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Medicine

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Liver & GIT

Question
12 out of 23
 

The presence of anti-Saccharomyces cerevisae antibody is a surrogate marker of one of the following:(MAY 10)



A Celiac disease
B Crohn's disease

C Ulcerative colitis
D Tropical sprue

Ans. B Crohn's disease

Endoscopic features-

a. Rectal sparing b. Aphthous ulceration

c. Fistula d. Skip lesions.

Radiological features.

a. Thickened folds.

b Aphthous ulcer.

c. Cobble stoning of small intestine.

d. Stricture, fistula in advanced disease.

e. ‘ String sign’ represents long areas of circumferential inflammation and fibrosis.

f. CT findings include mural thickening> 2cm, perianal disease and adenopathy.

Complications-

a. Fistula formation.

b. Perforation leading to peritonitis.

c. Intestinal obstruction.

d. Massive hemorrhage.

e. Malabsorption.

f. Carcinoma especially with colonic involvement.

Condition predisposing to colo rectal carcinoma

1. UC 2. CD 3.Uretero sigmoid anastomosis 4.Familial adenomatous polyposis

Recent Advances:

a. Capecitabine: This is an anti pyrimidine drug that could be given orally for breast and colorectal cancer.

b. Cetuximabis used in treatment of metastatic colorectal cancer and head and neck cancer.

Treatment-

Active disease Severe Perianal / Fistulizing disease

Mild –Mod 5 ASA Metronidozole / ciprofloxacin

(a) 5-ASA Metronidazole Azathioprine / 6 MP

(b) Metronidazole / ciprofloxacin Ciprofloxacin

(c ) Oral Glucocorticoids Oral.I/V Glucorticoid Infliximab

(d) Azathioprine Azathioprine I/V Cyclosporine

(e) 6 Mercaptopurine 6-Mercaptopurinle

(f) Infliximab Infliximab

I/V cyclosporine

Maintenance Therapy

Inflammatory

5-ASA

Metonidazole/ ciprofloxacin

Azathioprine / 6MP

Newer drugs for the treatment of IBD

1. Tacrolimus 2. Mycophenolate

3. 6 Thioguanine 4. Thalidomide 5.Natalizumab

Table 295-8 Indications for Surgery (H-18thPg- 2493)

Ulcerative Colitis

Crohn's Disease

i. Intractable disease

ii. Fulminant disease

iii. Toxic megacolon

iv. Colonic perforation

v. Massive colonic hemorrhage

vi. Extracolonic disease

vii. Colonic obstruction

viii. Colon cancer prophylaxis

iv. Colon dysplasia or cancer

A. Small Intestine

i. Stricture and obstruction unresponsive to medical therapy

ii. Massive hemorrhage

iii. Refractory fistula

iv. Abscess

B. Colon and rectum

i. Intractable disease

ii. Fulminant disease

iii. Perianal disease unresponsive to medical therapy

iv. Refractory fistula

v. Colonic obstruction

vi. Cancer prophylaxis

vii. Colon dysplasia or cancer

Extra Edge:

The differences between ulcerative colitis and Crohn’s disease (Ref. H-18thedi, Pg 2486,Table-295.5)

Features Ulcerative colitis Crohn’s disease

1. Monozygotic twins 8%concordance 67%concordance

2. Gross blood in stools present rare

3. Systemic symptoms rare present

4. Pain rare present

5. Abdominal mass rare present

6. Perineal disease absent present

7. Fistula absent present

8. Small int. obstruction absent present

9. Colonic obstruction rare present

10. Response to antibiotic absent present

11. Recurrence after surgery- absent present

12. ANCA positivity 60-70% 5-10%

13. Rectal sparing rare present

14. Continuous disease present rare

15. Cobblestone appearance- absent present

16. Granuloma absent present

17. Abnormal small int. absent present

18. Abnormal terminal ileum- rare present

19. Segmental colitis absent present

20. Asymmetrical colitis absent present

21. Stricture rare present

Serological markers for inflammatory bowel disease

1. Perinuclearantineutrophil Cytoplasmic Antibodies (p-ANCA)

a. Positive in 60 – 70% of U.C. patients (and 5 – 10% of CD patients)

b. p ANCA +ve with ASCA –ve = 97% specificity for UC

c. p ANCA +ve with ASCA +ve = 97% specificity for CD

2. Anti saccharomycesCerevisiae Antibodies (ASCA)

a. Positive in 60 – 70% of CD patients (& 10-15% of U.C. patients)

Liver & GIT Flashcard List

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