- Fis-h.d.a, FoA,mQi;on. to bowel, , skin - ENTEROc.

cnANEWS
- F,'~m(Q, ~ o n , to 4d,tG.GCKll- bOUlft., V~tica. - ENl'&ROVAC.INAL
FIS'TULA OCWA,, to L.oc.o.«A¥4, wou. -thinning witf,
MiCM>peA,fol'aliOTI .

.t.. PRO'l<IHIAL .SMAU. INTeSTlNf

- J-Jc.mo llc.itis
- M~o~on, to L.o&s al d.i9utivt. cM'td cabOA,pnvfl Sw,fau,.
- Nuhittonat. cieft'ci~ OGCUM to pr,o,., imo.u, M\d frifMc,
LOSI l~"'iJ io

Hctjf)O(l.lAxNmi nem,ia,
Q. . - W~nt.U omd Ed emQ,
b. H'd'J>oca.fumia,
C. Vito/min O Oeficit.n<.tt - Fraduu, e7I VfMU>T'Q,
d . M~Q.toblMh'c. Ane,mia,
e,. p~ra,
f · Hfcff'IIAOX a.tt«Ma, - Rema.(, Sionu ffirnQAi on,
• W""it mu,a.toblallh'c. AnfA'niQ, Omd pfAIClt,(a, OGCl,cA4

- Folic, ACAGC omtA 'Iwn not- oA:,iort,ed,

- ~wn Ruislotnt- ~10n OlzAic.4'U1<1f Anemia,
- pqAlo.'t"fC', - Ni ca.tin i& Q.Uo t\Ot- ~ t . d

• hon Ruistcmt In,n OflFiciflll~ Ane.,miQ, is al4o HMl in whic.h

condiiiOffi ?
o-thei,
, . ~ c . Dise.a.w.,
2. Ne.phwt,'c, .kafnclM>m&

............................................................................................. active space --.

Hyperoxaluria leading to renal
stone
3 . LMGE IHl"ES11NE

- C.Olit,"$ 0/nd pfAoiow-nal, DiH.OAt.

1. FtNU.. , H ~ o , - &~t Rt.d c.olotw e.lood in Sfvol

<Nfd Dia.Ywfx>e.a, Cl4t, common wi-tfl c.oliti.s

- sl-f.QA,mheQ, is not- a, FeoAw.l,

2 . Ab~ioca£ poin c..~c.d pcw0-911 CJ6 Fw,,l,
ma.ttAAol, -th"IOC.l'lf> NQM.OWe.d Oll'\d lnf.lcnr,e,d SC-9ments. of
bc)wQt.

3. shic.fu.w, l.ecl4in9 -to bowd. ob,hudion. com oCWA,

4- Fistt4a, Into "-tomQ.C.f, 01,, DW>dUlUlm co.u.&C4 vomiti"9 -C

Fe.cal, mM'f..Clia£ .

-active space -- -- --
 ,;. e.o.cA-wo.t o~rowfh d,cu,, to fA'ltuo<.olic. t=iciuta,
, . Rt.dovu,ino.t Ft"c-tulo, , Enmoc.u.ta.neou.r. F,sWcl. poiQnat-
Fishdca,
• &W'tMct£ o v ~ Leod6 to whidi vitcunin Oefic.ifHl"d?
- Vi tcMnin &12,. Defic:iemGf
- Treo.hnt,nl" is ~ntibiotiC4 Q/nd not- &12, S!Af>PIU"tl~ -
• WhiGh PQMUi~ CA:W4U e.12 Odie,~~
- Fi"sh woc.m.
=I , PfMomaL Dicea.&e, c.a.u.&e.! lnC.OMn«ice., Lewi" hemont>oidal,
T~ cmd £hicAu.w.&, Ano-\1.GtraL Fis'h40, crncA pq.Ali RWQ.l.
Abs.c.c.uu
-4 . GiAS'rRO DUODENAL DISEASE (trOMACA-4)

1. NQ.U6t.a, • 'lomiiin9 ood epi9Mhic. pcun

2 . H. PlfO'ri ~IR, &uhins
~ - Gia&hic, ~I« obll-n.tdion, in pa.tim~ witt, o.dNOtrad
taaA!-todaodend c.o.

