Investigations + management

Question 1

FBC?

Answer 1

coeliac disease, Crohns and UC can all cause anaemia from malabsorption of iron, folate or B12.

Question 2

ESR?

Answer 2

Crohns and UC are systemic inflammatory diseases that elevate ESR.

Question 3

CRP?

Answer 3

infectious diarrhoea, Crohns, UC

Question 4

TTG and IgA levels?

Answer 4

positive result has 90% sensitivity to coeliac.

Question 5

TFTs?

Answer 5

low TSH and high T3/T4 suggest hyperthyroidism

Question 6

U&Es?

Answer 6

may be dehydrated with electrolyte imbalances.

Question 7

Albumin?

Answer 7

low in patients with chronic diarrhoea and malabsorption.

Question 8

Capillary glucose?

Answer 8

tells if patient is diabetic.

Question 9

Faeces tests Faeces microscopy and culture?

Answer 9

exclude infection, and can indicate IBD.

Question 10

Faeces tests C. difficile toxin?

Answer 10

if patient has had recent antibiotic use

Question 11

Faeces tests Faecal occult blood test (FOBT)

Answer 11

point towards infection or UC and away from hyperthyroidism

Question 12

Crohns disease symptoms?

Answer 12

bloody diarrhoea and abdo pain often starting on lower right quadrant, can suffer weight loss and failure to thrive between attacks. The symptoms are due to chronic activation of the immune system in various tissues and its squelae

Question 13

UC symptoms?

Answer 13

pain is diffuse with bloody diarrhoea but patients are fine inbetween attacks

Question 14

AXR for UC?

Answer 14

essential for UC as rule out toxic megacolon, this can be detected as large bowel loop >6cm.

Question 15

What will colonoscopy see in IBD?

Answer 15

visualise interrupted lesions of Crohns or diffuse erythematous inflammation of UC and allows biopsies.

Question 16

Treatment for infectious diarrhoea?

Answer 16

oral rehydration, stay away from work until 48 hrs after diarrhoea.

Question 17

IBS diagnosis?

Answer 17

at least 3 months of recurrent abdo pain or discomfort associated with 2 or more of the following; improvement with defecation, onset associated with change in frequency of stool, onset associated with change in form of stool.

Question 18

IBS management?

Answer 18

Reassurance, antispasmodic (decrease bowel smooth muscle activity), antidepressants (slow colonic transit time) diet remedies (avoid certain food, increase fibre).

Question 19

C.difficile is common in

Answer 19

Elderly patients who are immunosuppressed

Question 20

C.difficile management?

Answer 20

ABC, faeces analysis, isolation, meticulous hygiene, antibiotic treatment (metronidazole 14 days).

Question 21

UC overview?

Answer 21

systemic inflammatory disease, GI affected distal to proximal, shows gross uniform inflammation with clear cut off, patients present with painless, bloody diarrhoea. Can also have; arthritis, sacroiliitis, uveitis, scleritis, episcleritis , erythema nodosum, anaemia of chronic disease. UC has a much stronger association with: colorectal adenocarcinoma, cholangiocarcinoma (CBD cancer), primary sclerosing cholangitis (obstructive jaundice and liver failure).

Question 22

UC management?

Answer 22

anti-inflammatories, disease monitoring due to high colonic adenocarcinoma rates and surgical therapy (remove affected bowel, potentially curative but results in lifelong end ileostomy bag).

Question 23

Hyperthyroidism symptoms and investigations?

Answer 23

increased frequency softer stools, heat intolerance, weight loss, resting tremor, lid lag, tachycardic. Check TSH and T3/T4. Most common aetiology is Graves, investigated by looking at the antithyroid perioxidase and a raised ESR.

Question 24

IBD complications outside the bowel?

Answer 24

Clubbing, eyes (inflammation leading to iritis, episcleritis, scleritis), skin (erythema nodusum or pyoderma anaemias), joints (enteric arthritis), blood (iron deficiency anaemia), biliary system (PSC, cholesterol gallstones), kidneys (stones), bones (lack of Ca2+ can lead to osteomalacia).

Question 25

Define fluid challenge?

Answer 25

IV bolus of 250-500ml crystalloid over 30mins, given to hypovolaemic patient.

Question 26

Define maintenance fluid?

Answer 26

restore 2.5l fluid, 100mM Na, 70mM K+ a day.

Question 27

Define replacement fluid?

Answer 27

some patients have abnormally high fluid loss and therefore need extra. I.E. fever, burns, stoma.

Question 28

What to do when giving fluids?

Answer 28

always document fluid input/output and always reassess patient clinically and biochemically. Clinical exam may reveal still dehysrated or overloaded. Blood biochemistry may reveal patient is still hyponatraemic or hyperkalaemic.