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27 Cards in this Set
- Front
- Back
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Crohn's disease gene mutation |
- CARD15/NOD2: especially Ashkenazi Jews, early onset disease, ileal involvement, fistulisingand stenotic disease - CARD15 gene product modulates NFκB, which is required for the innate immune responseto microbial pathogens |
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Differentiating CD from UC clinically |
- Distrib: CD bum to mouth, UC colon only, always involves recum - Rectal bleeding: UC 90%, uncommon in CD - Abdo pain: Post prandial/colicky in CD, uncommon UC - Fever: Common in CD, uncommon CD - Urgency/tenes: Uncommon CD, common UC - Recurrence after surgery: Common CD, never post colectomy in UC |
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Endoscopic finding CD |
- Cobble stone, pseudopolyps, patchy lesions, ulcers (stellate, aphthous, linear) |
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Endoscopic findings UC |
- Continuous diffuse inflamms, erythema, friability, loss of normal vascular pattern, pseudopolyps, frequent strictures and fistulae (not in UC) |
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Histological features CD |
- Transmural dist w skip lesions, focal inflamm, non-causeating granulomas, deep fissuring + aphthous ulcers, strictures, glands intact |
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UC histology |
Mucosal dist, continuous disease (not skip lesions), architectural distortion, gland disruption, crypt abscess, no granulomas |
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Complications CD and UC |
CD: fistulae, strictures, perianal disease UC: Toxic megacolon |
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Extraintestinal manifestations IBD |
- Perianal skin tags in 80% CD - Oral ulcers CD - Cholelithiasis 35% of people w ileal CD - Arthritis (CD>UC) - Sacroilitus (both) |
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Acute liver failure def + aetiology |
• severe decline in liver function: - coagulation abnormality (INR>1.5) +encephalopathy in setting of previously normal liver - rapid (<26 wk duration) Toronto Notes 2016 drugs (especially acetaminophen), hepatitis B (measure anti-HBc, IgM fraction becausesometimes HBV-DNA and even HBsAg rapidly becomes negative), hepatitis A, hepatitis C(rare), ischemic, idiopathic |
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Acute liver failure s/s |
- Encephalopathy - Cerebral edema: eg papilloedema, HTN, bradycardia - Jaundice - Ascites: hepatic vein thrombosis w rapid development in setting of fulminant hepatic failure w abdo pain - RUQ tenderness - Change in liver span: May be small due to hepatic necrosis or may be enlarged due to heart failure, viral hepatitis, or Budd-Chiari syndrome - Haematemesis or melena: D/t upper GI bleed - Hypotension + tachycardia: Due to reduced systemic vascular resistance |
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Acute liver failure aetiology |
- Drugs(especially paracetamol,mushroom tox) - Viral: hepatitis B, hepatitis A, hepatitis C(rare) - Ischemic: eg. budd-chiari (hepatic vein) or thrombosis hepatic artery, portal vein - Acute fatty liver of pregnancy=>fulminant hepatic failure. AFLP typically occurs in the third trimester; preeclampsia develops in approximately 50% of these patients. - Idiopathic |
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Irritable Bowel Syndrome definition |
≥12 wk in the past 12 mo of abdominal discomfort or pain that has 2 out of 3 features: • Relieved with defecation • Associated with a change in frequency of stool • Associated with a change in consistency of stool Supportive info - Abnormal stool freq (>3/d, <3/wk) - Abnormal stool form >1/4 poos - Abnormal stool passage >1/4 poos (straining etc) - Passage of mucous >1/4 stools - Bloating |
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Red flags that make IBS less likely |
- Weight loss - fever - Nocturnal defecation - Anaemia - Blood/pus in stool - Abnormal gross findings on flexible sigmoidoscopy |
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IBS ddx |
• Enteric infections e.g. Giardia - Lactose intolerance/otherdisaccharidase deficiency - Crohn’s disease - Coeliac - Drug-induced diarrhoea - Diet-induced (excess tea, coffee, colas) |
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GORD aetiology |
