Small intestine/Colon Disorders

Question 1

What is constipation?

Answer 1

Constipation is a common gastrointestinal issue characterised by infrequent or difficult bowel movements.
If severe, it can lead to faecal impaction, where hardened stool accumulates in the rectum or colon, making natural evacuation unlikely.

Question 2

How is constipation assessed?

Answer 2

History:Ask about bowel habits, stool consistency (Bristol Stool Chart), duration of symptoms, diet, fluid intake, exercise, medication use, and associated symptoms (e.g., abdominal pain, bloating).

Physical Examination:Check for abdominal distension, tenderness, and perform a digital rectal examination to assess for hard stools or masses.

Red Flags:Unintentional weight loss, rectal bleeding, persistent change in bowel habits, anaemia, or a family history of colorectal cancer require further investigation.

Question 3

What are the primary causes of constipation?

Answer 3

Low-fiber diet
Inadequate fluid intake
Sedentary lifestyle / lack of exercise
Ignoring the urge to defecate
Slow transit constipation (reduced colonic motility)
Pelvic floor dysfunction / dyssynergia
Irritable Bowel Syndrome (IBS) - constipation predominant (IBS-C)

Question 4

What are the secondary causes of constipation?

Answer 4

1. Medications:

Opioids (morphine, codeine)

Anticholinergics (e.g., antihistamines, tricyclic antidepressants)

Calcium channel blockers (verapamil)

Iron supplements

Antacids (especially those containing aluminum or calcium)

Diuretics

Antipsychotics
Antidepressants (TCAs, SSRIs)

2. Metabolic and Endocrine Disorders e.g

Hypothyroidism
Diabetes mellitus

3. Neurological Disorders e.g

Parkinson’s disease
Multiple sclerosis (MS)

4. Gastrointestinal/Structural Causes:

Colorectal cancer / strictures

Anal fissures or hemorrhoids (pain leading to avoidance)

Rectal prolapse

Megacolon / Hirschsprung’s disease

5. Psychological Factors:

Depression
Anxiety
Eating disorders (e.g., anorexia nervosa)

“DIMES” for Secondary Causes:
Drugs (opioids, anticholinergics)
Immobility / neurological
Metabolic (hypothyroidism, diabetes, hypercalcemia)
Endocrine / psychological
Structural / mechanical obstruction

Question 5

What is the general management of constipation?

Answer 5

General Measures

Dietary Advice:Encourage a balanced diet rich in fibre (fruit, vegetables, whole grains).
Hydration:Ensure sufficient fluid intake.
Physical Activity:Promote regular exercise to aid gut motility.

Question 6

What is the pharmacological treatment of constipation?

Answer 6

First-Line: Bulk-Forming Laxatives
- Examples: Ispaghula husk, methylcellulose.
- Mechanism: Increase stool bulk, stimulating peristalsis.
Note to patient : Ensure adequate fluid intake to prevent intestinal obstruction.

Second-Line: Osmotic Laxatives
-Examples: Macrogols (polyethylene glycol), lactulose.
-Mechanism: Draw water into the bowel, softening stools.
Note to patient: Macrogols are preferred for their effectiveness.

Third-Line: Stimulant Laxatives
Examples: Senna, bisacodyl.
Mechanism: Stimulate colonic nerves to enhance motility.
Note to patient: Use for short periods to avoid dependency.

Question 7

What is the management of feacal impactions?

Answer 7

Assessment:
Confirm impaction through history and examination

Treatment approach:
Oral Macrogols:First-line treatment, starting with a low dose and increasing until disimpaction occurs.
Add Stimulant Laxatives:If no response to macrogols, add a stimulant laxative after a few days.

Rectal Interventions:If oral treatments fail, consider suppositories (e.g., glycerol, bisacodyl) or enemas (e.g., phosphate enema).

Monitoring: Regularly assess treatment effectiveness and adjust as needed.

