinoma
What changes occur in Barrett’s oesophagus?
Metaplasia of the non-keratinising squamous epithelium of the oesophagus to abnormal columnar epithelium containing intestinal metaplasia.
What are the diagnostic criteria for diagnosis of Barrett’s oesophagus?
Endoscopic evidence of columnar lining in oesophagus above the gastroeosophageal junction
AND
Histological evidence of intestinal metaplasia (goblet cells) in biopsies from the columnar epithelium
What are the three islet cell types in the pancreas and what do they release?
Alpha cells - Glucagon
Beta cells - Insulin
Delta cells - Somatostatin
