UC and crohns

Question 1

UC - severe abdo pain , dry mucous membranes and abdo tender. In shock , transvere colon is 6.5cm what complciation is person present with

Answer 1

toxic megacolon

Question 2

UC - severe abdo pain , dry mucous membranes and abdo tender. In shock , transvere colon is 6.5cm what is intial management

Answer 2

IV fuids and IV hydrocortisone - if dont repsond in 48-72 hours surgery

Question 3

how do you distinguish between UC and IBS

Answer 3

fecal calprotectin - raised in IBD not IBS

Question 4

UC exacerbation measured how

Answer 4

Truelove and Witt’s Criteria for Severity

Question 5

peritonism caused by

Answer 5

Symptoms of peritonitis include: Belly pain or tenderness. Bloating or a feeling of fullness in the abdomen. Fever.

Question 6

flare of crohns presents with

Answer 6

unwell with fever and rasied inflammaotry markers

Question 7

bile acid malabsorption - terminal ileus - surgery leads to decreased absorption of vitamins and minerals

Answer 7

diarrhoea and fatty stools

Question 8

UC associated with what conditions

Answer 8

Ulcerative colitis is associated with a number of different conditions, including erythema nodosum, pyoderma gangrenosum, uveitis, scleritis, episcleritis and primary sclerosing cholangitis (PSC).
complication of PSC is cholangiocarcinoma ( biliary tract malignancy) - abnormal liver enzymes and weight loss

Question 9

what symtpom is more suggestive of IBD than IBS

Answer 9

waking at night to pass stool - suggesting malabsorption or problems with secretion of fluids or electrolytes

Question 10

in which one is rectal sparing occuring

Answer 10

UC

Question 11

A 30 year old male is seen in the gastroenterology clinic with anal mucus discharge and peri-anal discomfort. He is known to have Crohn’s disease.

MRI reveals a high trans-sphincteric fistula.

Which of the following is the most appropriate management?

Answer 11

Drainage seton

This is the correct answer. A seton is a thread passed through the fistula tract, forming a ring between the internal and external openings. It is used in the management of high trans-sphincteric fistulae, to prevent division of the anal sphincter muscles and incontinence. Closure of the fistula occurs by the formation of granulation tissue

Question 12

SE of metronidazole

Answer 12

peripheral neuropathy

Question 13

Mucosal inflammation and ulceration without crypt damage

Answer 13

infective colitis

Mucosal inflammation, ulceration and crypt damage on endoscopic biopsy
UC

Question 14

how does toxic megacolon occur

Answer 14

Toxic megacolon is a life-threatening complication of ulcerative colitis or ischaemic colitis. It occurs due to the increased release of nitric oxide from the inflamed colonic wall and inflammatory mediators.

Question 15

Xray of toxic megacolon would show

Answer 15

An abdominal x-ray would show a dilated large bowel of ≥6cm. There may also be thumbprinting observed, due to mucosal oedema. Pneumoperitoneum may also be present if perforation occurs.
loss of haustration

This patient should be managed conservatively with bowel decompression (place patient NBM, insertion of nasogastric tube and IV fluids). Surgery may be indicated if patient develops complications or does not respond to medical management

Question 16

in liver disease what do you need to maek sure to give

Answer 16

Vitmain K - coagulopahties

Question 17

when do you give fluids

Answer 17

Fluid boluses are given based on the heart rate and BP. When a patient has haemodynamic instability, fluid boluses can be given until stability is achieved. In this scenario, it may be appropriate to give maintenance fluids as the patient will be nil by mouth before the endoscopy but the most important next step is correcting the clotting abnormality.

Question 18

4 stages of hepatic encephalopahty

Answer 18

Altered mood and behaviour, disturbance of sleep pattern and dyspraxia
Drowsiness, confusion, slurring of speech and personality change
Incoherency, restlessness, asterixis
Coma