Question 8

How is this prevented for recurrence?

Answer 8

Education:Patients should understand the importance of diet, hydration, and regular bowel habits

Medication Review:Adjust or discontinue constipating medications where possible.

Regular Follow-Up:Monitor symptoms and adjust treatment plans accordingly

Question 9

What is irritable bowel syndrome (IBS)?

Answer 9

IBS is a chronic functional gastrointestinal disorder characterized by recurrent abdominal pain associated with altered bowel habits (diarrhea, constipation, or both), without any structural or biochemical abnormalities.Pain normally goes after defecation.

It is a diagnosis of exclusion after ruling out other organic causes.

Question 10

What are the signs and symptoms of IBS?

Answer 10

Recurrent abdominal pain (crampy) (improves or worsens with defecation)

Altered bowel habits:
IBS-C: Constipation-predominant
IBS-D: Diarrhea-predominant
IBS-M: Mixed (alternating constipation & diarrhea)
IBS-U: Unclassified

Bloating and gas and distension

Mucus in stool (may be present and will look whiteish)

Sensation of incomplete evacuation

Symptoms are chronic, often worsen with stress and food intake, and vary in intensity.

Question 11

What are the red flags of IBS which suggests organic disease?

Answer 11

Urgent referral if:
Unintentional weight loss

Persistent diarrhoea (>6 weeks) in patients >50

Rectal bleeding/melena

Severe nocturnal symptoms e.g diarrhoea that wakes you up from sleep

Family history of colorectal cancer or IBD

Anemia

Question 12

What are the investigations and diagnosis of IBS?

Answer 12

Clinical diagnosis using Rome IV criteria

Exclude organic disease:
Full blood count (FBC)
C-reactive protein (CRP)
Coeliac serology
Faecal calprotectin (if IBD suspected)
Colonoscopyonly if red flags present

Question 13

What is the Rome IV criteria?

Answer 13

Abdominal pain, on average, at least 1 day per week in the last 3 months, associated with 2 or more of the following:

1. Related to defecation
2. Change in stool frequency
3. Change in stool form (appearance)

(Symptoms should have started at least 6 months before diagnosis)

If Yes to any of above, IBS diagnostic criteria is met and the predominant stool form is asked using Bristol stool chart to determine the type of IBS. e.g IBS-D is Bristol type 5 or 6 (Diarrhea)

Question 14

What is the lifestyle and dietary management of IBS?

Answer 14

1. Fibre modification:
   Increase if constipated, reduce insoluble fibre if diarrhoea-predominant
2. Low FODMAP diet
3. Regular meals, avoid caffeine/alcohol
4. Yoga, Hypnosis and CBT for symptom management

Question 15

What is the pharmacological treatment of IBS?

Answer 15

Diarrhoea-predominant IBS:Loperamide

Constipation-predominant IBS:Laxatives (not lactulose)

Abdominal pain/bloating:
- Antispasmodics (mebeverine, hyoscine)
- Tricyclic antidepressants (amitriptyline)

Question 16

When must you refer with an IBS patient?

Answer 16

To gastroenterology if:
Red flag symptoms
Uncontrolled symptoms despite primary care treatment

Question 17

What is infectious diarrhoea?

Answer 17

Diarrhoea caused by bacterial, viral, or parasitic pathogens, usually self-limiting but can lead to dehydration and complications.

History:Travel, food history, sick contacts, antibiotic use.

Red Flags:Bloody diarrhoea, dehydration, immunosuppression, prolonged symptoms (>1 week).

Investigations:Stool culture,C. difficiletoxin, faecal calprotectin (if IBD suspected).

Question 18

What are the causes and risk factors of infectious diarrhoea?

Answer 18

Bacterial:Campylobacter, Salmonella, Shigella, E. coli

Viral:Norovirus, Rotavirus

Parasitic:Giardia, Cryptosporidium

Risk factors:Travel, food poisoning, immunosuppression, recent antibiotics

Question 19

What are the signs and symptoms of Infectious diarrhoea?

