Gastrointestinal - Bowel Disease

Question 1

what occurs in coeliac disease?

Answer 1

T cell mediated AI disease of the small bowel

results in an enteropathy to gluten

Question 2

features of coeliac disease?

Answer 2

diarrhoea
pale stools
wt loss
steatorrhoea
bloating 
ulcers
fatigue

Question 3

what is the intolerance to in coeliac disease? what is this in?

Answer 3

prolamin

alcohol soluble proteins (wheat, barley, rye, oats)

Question 4

Ix for coeliac disease and results?

Answer 4

FBC (anaemia)
ferritin
stool culture
B12/folate
anti TTG
endoscopy + duodenal biopsy

Question 5

what is seen on duodenal biopsy in coeliac disease?

Answer 5

villous atrophy
intra epithelial WBCs
crypt hyperplasia

Question 6

how can paeds diagnose coeliac disease?

Answer 6

blood tests if tTG >10x normal

if not, still need scope and biopsy

Question 7

Tx for coeliac disease?

Answer 7

gluten free diet

Question 8

what malignancy are those with coeliac disease at higher risk of?

Answer 8

T cell lymphoma (gastric)

Question 9

what rash is associated with coeliac disease?

Answer 9

dermatitis herpetiformis

Question 10

describe dermatitis herpetiformis?

Answer 10

extensors
buttocks
small blisters on a red base
itchy

Question 11

what is seen on biopsy of dermatitis herpetiformis?

Answer 11

granular deposits of dermal papillary IgA on immunofluorescence

Question 12

what is used to treat dermatitis herpetiformis?

Answer 12

gluten free diet
dapsone gel (Abx)

Question 13

where can crohn’s effect?

Answer 13

mouth to anus

Question 14

describe crohns pathology?

Answer 14

transmural
skip lesions
cobblestone
deep fissures
abscesses

Question 15

features of crohn’s?

Answer 15

diarrhoea
blood
urgency
abdo pain 
fever
ulcers
abscesses 
fistulae

Question 16

what other non GI symptoms can occur in crohn’s?

Answer 16

clubbing
erythema nodosum
gallstones
anterior uveitis

Question 17

what type of arthritis do those with crohn’s get? features?

Answer 17

enteropathic

peripheral joints and spine

Question 18

diagnostic Ix for crohn’s? what can be done in kids?

Answer 18

colonoscopy and biopsy

MRI small bowel barium study

Question 19

what other Ix should be done for crohn’s ?

Answer 19

LFTs, FBC, U+Es, CRP, ferritin, B12, folate
tTG
stool culture

Question 20

what faecal marker can be used to assess IBD?

Answer 20

faecal calprotectin

Question 21

Tx for crohn’s?

Answer 21

steroids in attacks
AZA/MTX
infliximab
stop smoking 
ileostomy 
colectomy

Question 22

complications of crohn’s?

Answer 22

bowel obstruction
fistulae
abscesses
toxic dilatation 
osteoporosis

Question 23

what size is classed as toxic colon dilatation?

Answer 23

> 6cm

Question 24

what IBD is made worse by smoking?

Answer 24

crohn’s

Question 25

what non GI symptoms can occur in UC?

Answer 25

``` clubbing ulcers erythema nodosum pyoderma gangrenosum joint pain anterior uveitis ```

Question 26

where does UC affect?

Answer 26

rectum to ileocaecal valve

Question 27

what is found on UC pathology?

Answer 27

crypt abscesses peudopolyps goblet cell depletion drainpipe colon (thin wall)

Question 28

what IBD is PSC more common in?

Answer 28

UC

Question 29

what IBD is bloody diarrhoea more common in?

Answer 29

UC

Question 30

Ix for UC?

Answer 30

FBC, U+E, CRP, Ferritiv faecal calprotectin stool culture colonoscopy

Question 31

Tx for UC?

Answer 31

topical mesalazine (rectal disease) oral mesalazine sulfasalazine steroids

Question 32

what surgery is curative in crohn's?

Answer 32

ileostomy (R sided) formed through a colectomy or proctocolectomy

Question 33

what cancer can occur as a complication of UC?

Answer 33

colorectal

Question 34

what are the categories of UC severity?

Answer 34

``` mild = <4stools mod = 4-6 stools severe = >6 stools and systemic upset ```

Question 35

features of IBS?

Answer 35

``` bloating urgency tenesmus mucus nocturia worse when stressed ```

Question 36

what is the rome IV criteria for IBS?

Answer 36

Recurrent abdo pain/discomfort for ≥1 day/week in the last 3 months + 2 or more of - pain associated with defecation (better/worse) - Onset associated with stool frequency - Onset associated with stool form

Question 37

Ix for IBS?

Answer 37

FBC, ESR, CRP TTG Ca125 (if suspicious) colonoscopy (if suspicious)

Question 38

Tx for IBS?

Answer 38

FODMAP diet reduce caffeine loperamide amitriptyline