Lower GI Disease

Question 1

How does UC present?

Answer 1

Mucosa of rectum + colon inflamed

Question 2

What are the causes of UC?

Answer 2

Environmental + immunological
Most likely autoimmune condition triggered by colonic bacteria

Question 3

What are the risk factors of UC?

Answer 3

Family history, oral contraceptives + non-smoking

Question 4

How does CD present?

Answer 4

Inflammation of mucosa any where from mouth to anus

Question 5

What are causes of CD?

Answer 5

Immune-mediated caused by environmental trigger in genetically susceptible people

Question 6

What are the risk factors of CD?

Answer 6

Family history, smoking, drugs

Question 7

What are UC + CD?

Answer 7

IBD

Question 8

What is the first test that can be done for IBD?
FBC

Answer 8

FBC = first blood count
= anaemia due to blood loss, malabsorption, malnutrition
= increased platelet count
= suggest active inflammation

Question 9

What is the 2nd test that can be done for IBD?
Inflammatory markers

Answer 9

CRP + ESR raised in active inflammation

Question 10

What is the 3rd test that can be done for IBD?
U&Es

Answer 10

Assess electrolyte disturbance or dehydration

Question 11

What is the 4th test that can be done for IBD?
LFT

Answer 11

May indicate protein-losing enteropathy = lead to malnutrition

Question 12

What is the 5th test that can be done for IBD?
Vitamin B12 + Vitamin D

Answer 12

Nutritional deficiences

Question 13

How do you control symptoms of diarrhoea?

Answer 13

Diet
Antibiotic colitis
Do NOT give anti-diarrhoeal = stops motility

Question 14

How do you control symptoms of constipation?

Answer 14

Check for bowel obstruction
Obstruction unlikely = tackle diet, fibre + fluids
Bulk-forming laxative - eg. ispaghula

Question 15

How do you control symptoms of abdominal pain?

Answer 15

Now obstruction = hospital
Paracetamol for relief

Question 16

Why are opiates + NSAIDs NOT recommended for abdominal pain?

Answer 16

Opiates = constipating effect
NSAIDs = gastric problems

Question 17

What are the clinical features of acute flare of UC?

Answer 17

5 stools a day plus
Temp increases
Tachycardia >90bpm
Anaemia
Blood in stool

Question 18

What are the other clinical features of UC?

Answer 18

Bloody diarrhoea > 6 weeks
Rectal bleeding
Nocturnal defecation
Faecal urgency
Abdominal pain (left quadrant)
Pre-defecation pain

Question 19

What are the treatment options for UC?

Answer 19

5-aminosalicylates
Steroids
Immunosuppressants
Ciclosporin
Biologics
Surgery

Question 20

Describe 5-ASA use for UC

Answer 20

Short term = induce remission
Long term = maintenance
Oral or rectal

Question 21

When is oral 5-ASA for UC used?

Answer 21

Higher up GI tract

Question 22

When is rectal 5-ASA for UC used?

Answer 22

Low in GI tract
= local + systemic action

Question 23

What side effect of 5-ASA?

Answer 23

Discolours tears or urine
Sensitivity to light

Question 24

What is sometimes required for 5-ASA?

Answer 24

Require prescribing by brand
= narrow therapeutic window
= need to be kept on same brand
eg. mesalazine

Question 25

Describe steroids use for UC

Answer 25

Short term = induce remission Used with or instead of 5-ASA Oral or rectal With food In morning

Question 26

What is required for use of steroids if long term use?

Answer 26

Tapering

Question 27

Why are steroids NOT used long term?

Answer 27

Osteoporosis Diabetes Hypertension

Question 28

What are the side effects of steroids?

Answer 28

Ance Weight gain Increase appetite

Question 29

Describe immunosuppressant use for UC

Answer 29

Relieve symptoms if steroids can't Tablet once a day BUT sometimes given as injections

Question 30

Why are steroids taken in the morning?

Answer 30

Reduce disturbance to sleep

Question 31

Why are immunosuppressants given as injections?

Answer 31

1x every few months = improves adherence

Question 32

What are the side effects of immunosuppressants?

Answer 32

Feeling + being sick Increased risk of infection + liver problems

Question 33

What are examples of immunosuppressants?

Answer 33

Azathioprine + mercaptopurine

Question 34

What is ciclosporin?

Answer 34

More powerful immunosuppressant

Question 35

Describe use of biologics for UC

Answer 35

Reduce inflammation Moderate to severe UC Given for 12 months Infusions

Question 36

What are side effects of UC?

Answer 36

Increased risk of infection Vertigo

Question 37

Describe use of surgery for UC

Answer 37

Removes colon

Question 38

What is an ileostomy?

Answer 38

Small intestine diverted out of hole in abdomen

Question 39

What is ileo-anal pouch?

Answer 39

Part of small intestine used to create internal pouch then connected to anus

Question 40

What is problem with oral contraceptives with women who have IBD?

Answer 40

Less reliable = malabsorption = vomiting

Question 41

Why can't barrier methods (condoms) just be suitable alone for women?

Answer 41

Teratogenic drugs eg. mercaptopurine

Question 42

Does IBD affect fertility?

Answer 42

NO BUT some drugs can eg. teratogenic drugs stopped 3 months before trying to conceive

Question 43

What are the clinical features of CD?

Answer 43

Unexplained persistent diarrhoea (4-6 weeks) Abdominal pain Weight loss Mouth ulcers Clubbing Perianal pain

Question 44

What are the treatments for CD?

Answer 44

NO cure Steroids = episodic Liquid diet Immunosuppressants Biological medicines Sugery

Question 45

Describe use of steroids for CD

Answer 45

May need couple of months Long term effects

Question 46

Describe liquid diet for CD

Answer 46

Drinks contain nutrients Avoids risk of slower growth

Question 47

What are side effects of liquid diet?

Answer 47

Nausea Diarrhoea Constipation

Question 48

Describe use of surgery for CD

Answer 48

Relieve symptoms + help stop them coming back BUT is it really viable if can happen throughout GI?

Question 49

What does the main operations for CD involve?

Answer 49

Small cuts in abdomen = keyhole surgery Removing small, inflamed sections of bowel Stitching healthy parts together

Question 50

What is the routine review for IBD?

Answer 50

Under care of consultant gastroenterologist Check mental health Compliance with meds Contraceptive advice Make aware need for colonscopic surveillance of colorectal cancer