Answer 19

Acutewatery or bloody diarrhoea
Fever, nausea, vomiting
Abdominal cramps
Dehydration (dry mucous membranes, hypotension)

Question 20

What are the red flags of infectious diarrhoea?

Answer 20

Urgent referral if:
Severe dehydration(tachycardia, hypotension, confusion)

Bloody diarrhoea + fever (dysentery)

Recent travel + persistent diarrhoea (>14 days)

Immunosuppression (HIV, chemotherapy, steroids)

Question 21

What is the difference between non inflammatory and inflammatory diarrhoea syndromes?

Answer 21

Non-inflammatory diarrhea is typically caused by pathogens that do not invade the intestinal wall but instead disrupt normal fluid absorption, leading to large-volume, watery stools. It is usually secretory or osmotic in nature, often caused by viruses like Norovirus or Rotavirus, bacteria like Enterotoxigenic E. coli (ETEC) or Vibrio cholerae, and parasites like Giardia lamblia. Patients usually do not have a fever or blood in the stool, and abdominal pain is mild. The primary concern is dehydration due to significant fluid loss. Stool cultures are often unnecessary unless symptoms are prolonged. Absence of fecal leukocytes. Traveller’s Diarrhoea

In contrast, inflammatory diarrhea is caused by invasive pathogens that damage the intestinal mucosa, triggering inflammation. This results in bloody, mucous-filled stools, lower abdominal pain, and fever. Common causes include Shigella, Salmonella, Campylobacter, Enterohemorrhagic E. coli (EHEC), Clostridioides difficile, and Entamoeba histolytica. Patients may experience tenesmus (a constant urge to pass stool) and systemic symptoms. Stool tests and cultures are often required to identify the specific pathogen and guide treatment. Presence of fecal leukocytes.
Hospital-Acquired Diarrhoea

Question 22

What are the investigations of Infectious diarrhoea?

Answer 22

Stool culture(if febrile, bloody diarrhoea, prolonged symptoms (>1/52))

C. difficile toxin(if recent antibiotics)

Electrolytes & renal function (U&Es) if severe dehydration

Question 23

What is the management of infectious diarrhoea?

Answer 23

1. Examine, observe patient ?admission ?safe for home management
   Refer if severe dehydration or shock, suspected sepsis or failure of outpatient management.
2. Rehydration:
   Oral rehydration (ORS); IV fluids if severe
3. Empirical antibiotics only if:
   -severe bacterial infection ( e.g. C difficile, cholera)
   -Immunocompromised patients

Question 24

How to prevent infectious diarrhoea?

Answer 24

Prevention of infectious diarrhea includes:
✅ Hand hygiene – Wash hands regularly with soap.
✅ Safe food and water – Eat well-cooked food, drink clean or bottled water, and avoid raw foods.
✅ Vaccination – Get vaccines like rotavirus (for children) and cholera if needed.
✅ Travel precautions – Follow the rule: “Boil it, cook it, peel it, or leave it.”
✅ Good sanitation – Proper waste disposal and avoiding contact with infected individuals.Prevention of infectious diarrhea includes:
✅ Hand hygiene – Wash hands regularly with soap.
✅ Safe food and water – Eat well-cooked food, drink clean or bottled water, and avoid raw foods.
✅ Vaccination – Get vaccines like rotavirus (for children) and cholera if needed.
✅ Travel precautions – Follow the rule: “Boil it, cook it, peel it, or leave it.”
✅ Good sanitation – Proper waste disposal and avoiding contact with infected individuals.

Question 25

What is Appendicitis?

Answer 25

Appendicitis is the inflammation of the appendix, a small, finger-like pouch attached to the large intestine. It is a common surgical emergency.

Question 26

What is the classical presentation of appendicitis?

