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Gastrointestinal > Small Bowel Pathology > Flashcards

Small Bowel Pathology Flashcards

(45 cards)

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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?

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A

Usually develops in childhood but can begin at any age

20
Q

How does coeliac disease present?

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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?

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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?

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A

DM1 as conditions are often linked

23
Q

What investigations are used in coeliac diagnosis?

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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?

Study These Flashcards
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
What should a patient do before confirming a diagnosis of coeliac?
Patient must be eating gluten in more than 1 meal a day for 6 weeks, otherwise serology and biopsy may be negative
26
What is the management for coeliac?
Lifelong guten free diet Coeliac antibody monitoring Pneumococcal immunisation, due to hyposplenism
27
What conditions are associated with coeliac?
DM1 Thyroid disease Autoimmune hepatitis Primary biliary cirrhosis Primary sclerosing cholangitis
28
Name some complications of coeliac disease
Refractory coeliac disease Anaemia (Folate, iron and B12 deficiency) Osteoporosis Small bowel adenocarcinoma Lymphoma Functional hyposplenism
29
Give features of angiodysplasia
Vascular malformation of the gut Occasional rectal bleeding Fatigue Dyspnoea Colonoscopy shows scattered bright lesions with branching appearance of vessels from central vessel
30
How is angiodysplasia managed?
Interventional endoscopy * Adrenalin injection * Photocoagulation * Clipping
31
What is acute mesenteric ischaemia?
Acute disruption of blood supply to small bowel
32
How is acute mesenteric ischaemia managed?
Emergency laparotomy
33
What causes small bowel obstruction?
Intra-abdominal adhesions, due to previous surgery Incarceration of hernias Malignancy IBD
34
How does small bowel obstruction present?
Central abdominal pain N&V, early Constipation, late Abdominal distention Tinkling/high pitched bowel sounds
35
How is small bowel obstruction managed?
IV fluids NG tube Emergency laparotomy
36
Differentiate between small and large bowel obstruction
In small, there is early onset N&V In large, there is late onset N&V
37
What investigations are used in small bowel obstruction?
AXR, first initial investigation * Dilated bowel loops CT, diagnostic investigation Erect CXR * Pneumoperitoneum, if perforation
38
What is the most common cause of small bowel obstruction?
Adhesions
39
What is Peutz-Jeghers syndrome?
Autosomal dominant condition characterised by numerous hamartomatous polyps within the gastrointestinal tract, along with pigmented freckles on the lips, face, palms and soles
40
What is the most appropriate initial investigation to assess presence of free fluid within the abdomen?
FAST scan CT is useful in the assessment
41
Give features of carcinoid tumours
Appendix and small bowel are common origins Serotonin secretion Abdominal pain and diarrhoea Flushing Wheeze Pulmonary stenosis
42
What investigations are used in carcinoid tumours?
Raised urinary 5-HIAA
43
How are carcinoid tumours managed?
Octreotide/somatostatin analogue that blocks serotonin release and counters its peripheral effects
44
Give features of whipples disease
Systemic condition caused by Tropheryma whipplei Diarrhoea and weight loss Joint pain Memory loss Acid-Schiff (PAS)-positive macrophages on duodenal biopsy
45
How is whipples disease managed?
Co-trimoxazole

Gastrointestinal (14 decks)

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