~:v-~
• If vomi-kc.6 contain Food EoA-m fflGmff hOUl.4 b ~ - GQ41-ric. OIA.tle.t
obshudion . - &GMwm siu.dA14 QA& bdte-.. to visu.~1t.,.

.............................................. ....................................... ....... active space ... .

• LA~'10RY FEATURES :
1· IILOOO

Q.. Anfll'lliQ , Lucc.o('dtoSiS.

b . lnCA.eo.6f.d ESR. CAP
G. Hfdpoo.tbumine.mia,

~- '5:ROLO'-V
o.. ASCA (Anti ~ c : e 4 c:ewi.siow, amt(~) - =tor.
b. P- ANCA (101-)
G. Ant; (JObl« Qnfibodie& C2,0 1-)
cf Anti colon omt;bodie& ( 10 :/.)
e,. pm,CMAtic cx.uAv orntibod.ie\ (ao :t.)
• In col)hicA, otfle.\. Oisea.ACZ& AtCA Mttibocliu. OM/ Ro.c"4,
- &t.hee,ts &ynciM> me,

3 . END0.5:'CDPIC FEA'tUAES
o.. Rwd, tpcu.iJlCi
b. Apt,tt,~ UICCAAfion.
G - FiS'hdQ/
d- ~li::ip Lu.iOM

" · AAOIOLOGICAL FEA1UR£S

Cl . 1hicj:ent4, Fold&
b . GObblutone, QfptOMJmC.f,"' inl"c,\,f;f)l2,
G- shicAuu.. F,~tu.ta, in CJ.dNM'lc:.t,d, oi,ea.u,
d. a Findln~ inc.tc.cde, mtd,Q.f, 'ltiiGteni"'I 2.c,rn. f)eA,i Q't)Q.f,
Oi,uw, c.nd A d ~

............... active space

 e . 1he, (ilT - • s:tRINCi ~t<iN' Rq>Y9!,tJOb a, ,e,veu, OQM,CX.Ui~ of»
Loop Sowef, , in which tflin 1hipe., of, c.onh'M~ within
ihe, Lwme,n L0o1c5. Libt o, 1hi"'t

• Whic.h offl«. c.oncf.jiion, eJXhibif$ Strifl Slif>

°'
intv.&tine,
- -ra intu-tine,.
• C<>MPLtc:AltONS :

1. MShd.oi Fo-nn<lltion,
2. PeM1)'<0ttion L~"9 -to pwtonitis
3 . 1n~44tina.t ~huc:,t;°"'
"1- MQ&Sive., hefflont>o.9e,
5 . Mc:ua.bs:o,q,tion,
6 - CQ.c.c.i-noma, c.olcm,

active space
 • pwmaAiOV\, w·,tt, se,,.,cu, pa.in ownd 60CJA.d Li~ Ricfidiftt amd mO!ld
fNf//n be, in s.hc>cAt . 1he, i:;Ylt- inva-ti9wlicm, is '?

.stwn~nta . jaA wnd"" Righi-

°'
x- R°'d Abdomf.(I whic.h s:hows
side, Oi°'f>bYO-ff m
• IMPan'ANT POI~.

- condin<>n.l ~q,osinia -to c.olo Ru.«a.t COM:inoma,

1. VG
ll . CO

a. uwttM> sh,moid AnMtomos:iS

4. Fo..mllial, AdtKIOfflQlfl)C.c4 POlcifPOSiS

- In wh1"c.h End.ocMn- c.o-ndificm colcmic. COMce4. i~ mou, c.ommon '?

• ~OMEC.ALY

• 'ffl.EATMENT

Active disease Severe Perianal / Fistulizing disease

Mild - Mod 5 ASA Metronidozole / ciprofloxacin
a. 5-ASA(Amino Salicylic Acid) Metronidazole Azathioprine / 6 MP(Mercapto purine)
b. Metronidazole / ciprofloxacin Ciprofloxacin
c. Oral Glucocorticoids Oral.-IN Glucorticoid Infliximab
d. Azathioprine Azathioprine IN Cyclosporine
e. 6-Mercaptopurine 6 - Mercaptopurine
f. Infliximab lnfliximab
IN cyclosporine