Answer 26

Abdominal pain: Starts around the umbilicus (belly button) and then shifts to the right lower abdomen (specifically at McBurney's point, about 1/3rd of the way from the anterior superior iliac spine to the navel). Nausea and vomiting: Often follows the onset of abdominal pain. Loss of appetite (anorexia). Fever: Typically low-grade, but can increase if the condition worsens. Tenderness in the right lower abdomen, especially with rebound tenderness (pain upon releasing pressure).

Question 27

What are the key signs of appendicitis?

Answer 27

McBurney’s point tenderness (classic location of pain) Rovsing's sign: Pain in the right lower abdomen when pressure is applied to the left lower abdomen. Psoas sign: Pain with right hip flexion, indicating irritation of the psoas muscle. Obturator sign: Pain with internal rotation of the right hip, suggesting pelvic appendix irritation

Question 28

What causes appendicitis?

Answer 28

Blockage of the appendix by fecal matter (fecalith), lymphoid hyperplasia, parasites, or tumors, leading to infection and inflammation.

Question 29

What are the risk factors of appendicitis?

Answer 29

Young male

Question 30

What are the symptoms of appendicitis?

Answer 30

Periumbilical pain → migrates to right iliac fossa Nausea, vomiting, anorexia Fever, tachycardia McBurney’s point tenderness Rovsing’s sign: Pain in RLQ when palpating LLQ Psoas sign: Pain on hip extension (retrocaecal appendix)

Question 31

What are the red flags of appendicitis?

Answer 31

Urgent referral if: Severe localised pain + guarding (perforation risk) High fever, sepsis signs Rebound tenderness (peritonitis)

Question 32

What are the investigations of appendicitis?

Answer 32

Clinical examination + history Bloods: Raised WBC, CRP Ultrasound: Preferred in children/pregnancy CT Abdomen: Gold standard in adults

Question 33

What is the management of appendicitis?

Answer 33

Definitive: Appendicectomy (laparoscopic) Pre-op: IV antibiotics (Check local trust guidelines - e.g might be cefuroxime + metronidazole) Supportive: IV fluids, analgesia

Question 34

When should a case of appendicitis be referred?

Answer 34

If you see patient in GP with suspected appendicitis / ED : Surgical referral ASAP if appendicitis suspected

Question 35

What are the complications of appendicitis if left untreated?

Answer 35

Perforation (rupture) Peritonitis Abscess formation

Question 36

What is Bowel obstruction?

Answer 36

A mechanical or functional blockage of the intestines preventing passage of contents. Classic Presentation:  Abdominal pain, distension, vomiting, constipation. Diagnosis: X-ray (dilated loops, air-fluid levels), CT for cause. Management: NG tube decompression, fluids, surgery if strangulation.

Question 37

What are the causes and risk factors of bowel obstruction?

Answer 37

Mechanical: Small bowel: Adhesions, hernia, malignancy Large bowel: Tumours, volvulus, strictures Functional:  Paralytic ileus (temporary paralysis of the bowel, often after surgery, trauma, or infections)

Question 38

What are the signs and symptoms of bowel obstruction?

Answer 38

Colicky abdominal pain Distension Vomiting (bilious if small bowel, faeculent if large bowel) Absolute constipation (no flatus, no stool) Absence bowel sounds Fecal odour in vomit Fever and tachycardia (if complications like perforation occur)

Question 39

When is an urgent referral required in Bowel obstruction?

Answer 39

Severe pain + tachycardia (suggests strangulation/perforation) Peritonitis signs (rigid abdomen, absent bowel sounds) Severe dehydration (hypotension, tachycardia)

Question 40

What are the investigations of bowel obstruction?

Answer 40

Abdominal X-ray: Dilated bowel loops, air-fluid levels CT scan: Confirms cause/location

Question 41

What is the management of bowel obstruction?

