Chronic Bowel Disorders

Question 1

What is coeliac disease?

Answer 1

Autoimmune condition associated with chronic inflammation in small intestine unable to absorb nutrients

Gluten intolerance

Question 2

What are the symptoms of coeliac disease?

Answer 2

Diarrhoea
Abdominal pain
Bloating
Higher risk of malabsorption of key nutrients

Question 3

How do you treat coeliac disease?

Answer 3

Gluten free diet
Osteoporosis treatment
Supplements

Question 4

What is diverticula disease?

Answer 4

Small bulges or pockets develop in the lining of the intestine

Question 5

What is diverticulitis?

Answer 5

When the pockets become inflamed or infected

Question 6

What are the symptoms of diverticula disease?

Answer 6

Lower abdominal pain
Constipation
Diarrhoea

Question 7

What is the treatment for diverticula disease?

Answer 7

High fibre diet
Bulk forming drugs

Antibiotics if diverticulitis

Question 8

What is ulcerative colitis?

Answer 8

Mucosal inflammation and ulcers restricted to colon and rectum

Question 9

What are the symptoms of ulcerative colitis?

Answer 9

Bloody diarrhoea
Abdominal pain, urgent need to defecate

Alternates between acute flare up and remission

Flare up - mouth ulcers, arthritis, sore skin, weight loss, fatigue

Question 10

What are the long term complications of ulcerative colitis?

Answer 10

Colorectal cancer
Secondary osteoporosis
VTE
Toxic megacolon

Question 11

What is contraindicated in ulcerative colitis?

Answer 11

Loperamide/codeine

Paralytic ileus - increased risk of toxic megacolon

Question 12

What type of colitis is treated orally?

Answer 12

Extensive

Question 13

What type of colitis is treated with enemas?

Answer 13

Left sided/distal

Question 14

What type of colitis is treated with suppositories?

Answer 14

Proctitis

Question 15

What type of colitis is treated with foam preparations?

Answer 15

Proctosigmoiditis

Question 16

What is used to treat mild-moderate exercise ulcerative colitis?

Answer 16

Proctitis and proctosigmoiditis first line - rectal aminosalicylate

Extensive colitis or left sided colitis first line - high dose oral aminosalicylate + rectal aminosalicylate or oral beclometasone if necessary

Question 17

What is used to treat subacute ulcerative colitis?

Answer 17

Oral prednisolone or mab

Question 18

What is used if treatment failure in acute mild-moderate ulcerative colitis?

Answer 18

+ oral prednisolone

+ oral tacrolimus

Question 19

What is used for severe acute colitis?

Answer 19

IV corticosteroid - assess for surgery

IV corticosteroid + IV ciclosporin

Question 20

What is used to maintain remission in ulcerative colitis?

Answer 20

Proctitis + proctosigmoiditis - aminosalicylates

Extensive or left sided - low dose oral aminosalicylate

Oral azathioprine/mercaptopurine if 2+ flare ups in 12 months

Mab

Question 21

What is Crohn’s disease?

Answer 21

Inflammation of GI tract from mouth to anus

Question 22

What are the symptoms of chrons disease?

Answer 22

Abdominal pain
Diarrhoea
Rectal bleeding
Weight loss
Low grade fever
Fatigue

Question 23

What are the complications of Crohn’s?

Answer 23

Intestinal strictures, abscesses, fistulae

Malnutrition
Anaemia
Colorectal cancer
Growth failure and delayed puberty 
Arthritis

Question 24

What is the lifestyle advice for Crohn’s?

Answer 24

High fibre diet
Smoking cessation
Loperamide or codeine phosphate

Question 25

What do you give for 1+ flare up of Crohn’s in 12 months?

Answer 25

Corticosteroid Budesonide/aminosalicylate

Question 26

What do you give for 2+ flare ups of Crohn’s in 12 months?

Answer 26

Azathioprine or mercaptopurine Methotrexate

Question 27

What is used to maintain remission in Crohn’s?

Answer 27

Azathioprine | Mercaptopurine

Question 28

What is used to maintain remission in Crohn’s after surgery?

Answer 28

Azathioprine or mercaptopurine Or aminosalicylates

Question 29

What are the aminosalicylates used in IBD?

Answer 29

Balsalazide Mesalazine Olsalazine Sulfasalazine

Question 30

What are the corticosteroids used in IBD?

Answer 30

``` Beclometasone Budesonide Hydrocortisone Methylprednisolone Prednisolone ```

Question 31

What are the drugs that affect the immune system that are used in IBD?

Answer 31

``` Azathioprine Ciclosporin Mercaptopurine Methotrexate Infliximab ```

Question 32

What is the mechanism of action of aminosalicylates?

Answer 32

Reduce cytokine and free radical formation and inhibit prostaglandin synthesis

Question 33

What are the side effects of aminosalicylates?

Answer 33

Blood dyscrasias Nephrotoxicity Salicylate hypersensitivity Yellow/orange bodily fluids with sulfasalazine

Question 34

What are the counselling points for aminosalicylates?

Answer 34

Report unexplained bleeding, bruising, sore throat, fever

Question 35

What is the interaction between mesalazine and lactulose?

Answer 35

Lactulose lowers stool in pH in the intestines Prevents sufficient release of the active ingredient in EC/MR preparations

Question 36

What are the symptoms of IBS?

Answer 36

Lower abdominal pain Bloating Alternating constipation and diarrhoea

Question 37

What are the antispasmodics used in IBS?

Answer 37

Alverine Mebeverine Peppermint oil

Question 38

What are the antimuscarinics used in IBS?

Answer 38

Hyoscine butylbromide Atropine Dicycloverine Propantheline bromide

Question 39

What are the laxatives used in IBS?

Answer 39

Lactulose not recommended Linoclotide

Question 40

What antimotility drug is used in IBS?

Answer 40

Loperamide

Question 41

Why are antidepressants used in IBS?

Answer 41

Abdominal pain/discomfort TCA SSRI

Question 42

What is short bowel syndrome?

Answer 42

Characterised by malabsorption following extensive resection of the bowel

Question 43

What vitamins are people with short bowel syndrome?

Answer 43

ADEK, fatty acids, zinc, selenium, hypomagnesaemia

Question 44

What do you need to give higher doses of in short bowel syndrome?

Answer 44

Warfarin Oral contraceptives Digoxin EC/MR not suitable Liquid formulations may be suitable