-- -- -- -- -- -- -- -- -- -- -active space -

4
• MAINTRINAN<:e °O'IE~AP'f

1. INFLAMMA10RY DISEAtE
Q. , S - ASA
b- Me,h,mi~I" / cipll)ftoxo.dn
c.. AJO'lhiopl'ine, / i MP

2.. PERI ANAL / PfSlULlitlNG Ot!.EASf

o.. MfA'l1>nido,1(>le, / Cip-,offoxoc.in

b- A11Mt1ioprine, / 6 MP

• IMPOII.TANT POI~

- 'TIIIF - 0( inhibrfor-5 c.ommol'Md c.c.&c.cf, in it\& T~ent- oi 1&0

o.. lnHi>Ci mellb
b. Adaf.imwn<M>
c. ce,noll~
- DM.up for 1".oltment- 1e,o.
o... V¢ctolilWfflab ( LPAM • 1 &IO~fk)
b. Uste,t.inw-no.b ( IL 12 / IL 1-=I e.l~fA.) - A~O <Medi in
C. Tofoc.iiinib ( 3'Ali: 1, 2, 3 6locJ:.IA,) - Antc,10,in9 spo~litis
... Also CA.w:f in - p,oMo.hic. Artfmtts
- P.hwmcuoid Arihmis.

• P.EGENT AOYANc.ES :
~ - qo 'J. +he. nQ.\mQL gut .flora. consi,~ al &o.otuolde6 omd Ft"rmic.uN6
b- F«,OJ, MiaobiotQ. T-ramtpl~on. is -tt,e, <..lf(Omi"1 TrGQl'm.nt
mocA@"6 fo-r 18D.

------- -- -- active space -

 • INPICA110N~ OF .SUMERII lilt ~O~N:S Ot~EA.£

CA. S:ma.te, ln~tine,

1. shi<AMu, ~cil obstnA.Glion ~po""i w, to l"fledAco.t, ~'4

!L. MQ£Siw, hf.imOTrt>Off0
3 . Re.fr~ Fisiuta,
'4 . Ai>£CA.U
b. COlcm omcl Redwm
1. lntm.d-aA:>le, Disecu•
2. Fc,J.minomt- oisea4e,
3- PtM~ Oiseo.u, c.mu1p~ve, -to mecf.icoJ,
'1 . A's11.&ia,
5, A~c.Q&S.

- SUMMARY OF UC M\tA GD ===========~~ a:20

Crohn's Disease Ulcerative Colitis
CLINICAL
Monozygotic twins 67%concordance 8%concordance

Gross blood in stool Occasionally Yes

Mucus in stool Occasionally Yes
Systemic symptoms Frequently Occasionally
Pain in abdomen Frequently Occasionally
Abdominal mass Yes Rarely
Significant perinea! Frequently No
disease

......... .. .. ....................................... active space --.

 Fistulas Yes No
Small intestinal Frequently No
obstruction
Colonic obstruction Frequently Rarely
ANCA positivity 5-10% 60-70%

ASCA Positivity 60-70% 5-10%

Response to Yes No
antibiotics
Recurrence after Yes No
surgery
RADIOGRAPHIC FEATURES
Small bowel Yes No
significantly
abnormal
Abnormal terminal Yes No
ileum
Segmental colitis Yes No
Asymmetric colitis Yes No
Stricture Frequently Occasionally

........................................................................................... active space -

,aneami,
 ENDOSCOPIC
FEATURES
Rectal sparing Frequently Rarely
Continuous Occasionally Yes
disease
"Cobblestoning" Yes No
Granuloma on Yes No
biopsy

............................................................................................. active space -

 Official Notes Partner: ~,u,,.
• •"-- "-r •...

°'
• Fca,mlliat, Ade-nornwfoa.\ po"1fPOSis is ()ti inhtM+ed cond.mon, In which,
nu.f'fl~ poltps mcainlt in h CfittleiU4'11 Lc»Jtf'
ln....,-nr,.
• ou, &U'lintn bwt com be, ma.tigncimt -
• GENE11c.&

1. FAP CM'! d i ~ t inhMitGinc:ll, p ~ O#ld ~fttA.enl- jf.flCAiG

CCW,UI .
2.. fN£ codlffon, Re&uds ~,om MIAAD.tian. In -iflo. N'G «i""6 , it- I&
lnhfAitt.d In om, AuJoloma.C, OOminam~
- 11- lnc.ideinc.. m~Clil i n ~ C04'6 1001.
:!5. M ~ in -4tic, M\11VH 1"1'1& ON, ln'-i~ In am. Au.tosot'OQ£
Rc.<A.Uive1pa,ffewl
• &IC.NS crnd S'IMP"IOMs :

