| |
GASTROENTEROLOGY the study of stomach and intestines and their related diseases.
Gastroenterologist is a practitioner who specializes in diseases of the digestive tract. QualificationsUniversity Degree in medicine Residency in gastroenterology
SubspecialitiesPaediatric 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 diseaseUlcerative 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 InvestigationFull blood count Blood culture C reactive protein Stool culture Plain abdominal x-ray Barium enema Colonoscopy EtiopathogenesisUnknown 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. ComplicationsAdenocarcinoma Cholangiocarcinoma Amyloidosis PrognosisVariable course Chronically relapsing disease. Proctitis alone-good overall prognosis Severe disease-25% mortality TreatmentAcute 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 colitisCAN AFFECT ANY PART OF intestine including the colon and is occasionally confined to colon alone (crohns disease) SIGNS AND SYMPTOMS Abdominal pain DiarrhoeaPain more than ulcerative colitis Bleeding less common InvestigationsSame as ulcerative colitis AetiopathogenesisBiopsy 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 colitisRisk factorsMore common in women. Signs and symptomsIntermittent chronic watery diarrhoea. Abdominal pain Asymptomatic during remission. InvestigationStool culture Inflammatory markers Colonoscopy PathogenesisAssociated 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 colitisRisk factors More in women Signs and symptomsIntermittent diarrhoea Abdominal pain InvestigationsStool culture Colonoscopy Biopsy shows intraepithelial lymphocytic infiltration without thickening of collagen layer PathogenesisImmune etiology suggested TreatmentAntidiarrhoeal drugs Sulphalazine Cholestyramine
CIRRHOSIS Cirrhosis is the end stage of all progressive liver disease. Signs and symptomsAsymptomatic 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 InvestigationsBiochemistry-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 PathogenesisLiver cirrhosis results from cell necrosis followed by fibrosis and regeneration and nodule formation ComplicationsPortal hypertension Ascites Hepatic encephalopathy hepatorenal syndrome Hepatocellular carcinoma PROGNOSIS50% survival in 5 years Grading of prognosis made on Childs criteria. TreatmentTreatment 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 factorsGallstones can be found in approximately 30% of the population in western world in Rare in Far East add Africa. Signs and symptomsGallstones 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 PathogenesisThree 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 ComplicationsAcute pancreatitis Ascending cholangitis Gallstone illeus Carcinoma of gall bladder PROGMNOSISDefinitive surgery is curative In situ stone formation in bile duct may cause recurrent symptoms TREATMENTAnalgesia 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.sgna.org |