GASTROENTEROLOGY the study of stomach and intestines and their related diseases.
Gastroenterologist is a practitioner who specializes in diseases of the digestive tract.
University Degree in medicine
Residency in gastroenterology
Paediatric gastroenterology Three years of specialized training programe in paediatric gastroenterology,hepatology and nutrition
Inflammatory bowel disease
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.
Full blood count
C reactive protein
Plain abdominal x-ray
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.
Chronically relapsing disease.
Proctitis alone-good overall prognosis
Severe disease-25% mortality
Localized disease-topical treatment –enema.
Avoid long-term steroid use.
5-aminosalicylic acid compounds
Immunosupression with azathioprine for patients not responding to steroids.
CAN AFFECT ANY PART OF intestine including the colon and is occasionally confined to colon alone (crohns disease)
SIGNS AND SYMPTOMS
Pain more than ulcerative colitis
Bleeding less common
Same as ulcerative colitis
Biopsy reveals presence of granulomas, which is pathognomic of crohns disease.
Same as ulcerative colitis
Surgery is considered curative in ulcerative colitis not in crohns
More common in women.
Intermittent chronic watery diarrhoea.
Asymptomatic during remission.
Associated with long term of steroidal NSAIDS
Underlying Immunologic cause also suggested.
SULPHALAZINE AND CHOLESTYRAMINE
Short-term steroids may be u7sed.
More in women
Biopsy shows intraepithelial lymphocytic infiltration without thickening of collagen layer
Immune etiology suggested
Cirrhosis is the end stage of all progressive liver disease.
Asymptomatic per se
Symptoms may arise due to either underlying disease when complications ensue.
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
Biochemistry-slightly raised trans amylases and alkaline phosphates
Full blood count-anemia due to gastrointestinal bleeding
Raised Alpha fetoprotein in hapatocellular carcinoma
Liver cirrhosis results from cell necrosis followed by fibrosis and regeneration and nodule formation
Hepatic encephalopathy hepatorenal syndrome
50% survival in 5 years
Grading of prognosis made on Childs criteria.
Treatment of any complications
Reduction in dietary sodium
Treatment of bleeding varices
Diuretic therapy-spironolactone, frusemide
Insertion of shunts
Correction of electrolyte imbalance, treatment of sepsis, etc. laxatives and enemas to reduce ammonia load.
Low protein diet
Gallstones can be found in approximately 30% of the population in western world in
Rare in Far East add Africa.
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.
Full blood count-neutrophilia
Liver function test-high bilirubin and alkaline phosphates.
Abdominal xray-not done routinely
Endoscopes retrograde cholangiopancreatography
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
Carcinoma of gall bladder
Definitive surgery is curative
In situ stone formation in bile duct may cause recurrent symptoms
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