9) Maternal Medicine - Gastro/Abdo pain

Question 1

Percentage of patients with IBD diagnosed<35 years

Answer 1

50%

Question 2

Where is the inflammation in UC?

Answer 2

Mucosal layer of colon

Question 3

Where is the inflammation in CD?

Answer 3

Transmural anywhere from mouth –> perianal area.

Question 4

Proportion of women with IBD conceiving after diagnosis made

Answer 4

25%

Question 5

Which IBD does smoking increase risk of relapse in?

Answer 5

Crohn’s

Question 6

Risk of relapse of IBD in pregnancy

Answer 6

30% relapse rate if stable.

2/3 if active disease at conception.

Question 7

When do most IBD relapses occur?

Answer 7

Early pregnancy

Question 8

Effect of pregnancy on overall relapses?

Answer 8

Lowers risk

Question 9

Effect of IBD on pregnancy

Answer 9

• Similar fertility (unless active disease or extensive surgery)
• Stable disease no increase in adverse outcomes
• Miscarriage, PTB, Low birthweight in patients with active disease

Question 10

What can be used to diagnose IBD flare?

Answer 10

• Clinical features
• CRP
• Faecal calprotectin
• Imaging

Question 11

Mycophenolate/methotrexate in IBD

Answer 11

Stop 3/12 before conception

Question 12

Aminosalicylates (sulfasalazine/mesalazine) in IBD

Answer 12

• Safe and should be continued (up to 3g/day)
• Higher doses associated with fetal nephrotoxicity
• Bloody diarrhoea in mesalazine
• Sulfasalazine needs high dose folic acid (DHFR inhibitor)

Question 13

Thiopurines (azathioprine/mercaptopurine) in IBD

Answer 13

Safe.

Azathioprine preferred.

Question 14

Calcineurin inhibitors (tacrolimus/ciclosporin) in IBD

Answer 14

If steroids refractory.

Link to PTB and low birthweight.

Question 15

Indications for surgery in IBD

Answer 15

Obstruction
Perforation
Haemorrhage
Abscess
Toxic megacolon

Question 16

Indications for CS in IBD

Answer 16

• Active perianal or rectal disease

- After ileo-anal pouch formation

Question 17

Perineum in IBD

Answer 17

Avoid episiotomy

Question 18

Analgesia in IBD

Answer 18

• NSAIDs can exacerbate for some

- Opiates lead to constipation and exacerbate perianal disease

Question 19

Incidence of acute abdomen in pregnancy

Answer 19

1 in 500

Question 20

Increase in childhood cancer risk from abdominal CT

Answer 20

0.1% and fatal adult cancers 0.3%

Question 21

Incidence of biliary colic/cholecystitis

Answer 21

1-6 in 1000

Question 22

Treatment for biliary colic/cholecystitis

Answer 22

If obstructive stone - ERCP.

Definitive surgery during index admission preferred.

Question 23

Incidence of bowel obstruction

Answer 23

1 in 1500

Question 24

Incidence of pancreatitis

Answer 24

3 in 10,000

Question 25

Blood tests in pancreatitis

Answer 25

Serum amyase 3 x uLN diagnostic.

Serum lipase more sensitive and specific.

Question 26

Normal renal tract dilatation

Answer 26

5mm left, 15mm right, 2cm ureters.

Question 27

Risk of visceral artery aneurysm rupture in pregnancy

Answer 27

4 x higher

Question 28

Which visceral artery aneurysm rupture most common?

Answer 28

Splenic artery rupture (95% cases during pregnancy)

Question 29

Most common surgical abdomen in pregnancy

Answer 29

Appendicitis

Gallstone disease next

Question 30

Incidence of appendicitis in pregnancy

Answer 30

1/800-1/1500

Question 31

Appendicitis in pregnancy more or less common?

Answer 31

Less common

Question 32

Most common time for appendicitis in pregnancy

Answer 32

2nd trimester.

Perforation most common in 3rd trimester.

Question 33

Which symptoms significantly different between pregnant appendicitis and non-pregnant?

Answer 33

More likely RUQ pain, dysuria.

Less likely rebound/guarding and low grade fever.

Question 34

Number of negative laparotomies for appendicitis

Answer 34

35%

Question 35

Incision for appendicitis

Answer 35

Transverse incision over point of maximal tenderness unless diagnosis uncertain then do lower midline

Question 36

Which routine of operation associated with higher risk of fetal loss?

Answer 36

Laparoscopic (RR 1.9)

Question 37

Incidence of failed intubation in pregnant

Answer 37

3.3%

Question 38

Intra-abdominal pressure during laparoscopy in pregnancy

Answer 38

<12 mmHg

Question 39

Fetal loss associated with appendicitis

Answer 39

1.5% Simple
6% Peritonitis
36% Perforated

Question 40

Risk of PTB with appendicitis?

Answer 40

1% second trimester, 9% 3rd trimester

Question 41

Percentage of patients operated on in first trimester who miscarry

Answer 41

10%