GI

Question 1

What is necrotising enterocolitis?

Answer 1

Inflammation and necrosis of a portion of the GI tract.

Question 2

What can increase the risk of necrotising enterocolitis?

Answer 2

IUGR.

Question 3

What can decrease the risk of necrotising enterocolitis?

Answer 3

Breast feeding and probiotics.

Question 4

Give 5 signs of necrotising enterocolitis.

Answer 4

1. Feed intolerance.
2. Bile-stained vomiting.
3. Distended abdomen.
4. Bloody stools.
5. Shock.

Question 5

How can you treat necrotising enterocolitis?

Answer 5

Broad spectrum antibiotics.

Question 6

Give 4 causes of chronic constipation.

Answer 6

1. Spurious/over-flow diarrhoea due to constipation.
2. Chronic non-specific diarrhoea.
3. Malabsorption.
4. Enteric infection.
5. IBD.
6. Drug induced.
7. Non-intestinal e.g. hypothyroidism

Question 7

Give 2 non-intestinal causes of diarrhoea.

Answer 7

1. Hyperthyroid.

2. Neuroblastoma.

Question 8

Give 2 infective causes of diarrhoea.

Answer 8

1. Adenovirus.
2. Rotavirus.
3. Protozoan: giardiasis.

Question 9

What is the diagnostic criteria for giardiasis?

Answer 9

Cysts in stool and motile forms in small intestine.

Question 10

How do you treat giardiasis?

Answer 10

3 days high dose metronidazole.

Question 11

Briefly describe the pathophysiology behind lactose intolerance.

Answer 11

A deficiency of intestinal lactase prevents the hydrolysis of lactose. The osmotic load of the unabsorbed lactose causes secretion of fluid and electrolytes until osmotic equilibrium is reached -> diarrhoea.

Question 12

What test can be done to check for lactose intolerance?

Answer 12

Hydrogen breath test.

Question 13

With what immunoglobulins is cow’s milk allergy associated with?

Answer 13

IgG or IgE.

Question 14

Give 3 symptoms of cow’s milk allergy.

Answer 14

1. Vomiting.
2. Abdominal pain.
3. Diarrhoea.
4. Malabsorption.
5. Intestinal bleeding.
6. Urticaria and lip swelling.

Question 15

What is the treatment for cow’s milk allergy?

Answer 15

Specialised formula feeds.

Question 16

A 6-month old breast fed infant developed widespread urticaria immediately after the first formula feed.

a) What investigation might you do?
b) What is the most likely diagnosis?

Answer 16

a) Skin-prick test for cow’s milk.

b) IgE mediated cow’s milk allergy.

Question 17

A 4-month-old infant, formula fed since birth, has loose stools and faltering growth. Skin prick test to cow’s milk is negative but elimination of cow’s milk results in resolution of symptoms which return on trial re-introduction. What is the most likely diagnosis?

Answer 17

Non-IgE mediated cow’s milk allergy.

Question 18

With which HLA molecules is Coeliac Disease often associated with?

Answer 18

DQ2 and DQ8.

Question 19

Give 3 risk factors for developing Coeliac Disease.

Answer 19

1. Family history.
2. T1 Diabetes Mellitus.
3. Down Syndrome.
4. IgA deficiency.
5. Often associated with other autoimmune disease.

Question 20

Describe the diagnostic criteria for Coeliac Disease.

Answer 20

1. Jejujunal biopsy showing characteristic histology e.g. villous atrophy, crypt hyperplasia, increased lymphocytes.
2. endomysial and IgA TTG antibodies are useful screening tests

Question 21

Describe Crohn’s disease.

Answer 21

A type of inflammatory bowel disease that affects anywhere from the mouth to the anus. It is characterised by patchy non-caseating granulomatous inflammation that can affect any layer of the bowel wall (transmural).

Question 22

Give 9 features of Crohn’s Disease.

Answer 22

Classical presentation:

1. abdominal pain
2. diarrhoea
3. weight loss

General ill health:

1. fever
2. lethargy
3. weight loss

Extra-intestinal manifestations:

1. Oral lesions
2. Perianal skin tags
3. Uveitis
4. Arthralgia
5. Erythema nodosum

Question 23

Give 3 extra-intestinal signs of Crohn’s Disease.

Answer 23

1. Oral ulcers.
2. Uveitis.
3. Arthralgia.
4. Erythema nodosum.

Question 24

Describe Ulcerative Colitis.

Answer 24

A type of inflammatory bowel disease that starts at the rectum and spreads proximally but only affects the colon. There is continuous inflammation that is confined to the mucosa.

Question 25

Give 3 symptoms of Ulcerative Colitis.

Answer 25

1. PR bleeding.
2. Diarrhoea.
3. Colicky pain.
4. Weight loss.
5. Growth failure.

Question 26

Give 2 extra-intestinal signs of Ulcerative Colitis.

Answer 26

1. Erythema nodosum.
2. Arthritis.
3. Iritis and episcleritis.

Question 27

What investigations might you want to do on someone who you suspect has IBD?

Answer 27

1. ESR and CRP.
2. Measure Hb - will often have microcytic anaemia (IDA).
3. Low serum albumin.
4. Endoscopy and biopsy

Question 28

What histological findings would you see on a biopsy taken from someone with IBD?

Answer 28

1. Mucosal inflammation.
2. Crypt damage.
3. Ulceration.

Question 29

Describe the treatment for Crohn’s.

Answer 29

Remission- steroids

Relapse:

1. Immunosuppresants- azathioprine, mercaptopurine, methotrexate
2. Anti-TNF agents- infliximab, adalimumab

Question 30

Give 3 benefits of using immunosuppressants as opposed to steroids for the treatment of IBD.

Answer 30

1. Safe.
2. Effective.
3. Steroid sparing.
4. Prevent relapse.

Question 31

Describe the mx of ulcerative colitis.

Answer 31

Mild:

1. aminosalyclates- mesalazine
2. topical steroids

Severe:

1. Remission- azathioprine
2. Corticosteroid