IBD, IBS and celiac disease

12 important questions on IBD, IBS and celiac disease

What is the mortality from diarrhoeal diseases worldwide?

The WHO estimates that diarrhoeal illness alone caused 1.4 million deaths in 2016

What are the symptoms of lower gastrointestinal disease

Change in bowel habit
  • while constipation is often a symptom of inadequate diet or physical exercise, unexplained loosing of stool, particularly if persistent, may be an symptom of colonic disease, including cancer and colitis

Rectal bleeding
  • fresh blood dripping after passing stool, or present on wiping, suggests anorectal disease including haemorrhoids. Blood mixed with stool may indicate colitis or colonic malignancy

Tenesmus
  • a feeling of incomplete rectal emptying after defecation suggests anorectal pathology such as a tumour

What are the warning signs of cancer?

'Red flag' symptoms suggestive of malignancy
  • Progressive weight loss
  • Anorexia
  • Symptoms of anaemia from chronic blood loss

Past medical history
  • Gastrointestinal disease
  • Autoimmune disease
  • Abdominal surgery

Drug history
  • All prescription drugs
  • Non-steroidal anti-inflammatories, over-the-counter drugs and herbal remedies
  • Recent courses of antibiotics

Social history
  • Smoking
  • Alcohol consumption
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What are the principle investigations in GI

  • Routine haematology
    • (full blood count and blotting. This basic screen checks for anaemia, elevated/depleted white cell or platelet counts = clotting abnormalities which can be present in several gastrointestinal diseases
  • Blood biochemistry
    • (serum creatinine and electrolytes, liver function tests)
  • Stool samples
    • Microscopy, culture and sensitivities in order to exclude infection in patients presenting with diarrhoea
    • Faecal calprotection is a protein found in stool during intestinal inflammation. It is commonly used in outpatients both diagnostically and for monitoring disease activity
  • Endoscopy
    • gastroscopy, colonoscopy
  • Radiology,  are the principal investigations

What is the purpose of colonoscopy?

Good visualisation of the whole colon and terminal ileum. Biopsies can be obtained and polyps removed. Cancer, polyps and diverticular disease are the most common significant findings.

What can be helpful count the imaging technique X-rays

Especially useful with acute events. Visualitsation of gas, obstruction or perforation, stones

What can be helpful count the imaging technique ultrasound

Involves no radiation and is the first-line investigation for abdominal distension. It can show dilated, fluid-filled loops of bowel in obstruction, and thickening of the bowel wall. It can be used to guide biopsies or percutaneous drainage. In an acute abdomen, ultrasound can diagnose cholecystitis, appendicitis, enlarged mesenteric glands and other inflammatory conditions

What can be helpful count the imaging technique MRI

Uses no radiation and is particularly useful in the evaluation of rectal cancers and of abscesses and fistulae in the perianal region. It is also useful in small bowel disease and in hepatobiliary and pancreatic disease.

What can be helpful count the imaging technique PET

Relies on detection of the metabolism of fluorodeoxyglucose. It is used for staging oesophageal, gastric and colorectal cancer and in detecting metastatic and recurrent disease. PET/CT adds additional anatomical information

Why are bone fractures a common symptom in patients with coeliac disease?

Malabsorption of nutrients, including calcium

How can a gluten-free diet improves symptoms in coeliac disease?

Gluten causes atrophy of the villi in the gut --> removal of gluten heals the intestinal lining

What are the types of medication of Ulcerative colitis.
From dependent on the severity of symptoms

  • Anti-inflammatory medications
  • immunosuppressors
  • Biologics
  • Colectomy - removal of the colon

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