Answer 41

Conservative (if partial obstruction): NBM (nil by mouth) NG tube decompression IV fluids Surgical intervention: If complete obstruction, strangulation, or perforation Emergency surgical referral for suspected complete obstruction

Question 42

What is inflammatory bowel disease?

Answer 42

IBD refers to a group of chronic inflammatory conditions affecting the gastrointestinal (GI) tract, with two main types: 1. Crohn's disease 2. Ulcerative Colitis

Question 43

What is Ulcerative colitis?

Answer 43

Ulcerative colitis (UC) is a chronic, relapsing-remitting inflammatory bowel disease (IBD) that causes diffuse inflammation of the colonic mucosa. Affects only the mucosal layer of the bowel wall. It typically starts in the rectum and extends proximally in a continuous manner, affecting part or all of the colon.

Question 44

What are the causes and pathophysiology of UC?

Answer 44

UC results from a dysregulated immune response to intestinal microbiota in genetically susceptible individuals. Key Factors: Genetic predisposition (first-degree relatives have higher risk) Environmental triggers (e.g., diet, stress, infections) Dysbiosis (altered gut microbiota) Loss of immune tolerance, leading to excessive inflammation in the colonic mucosa Key inflammatory mediators include TNF-α, IL-13, and IL-17, causing crypt abscesses, mucosal ulceration, and increased permeability of the intestinal barrier. Characterized by ulcers and sores in the colon.

Question 45

What are the risk factors of UC?

Answer 45

Age: Common onset between 15–30 years Family history of IBD Non-smoker (unlike Crohn’s, where smoking worsens disease, smoking appears to be protective in UC) Recent infections (e.g., gastroenteritis) Western diet (low in fibre, high in processed foods)

Question 46

What are the signs and symptoms of UC?

Answer 46

Typical Presentation: 1. Bloody diarrhoea (hallmark symptom) 2. Mucus in stool 3. Abdominal pain (typically lower left quadrant) 4. Tenesmus (urgency to defecate with incomplete evacuation) 5. Nocturnal diarrhoea Fatigue, weight loss, anaemia (in severe cases) Severe Disease Features: >6 bloody stools/day Tachycardia, fever, dehydration Significant weight loss

Question 47

When does UC need to be referred?

Answer 47

Urgent referral to secondary care if: Severe diarrhoea (>6 bloody stools/day) Systemic signs of sepsis (fever, tachycardia, hypotension) Abdominal distension, tenderness, or guarding (risk of toxic megacolon) Failure to respond to treatment

Question 48

What are the investigations of UC?

Answer 48

Blood Tests: (FBC): Anaemia (low Hb), leukocytosis in flares C-reactive protein (CRP) & ESR: Raised in active inflammation U&E: Assess for dehydration and electrolyte disturbances Stool Tests: 1. Faecal calprotectin (elevated in UC, differentiates IBD from IBS) 2. Stool culture & Clostridium difficile toxin (rule out infective causes) Imaging & Endoscopy: 1. Flexible Sigmoidoscopy / Colonoscopy (gold standard) Findings: Diffuse, continuous mucosal erythema, loss of vascular pattern, ulceration, contact bleeding, and pseudopolyps 2. Abdominal X-ray (AXR): Indicated in severe disease to check for toxic megacolon (>6 cm colonic dilation) 3. CT/MRI Abdomen (if complications suspected)

Question 49

How is the severity of Ulcerative colitis classified?

Answer 49

The Truelove and Witts criteria assess the severity of ulcerative colitis based on symptoms and lab results: Mild: < 4 stools/day, no fever or tachycardia, normal ESR, and hemoglobin. Moderate: 4-6 stools/day, blood in stool, low-grade fever, mild tachycardia, elevated ESR. Severe: > 6 stools/day, severe blood in stool, fever > 37.8°C, tachycardia, anemia, and significantly elevated ESR. These criteria help guide treatment decisions and determine if hospitalization is needed.

