IBD/Traveller's diarrhoea/High output stoma

Question 1

RIF mass

Answer 1

Crohn’s (terminal ileum mass)

Question 2

Stoma on rHS

Answer 2

Ileostomy

Question 3

Stoma on LHS

Answer 3

Colostomy

Question 4

intestinal manifestations of crohn’s

Answer 4

Perianal fistula and abscess
Strictures
Anaemia
Malabsorption
intestinal obstruction

Question 5

intestinal manifestations UC

Answer 5

Perforation
Colonic carcinoma
Toxic dilatation

Question 6

why may you have signs of CLD in an IBD patient?

Answer 6

UC and PSC

Question 7

type of arthropathy in IBD

Answer 7

Seronegative spondyloarthropathy, asymmetric, predilection for large joints orSIJ

Question 8

crohns vs UC histology

Answer 8

Crohn’s: transmural inflammation, granulomas

UC: Mucosal/submucosal layer, crypt abscesses

Question 9

Acute mx of severe Crohn’s

Answer 9

IV/PO Steroids

OR IV infliximab

Question 10

Maintenance therapy in Crohn’s

Answer 10

PO Steroids
Azathioprine
MTX

Biologics: infliximab, adalimumab

Question 11

Acute mx of severe UC

Answer 11

IV steroids
IV ciclosporin

Question 12

Maintenance therapy of UC

Answer 12

Oral/topical steroid
5-ASA ie mesalazine

Azathioprine

Question 13

crohn’s perianal infection abx

Answer 13

metronidazole

Question 14

extra-intestinal manifestations of IBD

Answer 14

Skin: EN, PG
Eyes: uveitis, episcleritis, scleritis
Joints: large joint arthritis, seronegative arthritidies
Apthuous ulcers
PSC

Question 15

most common site of involvement in crohns and UC

Answer 15

Crohn’s: terminal ileum
UC: Rectum

Question 16

sulphasalazine SE

Answer 16

Pancreatitis
SJS

Question 17

common electrolyte disturbances in high output stoma

Answer 17

hyponatraemia
hypomagnasemia

Question 18

what should patients not do in high output stoma?

Answer 18

DRINK MORE HYPOTONIC WATER!!!! NEED ORS

Question 19

what is considered a high output stoma?

Answer 19

> 1.5-2L/Day

Question 20

managing high output stoma

Answer 20

Minimise normal fluids like coffee, tea, water, fizzy drinks to 1L/day
Replacing with ORS like St Mark’s solutuon
If infective cause excluded, have anti diarrhoeal like loperamide and codeine
PPI
Increased salt intake

Question 21

what is particularly imporant in the history for infectious diarrhoea

Answer 21

EMPLOYMENT - IF FOOD HANDLER NEED TO NOTIFY UKHSA

Question 22

Possible complication of E Coli 0157 producing shiga toxin

Answer 22

Haemolytic uraemic syndrome (schistocytes on blood film), low platelets

Question 23

Manegemtn of HUS

Answer 23

Steroids
Dialysis
Blood transfusion

Question 24

Notifiable diarrhoea cuasing pathogens

Answer 24

Salmonella
Shigella
Yersinia
Giardia
Entamoeba
Campylobacter
Cryptosporidium