GI conditions: intestines

Question 1

Does UC or Crohn’s have a greater risk of developing colon cancer

Answer 1

UC

Question 2

Differentiating between UC and Crohn’s via symptoms

Answer 2

UC: usually bloody diarrhoea

Crohn’s: usually non-bloody diarrhoea

Question 3

Differentiating between UC and Crohn’s via histology

Answer 3

UC: superficial inflammation. Crypt abscesses.

Crohn’s: transmural inflammation. Granulomas

Question 4

Differentiating between UC and Crohn’s via endoscopy

Answer 4

UC: affected from rectum to ileocaecal valve. 
Get pseudopolyps (widespread ulceration)

Crohn’s: affected anywhere from mouth to anus. Get cobblestone appearance (deep ulcers + skip lesions)

Question 5

What causes crypt abscesses? What GI condition is associated with this

Answer 5

Crypt abscess = neutrophils migrating through the wall of glands

UC

Question 6

What causes granulomas? What GI condition is associated with this

Answer 6

Collection of macrophages to ward off “foreign bodies” during inflammation

Crohn’s

Question 7

AXR features of UC

Answer 7

1. leadpipe colon (narrow short colon, loss of haustra)
2. loss of haustra
3. pseudopolyps

Question 8

AXR features of Crohn’s

Answer 8

1. Kantor’s string sign (bowel strictures)

2. Rose thorn ulcers (deep ulcers)

Question 9

What causes thumbprinting on AXR

Answer 9

Wall thickening of colon, due to inflammation/ infection

–> colitis

Question 10

What causes loss of haustra on AXR

Answer 10

1. Chronic UC

2. Toxic megacolon

Question 11

Features of mild flare up of UC

Answer 11

Diarrhoea <4 times

Question 12

Features of moderate flare up of UC

Answer 12

Diarrhoea 4-6 times a day

No systemic features

Question 13

Features of severe flare up of UC

Answer 13

Diarrhoea >6 times a day

Systemic features eg fever, tachycardia, raised CRP

Question 14

Best cancer marker to monitor patients with colon cancer

Answer 14

CEA

Question 15

What surgery is done for colon cancer in

caecum - proximal transverse colon
distal transverse - descending colon
sigmoid colon
upper/middle rectum
distal 1/3 of rectum

Answer 15

caecum - proximal transverse colon = R hemicolectomy

distal transverse - descending colon = L hemicolectomy

sigmoid colon = Hartmann’s (sigmoidectomy + end colostomy)

upper/middle rectum = anterior resection

distal 1/3 of rectum = abdominal-perineal excision of rectum

Question 16

Describe grades 1-4 of internal haemarrhoids

Answer 16

1. No prolapse, but promiment blood vessels
2. Prolapse which can spontaneously reduce
3. Prolapse which requires manual reduction
4. Permanent prolapse

Question 17

Chronic treatment for mild-moderate UC that only affects distal colon

Answer 17

Rectal sulfasalazine

Question 18

Chronic treatment for mild-moderate UC that is widespread

Answer 18

Oral + rectal sulfasalazine

Question 19

Chronic treatment for moderate-severe UC

Answer 19

1. Oral + rectal sulfasalazine
2. Biologics eg infliximab
3. Azathioprine if >2 exacerbations a year/ severe relapse

Question 20

Management of an acute flare of UC

Answer 20

1. IV corticosteroids for 72h
2. IV ciclosporin
3. Infliximab
4. Surgery

Question 21

Indications for surgery in acute flare of UC

Answer 21

1. Stools frequency >8/day
2. Fever, tachycardia
3. AXR: colon dilation
4. low, albumin, low Hb, high platelets, high CRP

Question 22

When would a UC patient be put on regular oral azathioprine/ mercaptopurine

Answer 22

• severe relapse of UC

- 2 or more exacerbations in a year

Question 23

Management of mild-moderate flare of UC

Answer 23

Oral corticosteroids

Question 24

First line investigation for acute mesenteric ischaemia

Answer 24

Lactate (would get lactic acidosis)

Question 25

Most common site of diverticulitis

Answer 25

Sigmoid colon

Question 26

What does a positive C Diff antigen mean

Answer 26

Exposure to bacteria (does not necessarily indicate current infection)

Question 27

Most common cause of hereditary colon cancer

Answer 27

HNPCC (Lynch syndrome)

Question 28

What drug may reduce the risk of colon cancer in those with HNPCC (Lynch syndrome)

Answer 28

Aspirin daily

Question 29

HNPCC (Lynch syndrome) -What cancers are associated with this

Answer 29

Colon cancer Endometrial cancer Pancreatic cancer Gastric cancer

Question 30

FAP -What cancers are associated with this

Answer 30

Colon cancer Breast cancer Ovarian cancer Gardner's syndrome (osteomas of skull and mandible)

Question 31

Difference in presentation between large and small bowel obstruction

Answer 31

Small bowel: Present with vomiting early and absolute constipation late Large bowel: Present with constipation earlier

Question 32

Inheritance of FAP

Answer 32

Autosomal dominant

Question 33

2 most common watershed areas in colon What arteries are involved?

Answer 33

Splenic flexure: SMA + IMA Rectosigmoid junction: IMA + hypogastric artery

Question 34

UC is associated with which HBP condition?

Answer 34

UC is associated with PSC