15 - chronic abdominal pain

Question 1

Welcome to week 14

Answer 1

https://youtu.be/dQw4w9WgXcQ

Question 2

What is the ROME criteria

Answer 2

Used to diagnose functional gut disorders like IBS

Question 3

Symptoms of IBS

Answer 3

Abdo pain - colicky

Bloating

altered bowel habit

Greater than 6 months

Question 4

What are red flags for abdominal pain?

Answer 4

> 60 years

rectal bleeds

anaemia

weight loss

FH of colorectal cancer

Abdo/ rectal mass

Raised CRP/ESR

Question 5

What dietary advice should be given to patients suffering from IBS?

Answer 5

Avoid fermentable carbohydrates - fructose lactose

Question 6

What is Carnett’s sign?

Answer 6

Abdominal pain made worse on the site of palpation when a patient sits up.

If positive then pain is from the abdominal wall rather than the viscera.

Question 7

What is loperamide?

Answer 7

Opioid agonist which focuses on the mesenteric plexus.

Used for diarrhoea

Question 8

What is linaclotide?

Answer 8

Used for constipation (via CFTR) for constipatino > 12 months when laxatives dont work.

Used 2nd line (by definition) in IBS

Question 9

When can you initiate psychological therapy for IBS (NICE guildlines)?

Answer 9

> 12 months of suffering from IBS whith it not getting better

Question 10

How is ulcerative collitis diagnosed?

Answer 10

> 4 weeks of diarrhoea with evidence of acute and chronic inlfammation on endoscopic and biopsy

Question 11

How is Crohns disease diagnosed?

Answer 11

endoscopic evidence and imaging with compatible clinical history

Question 12

What is tenesmus?

Answer 12

Repeated need to empty bowels

Question 13

What is the definition of diarrhoea?

Answer 13

Greater than 2 unformed stools per day

Question 14

What is disentry?

Answer 14

Diarrhoea with blood in it

Question 15

What is acute diarrhoae?

Answer 15

Diarrhoea lasting less than 4 weeks

Question 16

What is chronic diarrhoea?

Answer 16

Diarrhoea lasting greater than 4 weeks

Question 17

Having antibiotics for greater than 1 months increases the risk of diarrheoa due to…

Answer 17

Clostridium deficile

Question 18

What is calportectin?

Answer 18

Indicates if there is any underlying inflammation in the GI tract. If negative would help to support a diagnosis of IBS

Question 19

Is smoking protective or harmful with Crohns?

Answer 19

Smoking is harmful, smoking cessation should be part of the treatment for Crohns.

Question 20

Is smoking protective or harmful with Ulcerative Collitis?

Answer 20

Smoking is protective with ulcerative colitis

Question 21

What features of Ulcerative collitis are present on endoscopy?

Answer 21

Continoues erthematous inflammation with pseudo polyps.

Question 22

What features of Crohns are during endoscopy?

Answer 22

Skipp lesions with a cobblestone appearence

Question 23

What complications can occur due to Crohns?

Answer 23

Stenosis

Abcess

Fistula and performation

Increase rate of colorectal cancer

Question 24

What complications can occur due to Ulcerative collitis?

Answer 24

Bleeds

Toxic megacolon

Ruptured bowel

increase risk of colorectal cancer

Question 25

When can you no longer take stool cultures from a patient in hospital?

Answer 25

Stool samples should ont be takem after 3 days.

Question 26

What is the commonest cause of gastroeneteritis in the UK?

Answer 26

Campylobacter

Question 27

What is HUS?

Answer 27

Haemolytic urea syndrome, caused by a strain of E. coli and shigella dysentry

Question 28

What is TTP?

Answer 28

thrombolytic thrombocytopenia purpura. Low platelet count caused by with many causes inculuding E.coli

Question 29

Patient has rice water stool after coming from abroad. What is the cause?

Answer 29

Cholera

Question 30

What is Giadrasis?

Answer 30

A parasite which can cause chronic diarrhoea

Question 31

What is the red flag for ovarian cancer?

Answer 31

Female over 50 with bloating.

Question 32

What does Ca125 indicate?

Answer 32

Marker for ovarian cancer

Question 33

What is the true witts criteria?

Answer 33

A way of measuring the severity of IBD

Question 34

Would be safe to do a colonoscopy during a flare up of US or Crohns?

Answer 34

NO due to risk of perforation, possibly flexible sigmoidoscopy

Question 35

What is the definition of a fistula?

Answer 35

Abnormal connection between to 2 epithelial linings

Question 36

When treating IBD TB should be excluded. How is TB tested for?

Answer 36

Quantifieron

Question 37

UC is limited to the large bowel, how can it effect the small bowel?

Answer 37

Backwash ileuitis

Question 38

What is the gold standard investigation for crohns?

Answer 38

Pilcam - a camera as a pil

Question 39

What is the MUST score?

Answer 39

Greater than 2 indicates malnutrition

Question 40

What is refeeding syndrome?

Answer 40

Fedding after MI which causes MI, due to washing over electrolytes over the cardiac tissue.

Question 41

What condition are 5-ASA drugs like mesalazine used for?

Answer 41

Ulcerative collitis and not Crohns

Question 42

What is first line for Crohn's?

Answer 42

Azathiopurine or mertaptopurine These can also be used for UC after mesalazine

Question 43

What medicaiton is second line for Crohn's disease?

Answer 43

Metotrexate

Question 44

After 4 weeks of a flare up of UC. What mediation can be used to induce remission?

Answer 44

Glucocorticoids

Question 45

What can be used for inducing remision of Crohns after a flare up?

Answer 45

1st glucocorticoids 2nd 5-ASA and 1st line therapy