Question 50

What are the complications of UC if left untreated?

Answer 50

Toxic megacolon: a life-threatening condition with massive colonic dilation. >6cm with sepsis and requires emergency surgery Colon perforation Strictures can case bowel obstruction Increased risk of colon cancer (long-term disease) Dehydration due to fluid loss from diarrhea Malnutrition due to reduced absorption Anemia due to chronic blood loss

Question 51

What is the first line management of UC?

Answer 51

1. Mild-Moderate Disease: Oral mesalazine (5-ASA) ± topical mesalazine suppository If no response: Add oral prednisolone (40mg daily, taper over 4–8 weeks) 2. Severe Disease: - IV hydrocortisone or methylprednisolone - IV fluids & thromboprophylaxis - If no improvement in 72 hours → Infliximab or ciclosporin -If refractory → Urgent colectomy

Question 52

What is the second line management of UC?

Answer 52

1. First-line: Oral mesalazine (5-ASA) 2. If frequent relapses or steroid dependence: - Azathioprine or mercaptopurine (immunosuppressants) 3. If severe or refractory disease: - Biologic therapy (Infliximab, Adalimumab, Vedolizumab)

Question 53

What is the surgical management of UC?

Answer 53

Indications: Toxic megacolon, perforation, fulminant colitis, refractory disease Procedure: Total proctocolectomy with ileal pouch-anal anastomosis (IPAA)

Question 54

What is Crohn's disease?

Answer 54

Crohn’s disease (CD) is a chronic, relapsing-remitting inflammatory bowel disease (IBD) characterised by transmural inflammation that can affect any part of the gastrointestinal tract from mouth to anus. It often presents with skip lesions (areas of inflammation interspersed with normal tissue) and granuloma formation on histology.

Question 55

What causes Crohn's disease and what are the key pathological features?

Answer 55

Crohn’s disease is caused by a dysregulated immune response to gut microbiota in genetically predisposed individuals, leading to chronic inflammation. Key Pathological Features: Transmural inflammation (affects the full thickness of the bowel wall) Skip lesions (patchy involvement with normal areas in between) Non-caseating granulomas (hallmark histological feature) Strictures and fistulae formation due to fibrosis Cobblestone appearance on endoscopy

Question 56

What are the risk factors of Crohn's disease?

Answer 56

Age: Peak incidence between 15–30 years Family history of IBD Smoking (increases risk and severity, unlike UC) Western diet (high processed foods, low fibre) Hygiene hypothesis (reduced early childhood infections may increase risk)

Question 57

What are the signs and symptoms of Crohn's?

Answer 57

Typical Presentation: - Chronic diarrhoea (often non-bloody) - Right lower quadrant abdominal pain (common due to ileal involvement) - Weight loss and malnutrition - Fatigue and malaise - Fever in active disease Complications-Specific Symptoms: - Strictures: Postprandial cramping, nausea, vomiting, bloating - Fistulae (e.g., enteroenteric, enterovesical): Recurrent UTIs, faecaluria, passage of gas in urine - Perianal disease: Anal pain, drainage, perianal abscesses

Question 58

When should Crohn's be referred?

Answer 58

Urgent referral to secondary care if: - Severe symptoms (weight loss, malnutrition, dehydration) - Bowel obstruction symptoms (vomiting, abdominal distension, no bowel movements) - Perianal complications (abscesses, fistulae, strictures) - Failure to respond to treatment

Question 59

What are the investigations of Crohn's?

Answer 59

Blood Tests: (FBC): Anaemia (iron or B12 deficiency due to malabsorption) CRP & ESR: Raised in active inflammation LFTs: Albumin may be low due to malnutrition U&E: Check for dehydration and electrolyte imbalance Stool Tests: Faecal calprotectin (elevated, differentiates IBD from IBS) Stool culture & Clostridium difficile toxin (rule out infections) Imaging & Endoscopy: Colonoscopy with biopsy (gold standard) Findings: Cobblestone mucosa, deep ulcers, skip lesions MR Enterography / Small Bowel Imaging Indicated in small bowel Crohn’s Findings: Bowel wall thickening, strictures, fistulae Abdominal X-ray (AXR) Indicated if obstruction is suspected

Question 60

How is Crohn's disease classified according to NICE?

