GI problems 1

Question 1

What things do we want to know about bowel habits?

Answer 1

• how regular
• diahorrea, constipation
• colour pale - jaundice, red - blood, black - from upper GI tract
• blood - normally inflammatory
• fatty
• pain
• what time of day

Question 2

What are common causes for diahorrhea with blood

Answer 2

• inflammation - crohns, UC, infection

- cancer

Question 3

Blood in diahorrhea, and weight loss differntials

-what to figure out enxt

Answer 3

• inflammation - crohns, UC, infection
• cancer
• weight loss - coeliac (not normally blood)
• full blood count
• want to know if there is malnutriton - coeliac, test b12, folate, iron ect
• want to know how long - iron low - blood for a while

-also do stool sample to see if infection

Question 4

Infection

Answer 4

• diahorrhea for a couple of weeks
• may be immune compromsied or taken antibitoics - c.difficle
• not normally blood
• check if recent travel
• normally self limiting

Question 5

IBS

Answer 5

• dont normally get irregular bowel habits at night

- no bleeding

Question 6

HOW CAN we tell if it is acute or prolonged blood loss?

Answer 6

microcytic anaemia - lots of iron lost so would be chronci

-if normal - then short term bledeign

Question 7

What are inflammatory markers?

Answer 7

• WBC, neutrophils, CRP, platelet
• normocytic anaemia
• low albumin, high ferritin - acute phase reaction

Question 8

** Differences between Crohns and ulcerative colitis

-other complications of crohns disease

Answer 8

Crohns - any part of GI tract

• discontinuous inflammation
• fistulisin, stricturing, perianal, anal fissure, deep ulcers

UC - colon only

• continuous inflammation starting at rectum
• shallow ulcers

Question 9

*** differences beteen colitis, ileitis, gastritis/duodentiits

Answer 9

– Colitis – diarrhoea, bleeding
– Ileitis – abdominal pain, typically at least an hour or so post-prandial
– Gastritis/duodenitis – dypepsia

Question 10

** symptoms of stricural disease

Answer 10

-if get obstruction - can get abdominal pain and distentsion, vomiting, bowels not opening

Question 11

*** UC symptoms

Answer 11

• diarrhoea, bleeding
• frequent bowel motions and urgency
• abdominal discomfort
• fever, malaise, weight loss
• raised CRP, ESR

Question 12

Other complicaitons of UC

Answer 12

Toxic megacolon

• occurs in severe UC and doesnt repsosd to teratment
• release NO, dont get contraction, and have dilated colon
• complications - perforation

-can get damage to other body organs

Question 13

Cause for weight loss with crohns

Answer 13

• reduced intake because of pain
• malabsroption
• chornci infalmmation inrease energy exependiture

Question 14

*** Treatment for IBD

Answer 14

• anti-inflamatorys - 5-aminosalicylates
• steroids e.g prednisone
• immunosupression

Surgery - does not treat this, but can remove parts of severe inflamamtion or stricures, absesses ect.

UC - can get colectomy is curative

Question 15

** what is consequence of resection of terminal ileum

Answer 15

• b12 is absorbed here
• bile salts are also absorbed here - reduced fat malabsorption - steatorrhoea
• bile salts in colon - irritant to colon, can get secretory diahorreha

Question 16

If person has microcytic anaemia what else do we need to fnd out?

Answer 16

• cause of iron deficicencey
• due to vegeterian or low iron intake?
• chronic blod loss
• abnormal absorption? (e.g coeliac)
• menstural loss

Question 17

Causes of abnormal blood loss?

Answer 17

-overat and occult bleeding, inflammation, ulcers, diverticulosis, polyps, cancer, angiodysplasia

Question 18

Diverticulitis

Answer 18

• increased muscle contractions
• causing high pressure causing branch out and form diverticular
• mainly in sigmoid colon
• get bleeding
• can get this will decreased fiber diets - constipation
• colonoscopy or CT scan

Question 19

** Rectal bleeding - colour

Answer 19

-Black - melena - upper GI tract ,small intestine
-Brigh red- outer bleedign - perianal
Bright red - left colon - mixed with stools
Dark red - proximal colon, distal smal intestine

Question 20

*** Commonest causes of GI bleeding in stomach

Answer 20

• Peptic ulcer - NSAIDS, H. pylori - stool test to check for bacterial antigen
• oesophagitis

Question 21

Coeliac Serology

Answer 21

• colonoscopy
• coelaic antibodies - elevated - need biopsy to confirm
• gluten causes an autoimmune response - get an increase in antibodies - cause damage to villi - cannot get absorption of nutrient and minerals
• igA tissue transglutaminase antibodies is most common
• before testing need to hav gluten in diet 2 pieces of bread
• can see damaged villi
• genetics - HLA-DQ2 or HLA-DQ8 - however 50% of population has this
• so if have other symptoms tehn may be case

Question 22

*** 3 conditions associated with coeliac disease

Answer 22

• skin conditions - dermatitis
• 1s degree relative with coeliac disease
• type 1 diabetes