Category Archives: Gastroenterology

Investigation

Investigative tests can be divided into: 1 Blood tests (a) Liver ‘function’ tests (i) Serum albumin (ii) Prothrombin time (b) Liver biochemistry (i) Reflecting hepatocellular damage-serum aspartate and alanine aminotransferases (ii) Reflecting cholestasis-serum alkaline phosphatase, y-glutamyl transpeptidase (c) Viral markers (d) Additional blood investigations, e.g. autoantibodies 2 Imaging technique

The peritoneum

The peritoneal cavity is a closed sac lined by mesothelium. It normally contains a little fluid that allows the intra-abdominal organs to move freely. Some conditions that can affect the peritoneum are shown . Peritonitis can be acute or chronic, as seen in TB. Most cases of infective peritonitis are secondary to gastrointestinal diseases but it occasionally occurs without intraabdominal sepsis in ascites du

Intestinal obstruction

Most intestinal obstruction is due to a mechanical block. Sometimes the bowel does not function, leading to a paralytic ileus. This occurs temporarily after most abdominal operations and with peritonitis. Some causes of intestinal obstruction are shown. Obstruction of the bowel leads to bowel distension above the block, with increased secretion of fluid into the distended bowel. Bacterial contamination occur

The acute abdomen

This section deals with acute abdominal conditions that cause the patient to be hospitalized within a few hours of the onset of their pain. It is important to make the diagnosis as quickly as possible to reduce morbidity and mortality. Although a specific diagnosis should be attempted, the immediate problem in management is to decide whether an ‘acute abdomen’ exists and whether surgery is requir

Functional bowel disease

This is the general term used to embrace two syndromes: 1 Non-ulcer dyspepsia 2 The irritable bowel syndrome These conditions are extremely common worldwide, making up to 60-80% of patients seen in a gastroenterology clinic. The two conditions overlap, with some symptoms being common to both. gives some gastrointestinal symptoms that are suggestive of psychosomatic disorders. Non-ulcer dyspepsia This consists o

Colorectal carcinoma

Adenocarcinoma of the large bowel is the second commonest tumour in the UK with a lifetime incidence of about 1 in 50 (both male and female). The incidence increases with age, the average age at diagnosis being 60-65 years. The disease is rare in Africa and Asia and this difference is thought to be largely environmental rather than racial. There is a correlation between the consumption of meat and animal fat

Anorectal conditions

These important conditions largely present to surgeons. The major conditions presenting initially to the physician include the following. Pruritus ani Pruritus ani, or an itchy bottom, is common and often no cause is found. Treatment consists of good personal hygiene and keeping the area dry. Secondary causes include any local anal lesions such as haemorrhoids, infestation, e.g. with threadworm (Enterobius ve

TREATMENT

Acute attacks are treated with bowel rest, intravenous fluids and antibiotics, e.g. gentamicin (or a cephalosporin) and metronidazole. Most attacks settle on this regimen, but a few require emergency surgery, which usually consists of a defunctioning colostomy to be followed later by resection. Acute episodes do not necessarily recur and elective surgery is mainly reserved for patients with intestinal obstru

The colon and rectum

STRUCTURE The large intestine starts at the caecum, on the posterior medial wall of which is the appendix. The colon is made up of ascending, transverse, descending and sigmoid parts, which join the rectum at the rectosigmoid junction. The muscle wall consists of an inner circular layer and an outer longitudinal layer. The outer layer is incomplete, coming together to form the taenia coli, which produce the

INVESTIGATIONS

Blood tests Anaemia is common and is usually the normocytic, normochromic anaemia of chronic disease. Deficiency of iron and/or folate also occurs. Despite terminal ileal involvement in Crohn’s disease, megaloblastic anaemia due to vitamin B\2 deficiency is unusual, although the vitamin B’2 level can be low. There is often a raised erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)