Cl,. Th«.fl mcuii blec.d, L~n, -h, 1"tUn O.fiCAUl'1f AnuniQ,

b . DeM.C.op Anania, -hi ~ i f d&Yelopi"9 poic..,s.
G. If MCUi9"'W"'1f clt,W,1~. ffiC116 P4f4tAili wiffl
j. W~hl" La&S
Ii. Altew:I bowel, lw,il;
Iii. Md06tuis to -the, UW,., EtwwhcM,

-- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- ---- -- -- -- -- -- -- -- -- -- -- -- ---- -- ---- -- -- -- -- -- -- -- -- -- -- -- -- -active space - -

+
d. 'Jhe, «aU1c,tic, dehM'ninom~ in Fa/milial, Acie,no,nwlOc.l& polv,>O&iS
"'°'If r,J,t,r, p.,.c4.ispoSlb ccw.ifM io ottwA. mo.t.i<jnomC:.itA ,
&i'· DcA.oden«Nl'I\ omd $tvma.c.t.
• 'The, oiu.o.&e. U6ut0."1f morni~w-s Oil> Mot.f,Q,bs~on c:irnd which
com Ocwc,lop maJi'dl>Q/Jl°d 1-u.-.
- COELIAC, DISEA,E

e.. 0 ~ 'Mj!M itlGI poinl- -to FAP au, pirw,nt"cd LUiCJM o{ ff>e.
Retinlll.
CI-IRPe - Contjflnita£ H~phW oi ttie, Rdinal, Pi9mf.fl~ Epiffletir.nn

······-····· 0Ct1ve space

f . It bq, o, paM' o( 6AP.DNE'R .SVNl>AOME
i. pol'dPosis
iL Jaw CijSl'S
iii. .Sd,o..ccow,. Cfd'IS
iv. Odt.0mdcl, (be.nif'I bone-~)
v. Fibroma.6
• Ma-ni fet.to.fiOM °' ~OA.dn& s~me,
,. SUf)fMlUA'fleMWcl TecAtl omd OdontomM.
2. ostt.omc:16 o6 -tt,e, ttc.c.U,

3 . Epidec.n-.oid, Clif'"'· FitnomM c:vnd Sema&a<.U,, <i'ls

4. PolffPS in -ffl4t (.()Ion.

1. Supernumerary teeth & odontomas .

2. Osteomas of the skull,
3. Epidermoid cysts, fibromas &
sebaceous cysts .
4. Polyps in the colon.

active space
 • SI.in mamifuta.tiOM. o( Gi~ne.v.. -''d'l"ldM)n'llll
1. Epido..mclR, °d't
.2. . Lipoma,
l, . FibTOM<ll

Fibroma
Epidermal cyst

• OIA6NOSIS OF FAP

1. l!><aMC.Nm E,MJmQ,

.2.. c.olono.s.c.oPd is c.ons.idw.d Pict.eanostic. ,-~t oi choice,

• AAOIOLDC.ICAL FEATURES OF ~~RONER ~VNOROME

- CDlonic. pol!fPS - -rhue, OMI c.ommcml'd ffl.md in int-ct.tine. This poll(P
ha6 h~ d&qrQ.G c,& 'MM)SfonnoAior,, Into o,
AdMlOCOA.Cinoma.

- osteoma, - °"" mo,t common, in F,wnta.t, bone. mowx:tibte., IT)(M(il\o,

rund £phflnoid bone,.
- ~Q.Giat de,fom,rffd m°'d oc.cw., 4-ub io p'NlUJO(.f, of, oitc,orr'JO, in t1lt1
tnomdi bl e,.

active space
 • TP.EATMENT :

