Medchrome » Gastrointestinal System

Crohn’s Disease vs Ulcerative Colitis : IBD

Administrator — Sat, 25 Sep 2010 14:35:42 +0000

Inflammatory bowel disease or IBD refers to a group of auto-immune disorders in which the intestines become inflamed. Ulcerative colitis and Crohn’s disease are chronic inflammatory bowel disease which have relapsing and limiting course. The diseases have many similarities and it is important to differentiate them.

Ulcerative Colitis vs Crohn's Disease

	Crohn’s Disease	Ulcerative Colitis
Most common site	Terminal ileum	Rectum
Distribution	Mouth to anus	Rectum to colon “backwash” ileitis
Spread	Discontinuity “skip” lesions	Continuous
Gross features	Focal aphthous ulcers with intervening normal mucosa Linear fissures Cobblestone appearance Thickened bowel wall “linitis plastic” Creeping fat	Extensive ulceration Pseudo-polyps
Micro	Noncaseating granulomas	Crypt abscess
Inflammation	Transmural	Limited to mucosa and submucosa
Complication	Strictures String sign on barium study Obstruction Abscess Fistula Sinus tract	Toxic megacolon
Genetic Association		HLA-B27
Extraintestinal manifestation	Uncommon	Common
Cancer risk	Slight 1-3%	5-25%
Presentation	Variable : Pain, diarrhea, weight loss	Bloody diarrhea

Reference:
Kaplan USMLE Lecture Notes

Hematemesis Or Vomiting Out Blood

Administrator — Sat, 03 Jul 2010 11:58:53 +0000

Hematemesis or Vomiting of Blood

Hematemesis : Peptic ulcer

When blood is present in the vomitus it is called Hematemesis. The color may be red when profuse. Often Black to coffee ground color when less sever – acid degraded due to formation of acid-hematin.

It usually indicated Bleeding proximal to Ligament of Teitz.

It should be differentiated from Malena and Hematochezia which present as blood in stool.

Causes of Hematemesis

Peptic Ulcer 35-50%
Gastric erosion 10-20%
Esophagitis- 10%
Mallory-Weiss Tear 5%
Vascular Malformations 5%
Variceal bleeding 2-4%
Cancer of Stomach and esophagus 2%
Aorto-enteric fistula 1%

Management

IV access
Initial Assessment- History, examination, Vitals, Comorbidities.
Blood tests- CBC, KFT,bleeding profiles, Blood grouping and matching
Resuscitation with Crystalloids, colloids or Blood transfusion
Monitor Central Venous Pressure.
Oxygen to all shocked patients
Endoscopy followed by Electrocautery, Sclerotherapy etc
Visceral Angiography
Drug therapy- PPI, H2 blockers, Somatostatin or Octreotide, Vasopressin
Surgery

Hiccups or Singultus : Causes and Treatment

Administrator — Fri, 28 May 2010 17:40:13 +0000

Hiccups or Singultus

Hiccups most of the time are only benign phenomena and only last for a transient period. Seldom there may a serious disorder underlying the cause of hiccups. It may range from, Idiopathic cause to AMI and acute pancreatitis. Several differential diagnoses of cause of Hiccup are:

Twitter hates hiccups...

Common Causes:

Idiopathic
Excessive smoking
Excess of alcohol
Air swallowing
Anxiety
Esophagitis
Uremia
Diaphragmatic Spasm ( Cyclical) after laughing, coughing, crying etc
Intake of large bolus of food with inadequate liquid.

Less common Causes:

Acute Myocardial Infarction
Gastric irritation or distension
Pancreatitis
Subphrenic abscess
Cholecystitis
Perforated intrabdominal viscus wih air under diaphragm
Phrenic nerve tumors

Treatment:

For simple hiccups, Home remedies : Distraction of attention, fright, painful or unpleasant stimuli, breathholding and sipping iced water are helpful.

Medical Measures:

Sedation
Nasopharyngeal stimulation with soft catheter
Gargling and swallowing viscous lidocaine
Antispasmodics
Rebreathing CO2
Antacids, Bacfen. Phenothiazines.
Bilateral phrenectomy- for intractable hiccups

Source: Manual Of Emergency Medicine, Wikipedia