Digestion pathologies

Question 1

definition of coeliac disease

Answer 1

autoimmune reaction to gluten causing chronic inflammation

Question 2

auto-antibodies in Coeliac disease?

Answer 2

• IgA Anti-endomyosial

- IgA Anti-tissue transglutaminase

Question 3

2 typical histological features in coeliac disease

Answer 3

• Villous atrophy
• Crypt hyperplasia
• inflammatory infiltration (influx of immune cells into lamina propria)

Question 4

gastrointestinal manifestations of malabsorption (4)

Answer 4

• bloating
• abdo pain
• loose stools
• steatorrhoea

Question 5

skin condition that is strongly associated with coeliac disease?

Answer 5

Dermatitis herpetiformis

blistering skin condition; intensely pruritic rash

Question 6

describe the rash of dermititis herpetiformis

Answer 6

extremely itchy papulovesicular rash on extenensor surfaces

subepidermal bullae are seen on histology with linear IgA deposite on dermal papillar

Question 7

management of Dermatitis herpetiformis

Answer 7

dapsone

Question 8

genetic associations with coeliac disease

Answer 8

HLA DQ2 gene

HLA DQ8 gene

Question 9

Chrons NESTS pneumonic for Chrons disease

Answer 9

N - no blood/mucus 
E - entire GI tract 
S - Skip lesion on endoscopy 
T - Terminal ileum & transmural thickness 
S - Smoking is a risk factor

Question 10

UC ‘Close up’ pneumonic

Answer 10

C - Continuous inflammation 
L - Limited to colon & rectum 
O - Only superficial mucosa affected 
S - Smoking is protective 
E - Excrete blood & mucus 
U - Use aminosalicylates 
P - Primary sclerosing cholangitis

Question 11

extracolonic manifestations of UC

Answer 11

• uveitis
• episcleritis
• arthritis
• aphthous ulcers
• erythema nodosum
• PSC (isolated rise in ALP)

Question 12

what is erythema nodosum

Answer 12

multiple, painful, purple nodules on the anterior aspect of the shins

Question 13

screening required for patients with IBD?

Answer 13

surveillance colonoscopy due to increased risk of colorectal cancer

Question 14

mechanism of ciclosprin

Answer 14

calcineurin inhibitor

Question 15

mechanism of infliximab

Answer 15

monoclonal antiboy targeting TNF alpha

Question 16

contraindications to infliximab?

Answer 16

latent TB

demyelination

active sepsis

Question 17

smoking effect on Chrons disease

Answer 17

worsens chrons disease

Question 18

type of IBD that can affect any part of thr GI tract

Answer 18

Chrons disease

Question 19

pathophysilogical/histological features of Chrons disease

Answer 19

• Cobblestone appearance
• Rosethorn ulcers
• Obstruction
• Hyperplasia
• Narrowing of lumen
• Skin lesions

Question 20

non caeseating granulomas

Answer 20

crohns disease

Question 21

2 skin lesions seen in crohns disease

Answer 21

• erythema nodosum

- pyoderma gangrenosum

Question 22

describe pyoderma gangrenosum

Answer 22

ulcerating nodules characterised by black (gangrenosum) edges & cdntral pus (pyoderma)

Question 23

what marker is released following degranulation of neutrophils in IBD

Answer 23

Faecal calprotectin

Question 24

number of bowel movements a day for mild, moderate & severe flare up?

Answer 24

mild - < 4 stools a day

moderate - 4 to 6 stools a day

severe - more than 6 stools a day

Question 25

medication to induce remission in mild-moderate UC flare up

Answer 25

oral 5-ASA: sulfasalazine/mesalazine

Question 26

management of severe UC flare up?

Answer 26

- admission - IV fluids - Hydrocortisone IV - rectal steroids - monitor stools & observations

Question 27

2 types of aminosalicylate?

Answer 27

- mesalazine | - sulfasalazine

Question 28

side effects of sulfasalazine

Answer 28

- headache - rash - nausea - diarrhoea

Question 29

adverse effects of azothioprine

Answer 29

- decrease blood counts - nausea - flu like sy,ptoms - liver inflammation - pancreatitis

Question 30

radiological findings in UC

Answer 30

- loss of haustrations if long standing: narrow colon, drainpipe colon

Question 31

inheritance of Lynch syndrome?

Answer 31

autosomal dominant

Question 32

most common cancers predisposed to with lynch syndrome

Answer 32

- Colorectal cancer | - Endometrial cancer

Question 33

NICE diagnostic criteria for IBS

Answer 33

``` Abdominal pain/discomfort OR associated with change in bowel habit & 2 of: - Abnormal stool passage - Bloating - Worse symptoms after eatign - PR mucus ```

Question 34

medication for diarrhoea in IBS?

Answer 34

Loperamide

Question 35

medication for constipation in IBS?

Answer 35

laxative

Question 36

medication for cramps in IBS?

Answer 36

Antispasmodic e.g. hyoscine butylbromide (Buscopan)

Question 37

2nd & 3rd line medication for IBS

Answer 37

2nd - Amitriptyline (TCA) 3rd - SSRI

Question 38

duration of symptoms needed for diagnosis of IBS

Answer 38

3 or more days a month and symptoms over 6 or more months

Question 39

what does a positive and negative Carnett's sign suggest?

Answer 39

positive - suggests abdominal wall cause of pain negative - suggests an intra abdominal cause of pain