Small Intestine + Appendix

Question 1

Appendicitis

Answer 1

IV ceph + met

laparoscopic appendectomy

Question 2

carcinoid tumor

Answer 2

resect (diarrhoea , facial flushing and tremor = triad)

Question 3

C Diff diarrhoea

Answer 3

stop abx
maintain fluid and food intake
metronidazole/vancomycin
avoid loperamide
cholestyramine can be helpful
barrier nursing

Question 4

bowel obstruction

Answer 4

NGT
IVI fluids
Catheterise for fluid balance
drip n suck

Question 5

Meckels IX

Answer 5

techtenium scan shows diverticulum

parietal cells take up radio labelled techtenium

Question 6

IBS success rate

Answer 6

management only works 50% time

Question 7

IBS treatment

Answer 7

self help, relaxation etc
diet, exercise, limit caffeine
FODMAP
antispasmodics (meberverine)
laxatives
low dose TCA/SSRI
CBT after 12 months --> refractory IBS = 12 months still persisting w/anti depressant treatment

Question 8

Laxative to avoid in IBS

Answer 8

lactulose-causes bloating

Question 9

Crohn’s treatment mild attack

Answer 9

oral pred

taper steroid review in clinic

Question 10

Crohn’s severe attack symptoms

Answer 10

raised temp, raised pulse

high ESR/CRP, low albumin

Question 11

Crohn’s severe management

Answer 11

NBM, parenteral nutrition
IV hydrocortisone
Infliximab - refractory non responsive disease
transfer to oral pred once improving 
surgical advice if unable to control

Question 12

Crohn’s maintenance

Answer 12

Azothiprine
Methotrexate 2nd line/ 1st line if TMPT deficent
Oral metronidazole for anal disease

Question 13

Mild UC flare (<6 motions a day, systemically well)

Answer 13

topical +/- oral mesalazine (proctitis/proctosigmoiditis)
+ oral pred after 4 weeks
+ tacrolimus after 4-6 weeks
specialist advice for biologics

Question 14

severe UC flare

Answer 14

MDT

1. IV corticosteroids
2. assessment by surgeons
3. SC heparin
4. avoid anti motility drugs (inc opioids)
5. IV ciclosporin
6. biologics
7. use trulove witts score for surgical assessment

Question 15

UC maintenance

Answer 15

5 ASA derivatives (mesalazine/sulfasalazine)
azothioprine/mecaptopurine
lifelong

Question 16

Coeliac

Answer 16

life long gluten free
check its working with endomyseal antibody tests
small increased risk of small bowel lymphoma and adenocarcinoma

Question 17

Chronic pancreatitis

Answer 17

analgesia
creon + multivite
monitor blood glucose
alcohol abstinence
low fat diet 
partial pancreatectomy/pancreajejunostomy if unremitting pain, narcotic abuse/weight loss

Question 18

PPIs can cause..

Answer 18

achlorhydria leading to campylobacter infection (food poisoning)