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Understanding Abdominal Pain and Inflammatory Bowel Disease

Learn about Crohn's and Ulcerative Colitis epidemiology, symptoms, diagnosis, and treatment options. Explore hernia types, causes, and complications. Peer-reviewed session notes.

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Understanding Abdominal Pain and Inflammatory Bowel Disease

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  1. 2017/2018

  2. GI/Liver Phase 2a Revision Session Rhi Buckley, Sarah Hoban 08/02/18 The Peer Teaching Society is not liable for false or misleading information…

  3. Abdominal Pain The Peer Teaching Society is not liable for false or misleading information…

  4. Abdominal Pain The Peer Teaching Society is not liable for false or misleading information…

  5. Abdominal Pain The Peer Teaching Society is not liable for false or misleading information…

  6. Abdominal Pain The Peer Teaching Society is not liable for false or misleading information…

  7. Abdominal Pain The Peer Teaching Society is not liable for false or misleading information…

  8. Abdominal Pain The Peer Teaching Society is not liable for false or misleading information…

  9. Abdominal Pain The Peer Teaching Society is not liable for false or misleading information…

  10. Abdominal Pain The Peer Teaching Society is not liable for false or misleading information…

  11. Abdominal Pain The Peer Teaching Society is not liable for false or misleading information…

  12. Abdominal Pain The Peer Teaching Society is not liable for false or misleading information…

  13. Inflammatory Bowel Disease (Crohns and Ulcerative Colitis) Epidemiology • Northern Europe, UK, North America Aetiology • Smoking INCREASES • Smoking DECREASES The Peer Teaching Society is not liable for false or misleading information…

  14. Inflammatory Bowel Disease (Crohns and Ulcerative Colitis) Epidemiology • Northern Europe, UK, North America Aetiology • Smoking INCREASES Crohns • Smoking DECREASES UC The Peer Teaching Society is not liable for false or misleading information…

  15. Inflammatory Bowel Disease (Crohns and Ulcerative Colitis) Crohns Small Bowel • Weight loss • Abdo pain Terminal ileum • RIF pain Colonic • Blood and mucus with diarrhoea • Pain Signs • Mouth ulcers • Anaemia UC • Bloody and mucusy diarrhoea • Crampy abdo pain The Peer Teaching Society is not liable for false or misleading information…

  16. Inflammatory Bowel Disease (Crohns and Ulcerative Colitis) CD UC Only GALS can be CROHNS Granulomas All Layers and Levels Skip Lesions The Peer Teaching Society is not liable for false or misleading information…

  17. Inflammatory Bowel Disease (Crohns and Ulcerative Colitis) Ix • Blood Tests • ↓ Hb • ↑ WCC, ESR, CRP • Colonoscopy • Biopsy to diff between two • XR • Exclude toxic dilation of colon • Assess extent of involvement The Peer Teaching Society is not liable for false or misleading information…

  18. Inflammatory Bowel Disease Crohns Tx • Smoking cessation! Mild attacks • Prednisolone Severe • IV hydrocortisone Additional • 5-ASA analogues (mesalazine) -> reduces relapses • Corticosteroids -> induce remission/treat relapses • Surgery The Peer Teaching Society is not liable for false or misleading information…

  19. Inflammatory Bowel Disease Ulcerative Colitis Tx Mild • Mesalazine (5-ASA) -> remission/maintenance • Steroids -> remission Moderate • Steroids -> if symptoms don’t improve treat as severe Severe • IV hydrocortisone • Ciclosporin (immunosuppresant) • Surgery Maintenance • 5-ASAs The Peer Teaching Society is not liable for false or misleading information…

  20. Hernias = protrusion of organ or tissue out of the body cavity in which it normally lies Aetiology Muscle Weakness Body Strain The Peer Teaching Society is not liable for false or misleading information…

  21. Hernias = protrusion of organ or tissue out of the body cavity in which it normally lies Aetiology •Constipation •Heavy weight lifting •Pregnancy Muscle Weakness Body Strain •Age •Chronic cough •Trauma damage •Failure of abdo wall to close properly in womb The Peer Teaching Society is not liable for false or misleading information…