• Inappropriate transient relaxations of LES – most common cause • low basal LES tone (especially in scleroderma) • contributing facts: delayed esophageal clearance, delayed gastric emptying, obesity, pregnancy, acid hypersecretion (rare) from Zollinger-Ellison syndrome |
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Complications of GORD |
- Bleeding - Perforation - GOO - Penetration=> Pancreatitis |
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Classic features of duodenal ulcers |
- Burning - Epigastric pain - Periodic (tends to occur in clusters over a week w periods of remission.) - Relieved by eating and antacids - Interrupts sleep - Develops 1-3hrs after meals |
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Hiatus hernia type 1 |
- Sliding hiatus hernia (90% all oesophageal hernias) - Herniation of stomach and Gastroesophageal (GO) junction into thorax - RFs: *age *increase intraabdo pressure (obesity, pregnancy, coughing, heavy lifting) *smoking s/s: - Majority asymptomatic *larger hernias frequently assoc w GORD d/t dec competence of LES Complications: *GORD most common *oesophagitis (dysphagia, heartburn) *Consequences of oesophagitis (peptic stricture, barrett's oesoph, oesoph carcinoma) *extra-oesophageal comps (pneumonitis/pneumonia, astham, cough, larygnitis) |
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Paraoesophageal (type II hiatus hernia) |
- Herniation of all or part of stomach through diaphragm, undisplaced GO junction (stays below diaphragm) - <10% of HHs - Complications: *haemorrhage *incarceration *strangulation (gastric volvulus) *obstruction *gastric stasis ulcer=>iron deficiency anaemia |
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Type III and IV hiatus hernias |
Type III: mixed (combo of sliding and paraoesoph) Type IV: herniation of abdo organis into thorax |
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Barrett's oesophagus |
- Metaplasia of normal squamous epithelium to abnormal columnar epithelium containing intestinal-type mucosa (intestinal metaplasia) - acquire from longstanding GOD=>damage to squamous epithelium - 10% GORD suffers will have it already by the time they seek help - M>F, increased gastric acid secretion, age >50, caucasion, smokers, overweight, hiatus hernia, long hx reflux - Malignant transformation low risk w low grade metaplasia, high risk (<60%/8 yrs) in high grade metaplasia |
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H.pylori and cancer risk |
- px w H. pylori have an increased risk of gastric adenocarcinoma - The risk increase appears to be restricted to non-cardia gastric cancer. |
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Coeliac disease and cancer risk |
- Malignant lymphoma - Small intestinal adenocarcinoma - Enteropathy-associated T-cell lymphoma |
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Peptic stricture |
- From oesophagitis - Dysphagia w a long hx of reflux sx - Diagnose w endoscopy (barium study if endoscopy unavail) tx: - Endoscopic dilation and indefinite PPI - Fundoplication if failure of above |
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Diffuse oesophageal spasm |
- Normal peristalsis interspersed w frequent, repetitive, spontaneous, high pressure, non-peristaltic waves - Idiopathic - Dysphagia of liquids and solids - Chest pain ix: - Manometry - Barium swallow (corkscrew) - Endoscopy would should normal mucosa (not first line, just to exclude) tx: *reassurance this is not cardiac pain *Anticholinergics, nitrates, calc channel blockers have variable benefit *surgical: balloon dilation, long oesophageal myotomy (rarely helpful) |
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Zollinger Ellison patho, comps |
- non–B islet cell, gastrin-secreting tumour of the pancreas =>stimulates parietal cells of the stomach to maximal activity=>hypertrophy gastric mucosa=>inc acid=> GI mucosal ulceration + diarrhoea + malabsorption - Idiopathic or as part of MEN1 - 1o tumor is usually in duodenum, pancreas, + abdo LNs, but ectopic locations also poss (eg, heart, ovary, gall bladder, liver, kidney). Comps <5% px *abdominal perforation *gastric outlet obstruction *oesophageal stricture. |
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Zollinger ellison s/s |
- Upper abdo pain in 75% (mimics PUD) - Diarrhoea in 73% - Heartburn - Nausea, vom - GI bleeds (d/t ulceration) - Weight loss - px w MEN1; hx of nephrolithiasis, hypercalcaemia, pituitary disorders |