Answer 60

NICE guidelines generally categorize Crohn's disease severity into mild, moderate, and severe based on: Mild: Occasional abdominal pain, mild diarrhea (< 4 stools/day), no significant weight loss or systemic symptoms. Managed with oral 5-ASA or steroids if needed. Moderate: Frequent abdominal pain, blood in stool, fatigue, weight loss. Managed with oral corticosteroids, immunosuppressants, or biologics. Severe: Severe symptoms (e.g., > 6 stools/day, weight loss > 10%, fever), with complications like fistulas or abscesses. Managed with hospitalization, high-dose corticosteroids, biologics, and possible surgery.

Question 61

What is the first line of management of Crohn's?

Answer 61

1st Line: Inducing Remission Mild-to-Moderate Disease: - Oral budesonide (for ileocaecal Crohn’s) or prednisolone (40mg daily, taper over 8 weeks) - If no response → Immunomodulators (azathioprine, mercaptopurine, methotrexate) Severe Disease: - IV hydrocortisone or methylprednisolone - Biologic therapy (infliximab, adalimumab) if steroid-refractory - If no improvement → Surgical intervention

Question 62

What is the second line of management of Crohn's?

Answer 62

2nd Line: Maintenance Therapy (Preventing Relapse) 1. First-line: Azathioprine or mercaptopurine - Alternative: Methotrexate (if thiopurine-intolerant) - Biologic therapy: Infliximab, adalimumab, vedolizumab if frequent relapses 2. Surgical Management (For Severe or Refractory Crohn’s) - Indications: Strictures, fistulae, obstruction, failure of medical therapy - Common procedure: Resection of affected bowel with anastomosis (e.g., ileocaecal resection) - Unlike UC, surgery is not curative and recurrence is common

Question 63

What are the complications of Crohn's disease?

Answer 63

Strictures: Narrowing of the bowel leading to obstruction Fistulae: Abnormal connections (e.g., enterocutaneous, enteroenteric) Malabsorption: Deficiencies in iron, B12, folate, vitamin D Perianal Disease: Abscesses, fissures, fistulae Small Bowel Cancer: Increased risk with long-standing disease

Question 64

What are the differences between UC and Crohn's?

Answer 64

1. Affected Areas: Ulcerative Colitis (UC): Affects only the colon and rectum, starting from the rectum and extending proximally in a continuous pattern. Crohn's Disease: Can affect any part of the gastrointestinal tract from the mouth to the anus, often affecting the terminal ileum and right colon. The inflammation is typically discontinuous, with areas of healthy tissue between inflamed sections (skip lesions). 2. Depth of Inflammation: UC: Involves only the mucosal layer (the inner lining of the bowel). Crohn's Disease: Can involve all layers of the bowel wall (transmural inflammation), leading to complications like fistulas, abscesses, and strictures. 3. Pattern of Inflammation: UC: Continuous inflammation starting from the rectum and moving upward. Crohn's Disease: Patchy or discontinuous inflammation (skip lesions) throughout the GI tract. 4. Symptoms: UC: Typically presents with bloody diarrhea, abdominal cramps, and rectal bleeding. Crohn's Disease: Often causes non-bloody diarrhea, abdominal pain, weight loss, and fatigue, with potential for complications like fistulas or abscesses. 5. Complications: UC: Can lead to toxic megacolon and an increased risk of colon cancer with long-term disease. Crohn's Disease: Can cause strictures, fistulas, abscesses, and malnutrition due to involvement of the small intestine. 6. Surgery: UC: Colectomy (removal of the colon) is often curative. Crohn's Disease: Surgery is not curative because the disease can recur in other parts of the GI tract after surgery.

