8. Lower GI Flashcards
A 22 y/o female presents to her GP with a two year history of intermittent diarrhoea and constipation. She complains of bloating and abdominal pain, which eases with defecation. Which condition is she likely to have?
A. Coeliac disease B. Ulcerative colitis C. Crohn’s disease D. Irritable bowel syndrome E. Infectious diarrhoea
D. Irritable bowel syndrome
A 26 y/o male presents to his GP with weight loss, abdominal pain and watery diarrhoea. On examination he looks pale and you notice ulcers in his mouth. Which condition is he likely to have?
A. Coeliac disease B. Ulcerative colitis C. Crohn’s disease D. Irritable bowel syndrome E. Infectious diarrhoea
C. Crohn’s disease
A 23 y/o female presents to her GP with a limp. On further questioning she reveals she has recently lost weight and has had bloody, mucoid diarrhoea. On examination her right knee is tender and swollen, and her eyes are red. Which condition is she likely to have?
A. Coeliac disease B. Ulcerative colitis C. Crohn’s disease D. Irritable bowel syndrome E. Infectious diarrhoea
B. Ulcerative colitis
A 27 y/o male presents with a history of mucoid, bloody diarrhoea and weight loss. On examination you note a number of red marks on his shins. After a number of investigations his diagnosis is confirmed. Which treatment would you start him on?
A. IV corticosteroid B. Oral prednisolone C. Topical mesalazine D. Oral azathioprine E. IV cyclosporin
C. Topical mesalazine
A 31 y/o male presents with a history of diarrhoea, weight loss and RIF pain. On examination you note a number of red marks on his shins. After a number of investigations his diagnosis is confirmed. Which treatment would you start him on?
A. IV corticosteroid B. Oral prednisolone C. Oral mesalazine D. Oral azathioprine E. IV cyclosporin
B. Oral prednisolone
After starting treatment, his symptoms improve. Which additional treatment would you start him on to maintain his remission?
A. IV corticosteroid B. Oral prednisolone C. Oral mesalazine D. Oral azathioprine E. IV cyclosporin
D. Oral azathioprine
A 55 y/o female presents to her GP with an itchy rash on her forearms. On further questioning she reveals she has recently lost weight and has had mucoid diarrhoea. Which test will best confirm her diagnosis?
A. Endoscopy with duodenal biopsy B. Serum antibodies to tissue-transglutaminase C. Serum anti-endomysial antibodies D. Colonoscopy E. Endoscopy with ileal biopsy
A. Endoscopy with duodenal biopsy
UC Signs and Symptoms
Diarrhoea - With blood fresher and redder than upper GI bleeding; Mixed in (unlike anal fissure and haemorrhoids) + mucus
Abdominal pain
Relapsing-remitting
Extra-intestinal manifestations of IBD
A PIE SAC:
- Aphthous (mouth) ulcers [CD>UC]
- Pyoderma gangrenosum
- I (eye) – iritis, uveitis, episcleritis [CD>UC]
- Erythema nodosum - raised red marks
- Sclerosing cholangitis (primary) [UC]
- Arthritis
- Clubbing fingers [CD>UC]
CAI is more CD than UC
Invx for CD
- Stool sample (first line)
- Blood tests
- CT/MRI abdomen
- (Colonoscopy and biopsy)
Biopsy = confirmatory not diagnostic - crypt architectual changes
Invx for UC
- Stool sample (first-line)
- Blood tests - WBC, CRP, ESR, (inflam baseline) LFT (PSC)
- AXR: toxic megacolon, lead pipe
- Colonoscopy/flexible sigmoidoscopy and biopsy - necessary: mucin depletion, diffuse mucosal atrophy, continuous from the rectum with anal sparing.
Radiology signs in IBD
Where are they found?
Lead pipe sign: loss ofhaustral markings in the diseased section of colon; organ appears smooth-walled and cylindrical.Due to inflammation.
Thumbprinting (projections into aerated lumen) - large bowel wall (haustra) thickening at regular intervals, usually caused by oedema, related to an infective or inflammatory process (colitis).
In UC these signs will be focused near the rectum, in Crohn’s focused in terminal ileum.
Toxic megacolon
Definition
Symptoms
Mx
When IBD/C. diff is serious enough to cause inflammatory colitis.
Symptoms: extreme vomit, abdo pain and abdo distention (think obstructive symptoms). EMERGENCY!
§Treat with resuscitation (fluids, adrenaline etc, likely to be in shock), nasogastric decompression and corticosteroids in the case of IBD complication.
CD Management
Inducing remission: Corticosteroids
Maintaining remission: Azathioprine Methotrexate Cyclosporin Infliximab (TNFa)
Surgery: NOT curative
UC Management
Inducing remission: Aminosalycilates -Topical -Oral (low dose) -Oral (high dose)
Maintaining remission: Azathioprine Methotrexate Cyclosporin -
Surgery: Curative
Prognosis and Complications of IBD
Crohn’s: Increased mortality.
(Duration of the disease) higher comorbidity score increase this.
UC: Mortality not affected
But toxic megacolon is a concern