  22. Hernias Definitions Irreducible = hernia cannot be pushed back into the right place Reduction = pushing tissue/organ back into place Incarceration = contents of hernial sac are stuck inside by adhesions Obstructed = bowel contents cannot pass through them Strangulated = if ischaemic occurs The Peer Teaching Society is not liable for false or misleading information…

  23. Hernias Types The Peer Teaching Society is not liable for false or misleading information…

  24. Hernias Types 1) Hiatal 2) Inguinal 3) Femoral 4) Incisional (after surgery) 5) Umbilical (<6m, normally corrects itself) The Peer Teaching Society is not liable for false or misleading information…

  25. Hernias - Inguinal • Most common type - 70% • More common in MEN because after testicles descend through canal after birth the canal doesn't always close properly so is weakened • Direct • Protrudes DIRECTLY into inguinal canal • Medial to inferior epigastric vessels • Indirect • Protrudes through internal inguinal ring • Lateral to inferior epigastric vessels The Peer Teaching Society is not liable for false or misleading information…

  26. Hernias - Hiatal = part of stomach herniates through oesophageal hiatus of diaphragm • Sliding - 95% • GO junction slides through hiatus and lies above diaphragm • No symptoms unless reflux occurs • Para-oesophageal hernia - uncommon • Gastric fundus rolls up through hiatus alongside oesophagus, GO junction remains below diaphragm • Serious risk of complications (gastric volvulus, bleeding) • Treated surgically · The Peer Teaching Society is not liable for false or misleading information…

  27. Pancreatitis Aetiology? The Peer Teaching Society is not liable for false or misleading information…

  28. Pancreatitis The Peer Teaching Society is not liable for false or misleading information…

  29. Pancreatitis - Acute Presentation • Epigastric or central abdo pain • Radiating to back • Relieved by sitting forward • Guarding and rigidity • Nausea and vomiting • Jaundice • Signs? The Peer Teaching Society is not liable for false or misleading information…

  30. Pancreatitis - Acute Presentation • Epigastric or central abdo pain • Radiating to back • Relieved by sitting forward • Guarding and rigidity • Nausea and vomiting • Jaundice • Cullen’s sign - periumbilical bruising • Grey Turner’s sign - flank bruising The Peer Teaching Society is not liable for false or misleading information…

  31. Pancreatitis - Acute Ix • Serum amylase 3X higher than normal • Lipase levels more sensitive • Contrast CT or MRI to confirm diagnosis Management • Fluids • Analgesia • 02 • ?Abx • ?Surgery The Peer Teaching Society is not liable for false or misleading information…

  32. Pancreatitis - Chronic IRREVERSIBLE Ax= Alcohol main cause Presentation • Pain to acute • Weight loss • Steatorrhoea (XS fat in stools bc exocrine insufficiency) • Diabetes Mellitus The Peer Teaching Society is not liable for false or misleading information…

  33. Pancreatitis - Chronic Ix FBC not a good test • May not be enough healthy tissue to produce pancreatic enzymes Radiology • USS/AXR - pancreatic calcification Treatment • Lifestyle • Analgesia • Pancreatic enzyme supplements The Peer Teaching Society is not liable for false or misleading information…

  34. Peptic Ulcers = open sore on mucosa in/adjacent to an acid bearing area. Common in 1) 2) The Peer Teaching Society is not liable for false or misleading information…

  35. Peptic Ulcers = open sore on mucosa in/adjacent to an acid bearing area. Common in • Stomach (gastric) • Duodenum The Peer Teaching Society is not liable for false or misleading information…

  36. Peptic Ulcers Aetiology • H. Pylori • NSAIDS • Smoking Presentation •Epigastric tender and painful –Worse while eating (Gastric) –Worse when hungry (Duodenal) •Bloating •Fullness after meals •Heartburn nausea The Peer Teaching Society is not liable for false or misleading information…

