Altered Bowel Habit and Abdominal Pain

Question 1

What is altered bowel habit?

Answer 1

change in frequency/consistency of your bowel movements

Question 2

What are some chronic conditions causing altered bowel habit?

Answer 2

coeliac disease
chron's disease
diverticulosis
IBS
thyroid disorders
IBD

Question 3

What is the scoring system for UC?

Answer 3

truelove and witts criteria

Question 4

What is the gene mutation for increased risk of Chron’s disease?

Answer 4

NOD2/CARD15 gene

Question 5

Symptoms of IBD?

Answer 5

diarrhoea
blood/mucous in stools
anaemia
malaise
weight loss
mass +/- RIF
colicky abdominal pain
cramps
local peritonitis

Question 6

Treatments for IBD?

Answer 6

aminosalicylates - 5 ASA (sulfasalazine/mesalazine)
corticosteroids
immunomodulators (azathioprine/methotrexate/anti-TNF infliximab)

Question 7

What is seen in a biopsy of UC?

Answer 7

inflammatory infiltrate
goblet cell depletion
glandular distortion
mucosal ulcers
crypt abscesses

Question 8

What are the symptoms UC?

Answer 8

episodic or chronic diarrhoea
increased bowel frequency
urgency
tenesmus
fever/malaise/anorexia/weight loss

Question 9

What are signs of UC?

Answer 9

clubbing
oral ulcers
episcleritis/iritis/conjuctivitis
large joint arthritis
sclerosing cholangitis
ankylosing spondlitis
osteomalacia

Question 10

What is the treatment for mild UC?

Answer 10

steroids

5-ASA

Question 11

What is the treatment for moderate UC and how is it classified?

Answer 11

4-6 motions/day but otherwise well

prednisolone 40mg for 7 days then reducing with steroid enemas

Question 12

What is the treatment for severe UC and how is it classified?

Answer 12

>6 motions/day and unwell
admit to hospital
NBM and IV fluids
IV hydrocortisone
after improvement - prednisolone with 5-ASA

Question 13

On day 3 of severe UC flare up if CRP >45 or >6 stools what should be done?

Answer 13

colectomy

rescue therapy with ciclosporin or infliximab

Question 14

What are the indications for surgery in UC?

Answer 14

perforation
massive haemorrhage
toxic dilatation
failed medical therapy

Question 15

What is the type of surgery in UC?

Answer 15

proctocolectomy and terminal ileostomy

Question 16

What are the side effects of 5-ASAs?

Answer 16

rash
haemolysis
increased temperature
hepatitis
pancreatitis

Question 17

How is Chron’s disease characterised?

Answer 17

transmural granulomatous inflammation

Question 18

What does the histology of Chron’s look like?

Answer 18

granulomas containing multinucleate giant cells
transmural inflammation
neutrophil infiltrates
skip lesions
wall thickening

Question 19

What are the symptoms of Chron’s?

Answer 19

abdominal pain
diarrhoea
urgency
weight loss
fever
malaise

Question 20

Additional features in Chron’s?

Answer 20

skin tags
fissure
fistula
anal disease
adhesions
strictures
perforation

Question 21

What are extra-intestinal signs of Chron’s?

Answer 21

same as UC

renal stones

Question 22

What are complications of Chron’s?

Answer 22

small bowel obstruction
toxic dilatation
abscess formation
fistulae
rectal haemorrhage
B12 deficiency
iron deficient anaemia
venous thromboembolism

Question 23

What is the treatment for mild flare ups of Chron’s

Answer 23

oral prednisolone

Question 24

What is the treatment for severe flareups of Chron’s?

Answer 24

IV hydrocortisone
admission to hospital
NBM
IV fluids

Question 25

What 2 types of cancers are found in the oesophagus and where are they found?

Answer 25

squamous in mid-thoracic portion | adeno in lower oesophagus

Question 26

What is the treatment for oesophageal cancer?

Answer 26

oesophageal stenting radical radiotherapy chemotherapy surgery

Question 27

Where is gastric cancer common?

Answer 27

adenocarcinoma in the pyloric region

Question 28

What are the risk factors for gastric cancers?

Answer 28

``` japanese hypo/achlorhydria male high salt and nitrates gastric polyps ```

Question 29

How does gastric cancer present?

Answer 29

``` dyspepsia epigastric pain anorexia weight loss early satiety iron deficiency anaemia haematemesis and melena ```

Question 30

What is the commonest colorectal cancer and where is it found?

Answer 30

adenocarcinoma | rectum and sigmoid colon

Question 31

What are the risk factors for colorectal cancer?

Answer 31

``` male family history IBD especially UC low fibre diet high fat and red meat diet obesity ```

Question 32

What are the clinical signs of right sided colon cancer?

Answer 32

iron deficiency anaemia abdominal pain abdominal mass

Question 33

What are the clinical signs of left sided colon cancer?

Answer 33

blood per rectum altered bowel habit abdominal mass

Question 34

What are the clinical signs of rectal cancer?

Answer 34

blood per rectum tenesmus obstruction

Question 35

What does treatment of colorectal cancer depend on?

Answer 35

Duke's classification

Question 36

How does pancreatic cancer present?

Answer 36

abdominal pain radiating through to back weight loss obstructive jaundice

Question 37

What is usually maintained in pancreatic cancer?

Answer 37

endocrine and exocrine function

Question 38

What is released from exocrine cancer cells?

Answer 38

CA19-9

Question 39

Where are metastases of hepatobiliary cancer usually from?

Answer 39

stomach colon breast lung

Question 40

What suggests the diagnosis of hepatobiliary cancer?

Answer 40

raised alpha fetoprotein

Question 41

What is the treatment for hepatocellular carcinoma?

Answer 41

transplant chemo/ethanol injection resection

Question 42

What are teh predisposing factors for cholangiocarcinoma?

Answer 42

primary sclerosing cholangitis liver fluke infection choledochal cyst Caroli's disease