- T.wa.hn.-nt fer F=AP de.ptJnd4 on ,tbc, ~et'l01'pl,

a.. Most- lncti vidu.~ wiitl APG rru.ta,h'on, will dew.lop c.olOn COfflGM,

,thQ, ~II ol "tO 'lfCCM4,

b. 1"w.fotc., fW>~lo..cAic. s"'ielol6 is Recommended in c:. 25 t~ ca~

c..Onc.c, ....., Di011'10CiS °'
FAP is mad•. w:s.o, c.olonouopic, ~w.illomc.c,
wit+i pol~""d
d. pYOph'dla.c.fic. c.olec.t1>nYtf is indic.cLtt.d if mote, ff>om o, 100 pol!f1>S OM,
p.wc,nt • if itleM, <Mt, scwtA.Wd ohpplcuhc. potvw,s. CM, if mwfiple,
pol~ l~e,. 1 C1rn au, prv..fJl'lt
&, Vcwow. med.cca.tion4 OM, f-or i:l0e.1>i"'l ma.e;,anomt d1Z1tA11A41ion.
of pol'fPS
/ . The, NSAIDS be.eYI i:hown io Si'i""'i~~ ~ e , tflc, nuirnbfA.
ho.w,
ol pol'lfPS bvJ- d.o 1101' CAAUo,llV o.tm. maM9unM1t sinc4, -H,tM, ou,
Still -too fflMlfd pol'fPS -lo bf, follCIWf.d Qmd he4tc.d End.osc.opiCAlllt

............................................................................................. active space .

 Officia l Notes Partner: -
. ,i,..,-,.., ...

GI~~
• ~1srs - Ga4m> lnNMinaJ. shomol, numors
• 'lhc.u, °' conne.c.tiYlb ,tiUU,f,6 - &MC.OMAS
" 111... OM,e, mm lntw.1itiat. ed.C6 of '°da.t• (I ec)

• 'lh-, LoaA -to &low IA>OW6 c.ondudion, .S it,e, lmoo-tfoi mc.c6d•

D
. ··••-•----·- active space --•··
 • All ,\Ad\ twmOYS shou.td b-. AncahiJy.,d ffl Q, rnCAl'Qlf,"on, in ,ttie,
c:.- 11:;IT Rec4f)tin ( Ti,10sine, kina&e,)

- l~u.tin t11>Wtt1 fa,cAor iijna.UiOf•

GIST Fig 2

of .,IMstmj eel of c .,.i malurab0n and GIST tormation. lnlentibal eel of

C .... stem t elt mature 10 pa,tilllly differentiate<! and 1Mer ru,y diffef'entiated In~
cell of Cajal under lie Influence of KrT aignaling and inlUlin grodl factor ligneling
and liltety many ohtr growth and devetopment racton. KIT or mutation in 0Chet' genes
IM.leh • ~-deft'led o,ow11 r.ctor rtteptor A IHdt 10 GIST formation

• Evc,n itlou, LWOM -that mOi Qff)«QN buiitn on histolOCfica.t

OOMinMion m~ be, Mcw9namt
• 'Ttieu, +wm~ Rcwl,I~ invcwe A~cw,nt vi,QA.Q, CM'ld ~eusn~
lllrNrA, invtA.de, L'lfmPh Nod&\, bu.-t if'lir, c.am "f.Ud wd£ 1o L ~

• Thf-1 mo~ involve, ibz, omt-e.c.ic,,,, ~d ~te\iiot,, W0.U4 oC

-IN, Fumd.c.c.6 c,S stomo.c..b-
• 0Hu1 O I ~ amd e,tu.cf.
• Th'-" l'O°'cj be, susile, CM. pt.d'-fflc.c.J,o.ted proje.dir, into itlt, cacwnc,
LCMl'YlfKI 0.\, EXhGiCJCUhicA.t both - DOM6 Bel.&. AppeOA,~

• M~l\M"I"' is s~1e,stect be, it,e, SiJ6 mou, 1flGVrl s (A"() Qlnd ~rrnul
no-lint inc.wu..ed Mitosis on Bi~-
• De,noitive, oica.~is i~ Bi~

......................................................................................... active space••·. . .................................................. .

 °"$~
• CA.INICAI.. FEAWRES

Q.

b- Gttu.hointw-ina.t Hemo1'rilo.f~
C. MeA'CZ.&tala4C4 .

• 1REATMENT :

Cl. TreQJmu,~ ag e,hoia, i$ ScAAiVAld'

b. chfflo~ ( lmQ.f;nib , SCNniiinib • both ou, inhibitor +he,
c.- kit" Tct~ine, ~incu.c. - 0MI u.u.d for pCl,f;eA\1$
wi-th mflhl.&.talic. oi1uu.e, ) .

-• --- - - . -active space -