Peptic Ulceration, Neuroendocrine Tumours and Crohns Disease

Question 1

why can people live without a large intestine?

Answer 1

large bowel function is absorption of water not nutrients

Question 2

secretory diarrhoea

Answer 2

over secretion of water and electrolytes often due to bacterial toxins
affects absorption of water and chloride

Question 3

inflammatory diarrhoea

Answer 3

cellular damage of mucosa causing hypersecretion

Question 4

osmotic diarrhoea

Answer 4

osmotically active solutes e.g, lactose intolerance

Question 5

acute vs chronic diarrhoea

Answer 5

acute - 2 weeks
chronic - 4+ weeks

Question 6

manifestation of Crohn’s disease

Answer 6

abdominal pain
diarrhoea
weight loss
lethargy
anaemia
mouth aphthous ulcers

Question 7

other complications associated with Crohn’s disease

Answer 7

skin conditions e.g., erythema nodosum
eye issues - iritis, conjunctivitis
joint problems

Question 8

Drugs for Chron’s disease

Answer 8

steroids - prednisolone, budenoside
immunosuppressants - methotrexate
biologics - vedolizumab, infliximab

Question 9

causes of peptic ulcers

Answer 9

NSAID, h-pylori, crohn’s disease
rarely - gastrinoma

Question 10

management of peptic ulcers

Answer 10

fluid resuscitation
stop NSAID
PPI - omeprazole

Question 11

the stomach secretes:

Answer 11

acid
water
electrolytes
glycoproteins - mucin, intrinsic factor, enzymes

Question 12

gastric acid is necessary for:

Answer 12

protein digestion
absorption of Ca+, iron, vitamin B12 and thyroxin
prevents bacterial overgrowth and enteric infections
reduction or elimination of food allergenicity

Question 13

mechanisms of acid secretion control

Answer 13

hormone - released into blood e.g., gastrin

paracine - released into tissue, reaches target via diffusion e.g., histamine, somatostatin

Question 14

which neuroendocrine tumours do carcinoid syndrome typically occur in

Answer 14

mainly small bowel neuroendocrine neoplasms
some bronchial NEN
some pancreatic NEN

Question 15

features of carcinoid syndrome

Answer 15

flushing
diarrhoea
abdominal pain
carcinoid heart disease
telangiectasias - spider veins
bronchospasm
pellagra

Question 16

carcinoid crisis

Answer 16

severe symptoms of carcinoid syndrome + hypotension during GA procedures as well as in TAE (trans arterial embolisation) when patient on inotropes

Question 17

features of carcinoid syndrome flushing

Answer 17

dry, intermittent, provoked by exercise, alcohol, food containing tyramines e.g., blue cheese
involves face and upper trunk as far as nipple line

Question 18

diagnostic approach for carcinoid syndrome

Answer 18

history and clinical exam
biochemical tests
imaging studies - localise legions
histology - gold standard

Question 19

characteristics of NEN cell

Answer 19

high amounts of serotonin through abnormal metabolism of tryptophan and:
- tachykinins
- prostaglandins
- kallikrein
- bradykinins

Question 20

treatment for carcinoid syndrome

Answer 20

somatostatin analogues e.g., lanreotide autogel
octreotide LAR

telotristat ethyl