  37. Peptic Ulcers Investigations •Endoscopy –Biopsy all ulcers to exclude malignancy •C13 Urea breath test –H pylori •Stool antigen test –H pylori The Peer Teaching Society is not liable for false or misleading information…

  38. Peptic Ulcers Tx H pylori +ve •Omeprazole •Metronidazole •Clarithromycin H pylori –ve •Stop NSAIDS •PPI (lansoprazome) •H2 blocker (rantidine) The Peer Teaching Society is not liable for false or misleading information…

  39. Appendicitis Epidemiology •All ages •Rare in very young and very old Aetiology •unknown The Peer Teaching Society is not liable for false or misleading information…

  40. Appendicitis Clinical Presentation •Abdo pain central -> RIF •Vomiting •Diarrhoea •Loss of appetite •Pt prefers to have legs bent, not lying straight - guarding Ix •USS abdo Tx •surgery The Peer Teaching Society is not liable for false or misleading information…

  41. GORD = prolonged or recurrent reflux of gastric contents into the oesophagus Aetiology • Smoking • Alcohol • Obesity • Big meals • Pregnancy • hernia Epidemiology • Experienced by 25% adults The Peer Teaching Society is not liable for false or misleading information…

  42. GORD = prolonged or recurrent reflux of gastric contents into the oesophagus Aetiology • Smoking • Alcohol • Obesity • Big meals • Pregnancy • hernia Epidemiology • More common in men • Experienced by 25% adults The Peer Teaching Society is not liable for false or misleading information…

  43. GORD Presentation • Heartburn • Lying down • After meals • Painful swallowing • regurgitation Ix • Clinical diagnosis • Endoscopy Tx • Lifestyle changes • Antacids • H2 receptor blocker • ranitidine • PPIs • Omeprazole • lansoprazole The Peer Teaching Society is not liable for false or misleading information…

  44. GI Malignancy - Oesophagus OGD • Biopsy • Diagnoiss CT • staging Management • Surgical resection The Peer Teaching Society is not liable for false or misleading information…

  45. GI Malignancy - Gastric OGD/gastroscopy • Biopsy • Diagnosis CT • stage Management • Surgical recection • chemo/radio for more advanced The Peer Teaching Society is not liable for false or misleading information…

  46. GI Malignancy - Colorectal M Colonoscopy • Biopsy FBC • Anaemia Radiology • Staging • Mets Management • Surgical resection Screening • Biannual faecal occult blood tests for people 60-69 years old The Peer Teaching Society is not liable for false or misleading information…

  47. (Oesophago-gastric) Varices 10-20% of all UGIB Description: Dilated veins at the junction between the portal and systemic venous systems, leading to variceal haemorrhage Presentation: Haematemesis, pallor, shock Cause: Chronic liver disease = portal hypertension -> veins at the junction with the systemic venous system distend (varices). These can tear and cause bleeding. The Peer Teaching Society is not liable for false or misleading information…

  48. (Oesophago-gastric) Varices Diagnosistic test: Endoscopy Management: ABCResuscitation. Maintain airway. Treat shock. Vasoactive drugs, endoscopic band ligation and antibiotics (as prophylaxis). Can obturate with glue like substance. Complications: 70% chance of rebleeding. Significant risk of death. The Peer Teaching Society is not liable for false or misleading information…

  49. Mallory Weiss tear • 4-8% of all UGIB • Description: Haematemesis from a tear in the mucosa of the oesophagus, caused by prolonged vomiting or straining/retching (sudden increased pressure within nondistensible lower oesophagus) • Presentation: Bout of retching or vomiting -> Haemetesis. Shock: Syncope, light headedness • Causes: Alcohol Excess, Chronic cough, Bulimia etc The Peer Teaching Society is not liable for false or misleading information…

  50. Mallory Weiss tear Investigations: Endoscopy Management: ABC Resuscitation. Maintain airway, high flow oxygen, correct fluid losses. Identify comorbidities. Tear tends to heal rapidly Complications: Hypovolaemic shock (and death). Rebleeding. The Peer Teaching Society is not liable for false or misleading information…

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