GI

Question 1

Which parts of the GI tract are affected by crohns?

Answer 1

Anywhere from mouth to anus

Question 2

Transmural inflammation occurs in which bowel condition?

Answer 2

Crohn’s

Question 3

Which findings on investigation would indicate a diagnosis of crohn’s disease? (4)

Answer 3

1. raised inflammatory markers
2. increased faecal calprotectin
3. anaemia
4. low vit B12 and vit D

Question 4

Which extra-intestinal features are associated with crohn’s disease ?

Answer 4

1. arthritis
2. episcleritis
3. erythema nodosum

Question 5

What is the differnece between the pattern of disease in UC and Crohn’s?

Answer 5

UC - continuous disease from rectum to ileocecal valve
Crohn’s - skip lesions from mouth to anus

Question 6

What is the management for Crohn’s disease?

Answer 6

1. Start monotherapy with prednisolone to induce remission at first presentation
2. If there are multiple inflammatory exacerbations in 12 months then add azathioprine
3. For severe active crohn’s disease - add infliximab

Question 7

Give 4 symptoms of UC

Answer 7

1. bloody diarrhoea
2. tenesmus
3. left iliac fossa pain
4. extra-intestinal features

Question 8

Which area of the GI tract is typically most affected in Crohn’s disease?

Answer 8

Terminal ileum

Question 9

What is the management of UC to induce remission?

Answer 9

1. First line = topical aminosalicylate e.g. mesalazine
2. Second line = oral aminosalicylate
3. topical/oral corticosteroids e.g. prednisolone

Question 10

What would you find of biopsy of someone with UC?(4)

Answer 10

1. red, raw, friable mucosa
2. no inflammation beyond submucosa
3. crypt abscesses
4. depletion of goblin cells

Question 11

What findings would you expect to see on an abdominal X ray of someone with UC?

Answer 11

lead pipe appearance of colon

Question 12

Which extra-intestinal features are most commonly associated with UC? (3)

Answer 12

1. arthritis
2. primary sclerosing cholangitis
3. uveitis

Question 13

How would you treat a symptomatic perianal fistula in crohn’s disease?

Answer 13

metronidazole

Question 14

What is the grading criteria for UC severity?

Answer 14

Truelove and Witts Criteria

Question 15

Which symptoms would be graded as ‘severe UC’? (6)

Answer 15

1. > 6 bowel movements/day
2. blood in stool
3. pyrexia
4. pulse > 90 bpm
5. anaemia
6. ESR > 30

Question 16

When would you admit someone with UC?

Answer 16

1. severe colitis
2. moderate disease that doesn’t respond to steroid treatment within 2 weeks

Question 17

How would you treat an acute severe flare of UC?

Answer 17

1. IV corticosteroids
2. IV ciclosporin/surgery

Question 18

What is a complication of UC that needs to be monitored for?

Answer 18

colorectal malignancy

Question 19

What is diverticulosis?

Answer 19

Very common condition causing outpouching of bowel wall, no symptoms

Question 20

What are risk factors for diverticular disease? (2)

Answer 20

1. increasing age
2. low-fibre diet

Question 21

What are symptoms of diverticular disease? (2)

Answer 21

1. altered bowel habit
2. colicky left sided abdo pain

Question 22

What are the symptoms of diverticulitis? (4)

Answer 22

1. constant LIF pain and tenderness
2. anorexia, N&V
3. diarrhoea
4. features of infection

Question 23

How is diverticulitis managed?

Answer 23

Systemically unwell = oral co-amoxiclav

Features of complicated acute diverticulitis = NBM, IV fluids, IV AbX

Question 24

What are 4 possible complications of acute diverticulitis?

Answer 24

1. abscess formation
2. peritonitis
3. obstruction
4. perforation

Question 25

How do gastric ulcers present?

Answer 25

Epigastric discomfort or pain Nausea and vomiting Dyspepsia Haematemesis/IDA

Question 26

What are the 2 most common causes of peptic ulcer disease?

Answer 26

NSAIDs Helicobacter Pylori infection

Question 27

How would you manage someone with suspected peptic ulcer disease?

Answer 27

1. Review and stop NSAIDs/aspirin/bisphosphonates/steroids/SSRIs 2. Test for H Pylori infection - negative + no NSAIDs = PPI 4-8wks - negative + NSAIDs = PPI 8 wks - positive + no NSAIDs = H Pylori eradication

Question 28

What does H Pylori eradication involve?

Answer 28

PPI + 2 antibiotics e.g. lansoprazole + amoxicillin + clarithromycin

Question 29

How and when do you test for H Pylori?

Answer 29

How: - Urea (13C) breath test - Stool helicobacter antigen test When: - if dyspepsia symptoms have not improved after a month of PPI - unexplained IDA after malignancy ruled out - 6-8 weeks post treatment if no improvement

Question 30

How is Barrett's oesophagus managed?

Answer 30

1. High dose PPI 2. Metaplasia = endoscopic biopsies every 3-5 years 3. Dysplasia = endoscopic ablation

Question 31

How would you manage a patient with endoscopy confirmed GORD?

Answer 31

PPI 4-8 weeks - 2nd line = H2 receptor antagonist (ranitidine)

Question 32

Which drugs may exacerbate the symptoms of GORD?

Answer 32

- alpha-blockers - anticholinergics - benzodiazepines - beta-blockers - bisphosphonates - calcium-channel blockers - corticosteroids - NSAIDs - nitrates - theophyllines - tricyclic antidepressants

Question 33

What are possible complications of GORD?

Answer 33

oesophagitis ulcers anaemia benign strictures Barrett's oesophagus oesophageal carcinoma