Gastroenterology

 


GASTROENTEROLOGY the study of stomach and intestines and their related diseases.


Gastroenterologist is a practitioner who specializes in diseases of the digestive tract.

Qualifications

University Degree in medicine

Residency in gastroenterology



Subspecialities

Paediatric gastroenterology Three years of specialized training programe in paediatric gastroenterology,hepatology and nutrition






Major diseases treated under gastroenterology


Inflammatory bowel disease

Cirrhosis

Gallstones



Inflammatory bowel disease

Ulcerative colitis

Crohns colitis

Collagenous colitis

Microscopic colitis

ULCERATIVE COLITIS

Risk factors

5-8 people out of 100000 in Europe and the USA are affected

20-40 years age group is more at risk

Women more prone

Patients with ulcerative colitis are more likely to be non-smokers or x-smokers

Signs and symptoms

Diarrhoea usually associated with presence of pus and mucus. Upto 20 loose motions per 24 hrs during an attack.

Malaise

Anorexia

Abdominal pain

Investigation

Full blood count

Blood culture

C reactive protein

Stool culture

Plain abdominal x-ray

Barium enema

Colonoscopy

Etiopathogenesis

Unknown etiology

Histological features same as infectious diarrhoea

Perinuclear antineutrophilic cytoplasmic antibodies can be found in 60 % patients

Ulcerative colitis affects the rectum and may extend along the whole length of the colon.

Microscopically the inflamatio0n is limited to the mucosa and submucosa with inflammatory cells accumulating in the lamina propria and colonic glands to form crypt abscesses.

Complications

Adenocarcinoma

Cholangiocarcinoma

Amyloidosis

Prognosis

Variable course

Chronically relapsing disease.

Proctitis alone-good overall prognosis

Severe disease-25% mortality

Treatment

Acute attack-corticosteroids

Localized disease-topical treatment –enema.

Avoid long-term steroid use.

5-aminosalicylic acid compounds

Immunosupression with azathioprine for patients not responding to steroids.

Surgical resection




Crohns colitis

CAN AFFECT ANY PART OF intestine including the colon and is occasionally confined to colon alone (crohns disease)

SIGNS AND SYMPTOMS

Abdominal pain

Diarrhoea

Pain more than ulcerative colitis

Bleeding less common

Investigations

Same as ulcerative colitis

Aetiopathogenesis

Biopsy reveals presence of granulomas, which is pathognomic of crohns disease.

Treatment

Same as ulcerative colitis

Surgery is considered curative in ulcerative colitis not in crohns


Collagenous colitis

Risk factors

More common in women.

Signs and symptoms

Intermittent chronic watery diarrhoea.

Abdominal pain

Asymptomatic during remission.

Investigation

Stool culture

Inflammatory markers

Colonoscopy

Pathogenesis

Associated with long term of steroidal NSAIDS

Underlying Immunologic cause also suggested.

Treatment.

Stop NSAIDS

ANTIDIARRHOEAL DRUGS

SULPHALAZINE AND CHOLESTYRAMINE

Short-term steroids may be u7sed.




Microscopic colitis

Risk factors

More in women

Signs and symptoms

Intermittent diarrhoea

Abdominal pain

Investigations

Stool culture

Colonoscopy

Biopsy shows intraepithelial lymphocytic infiltration without thickening of collagen layer

Pathogenesis

Immune etiology suggested

Treatment

Antidiarrhoeal drugs

Sulphalazine

Cholestyramine




CIRRHOSIS

Cirrhosis is the end stage of all progressive liver disease.

Signs and symptoms

Asymptomatic per se

Symptoms may arise due to either underlying disease when complications ensue.

Hepatomegaly

Splenomegaly

Ascites

Dilated umbilical veins

Anemia, jaundice, palmar erythema, finger clubbing, pruritis, spider naevi, loss of hair, testicular atrophy, parotid enlargement, gynaecomastia, amennorhoea, drowsiness, confusion, ankle edema

Investigations

Biochemistry-slightly raised trans amylases and alkaline phosphates

Full blood count-anemia due to gastrointestinal bleeding

Coagulopathy

Raised Alpha fetoprotein in hapatocellular carcinoma

Ultrasound

Endoscopy

Liver biopsy

Pathogenesis

Liver cirrhosis results from cell necrosis followed by fibrosis and regeneration and nodule formation

Complications

Portal hypertension

Ascites

Hepatic encephalopathy hepatorenal syndrome

Hepatocellular carcinoma

PROGNOSIS

50% survival in 5 years

Grading of prognosis made on Childs criteria.

Treatment

Treatment of any complications

Reduction in dietary sodium

Treatment of bleeding varices

Diuretic therapy-spironolactone, frusemide

Paracentesis

Plasma expanders-gelofusin

Insertion of shunts

Correction of electrolyte imbalance, treatment of sepsis, etc. laxatives and enemas to reduce ammonia load.

Low protein diet




GALLSTONES


Risk factors

Gallstones can be found in approximately 30% of the population in western world in

Rare in Far East add Africa.

Signs and symptoms

Gallstones per se do not cause symptoms

Flatulence, dyspepsia, fat intolerance

Biliary colic, cholecystitis

Cholangitis may occur if bile is infected. -Fever; right upper quadrant pain, nausea, and vomiting, clinical jaundice

Murphy’s sign-pain in upper quadrant on deep inspiration.

INVESTIGATIONS.

Full blood count-neutrophilia

Liver function test-high bilirubin and alkaline phosphates.

Abdominal xray-not done routinely

Ultrasound

Radioisotope scans

Endoscopes retrograde cholangiopancreatography

Pathogenesis

Three types of gallstones described

Mixed stones70-90%stones contain cholesterol with bile pigments and calcium

Cholesterol stones –account for upto 10% stones –solitary, smooth, pale in color

Pigment stones-contain bile pigments

Exact pathogenesis unclear

Increased cholesterol intake and bile salts implicated

Complications

Acute pancreatitis

Ascending cholangitis

Gallstone illeus

Carcinoma of gall bladder

PROGMNOSIS

Definitive surgery is curative

In situ stone formation in bile duct may cause recurrent symptoms

TREATMENT

Analgesia

Intravenous fluids

Broad-spectrum antibiotics

Cholecystectomy

ERCP

Chenodeoxylate and ursodeoxycolic acid taken orally

Treatment takes upto 6 months

Reoccurrence occurs in over 50% patients once treatment is stopped.




MOSBY!S CRASH COURSE –GASTROENTEROLOGY

MANUAL OF GASTROENTEROLOGY-GREGORY L. EASTWOOD

CURRENT GASTROENTEROLOGY-GARY GITNICK

GASTROINTESTINAL DISEASE-SLEISENGER AND FORDTRAN

www.gastro.org

www.acg.gi.org

www.bsg.org.uk

www.jpgn.org

www.sgna.org