Question 65

What are the differences between IBS and IBD?

Answer 65

IBS (Irritable Bowel Syndrome) and IBD (Inflammatory Bowel Disease) are both gastrointestinal disorders, but they differ in key ways: Cause: IBS is a functional disorder without inflammation, often linked to gut motility and stress. IBD is an autoimmune condition causing chronic inflammation in the digestive tract. Symptoms: IBS causes abdominal pain, bloating, and altered bowel habits (diarrhea/constipation), with no visible damage with mucus in stool. IBD, including Crohn's Disease and Ulcerative Colitis, involves inflammation, and can lead to tissue damage, bleeding, and more severe symptoms. Treatment: IBS is managed with dietary changes, stress management, and medications to relieve symptoms. IBD requires anti-inflammatory drugs, immunosuppressants, and sometimes surgery due to the inflammation and tissue damage.

Question 66

What is Diverticulitis?

Answer 66

Diverticulitis is inflammation and/or infection of colonic diverticula (small pouches that form in the bowel wall, usually in the sigmoid colon). It can range from mild inflammation to severe complications such as perforation or abscess formation.

Question 67

What is diverticulosis?

Answer 67

Diverticulosis is a condition where small, bulging pouches (called diverticula) form in the walls of the colon, usually in the sigmoid colon. These pouches develop due to increased pressure within the colon and are typically asymptomatic.

Question 68

What is the difference between diverticulitis and diverticulosis?

Answer 68

Diverticulosis is the presence of non-inflamed diverticula in the colon, often asymptomatic but may cause mild discomfort. It typically results from increased pressure in the colon, often due to a low-fiber diet. Diverticulitis occurs when one or more of the diverticula become inflamed or infected, causing symptoms like severe abdominal pain, fever, nausea, and changes in bowel habits. It can lead to complications like abscesses or perforation. In short, diverticulosis is the condition of having diverticula, while diverticulitis is the inflammation or infection of those pouches.

Question 69

What are the risk factors of diverticular disease?

Answer 69

Age Low fiber diet (can lead to hard stools and constipation which can increase the pressure in the colon) Obesity Lack of Exercise Genetic predisposition Smoking alcohol NSAIDS, steroids

Question 70

What are the signs and symptoms of diverticular disease?

Answer 70

Fever bloating Mucus or blood in faeces Lack of appetite Lower abdominal pain and cramping- left lower quadrant common in western populations changes in bowel habits ( diarrhoea/constpation) Nausea and vomiting Right sided pain (asian populations)

Question 71

What are the red flags of severe or complicated diverticulitis?

Answer 71

Perforation → Generalised peritonitis, rigidity, guarding Abscess → Localised mass, persistent fever Fistula → Pneumaturia (colovesical), faecaluria Obstruction → Distension, vomiting, absent bowel movements

Question 72

What is the management of diverticulitis?

Answer 72

Uncomplicated Diverticulitis (mild, no systemic symptoms): Oral antibiotics (e.g., co-amoxiclav or ciprofloxacin + metronidazole) Clear fluids or low-residue diet Analgesia (paracetamol, avoid NSAIDs) Outpatient follow-up Complicated Diverticulitis (perforation, abscess, obstruction, or fistula): Hospital admission IV antibiotics IV fluids & analgesia Surgical intervention (for severe cases) – Hartmann’s procedure (resection + stoma)

Question 73

What are the investigations of diverticulitis?

Answer 73

Blood tests – ↑ WCC, CRP, U&Es (dehydration)  CT Abdomen/Pelvis (gold standard) – Look for diverticula, inflammation, abscess, perforation  Abdominal X-ray – Look for free air (if perforation suspected)  Colonoscopy (after acute phase) – To rule out malignancy