Bowel Diseases

Question 1

Crohn’s Disease

Answer 1

An inflammatory disease of the whole GIT, it usually presents with abdo pain. diarrhoea, vomiting, weight loss and may have joint or eye involvement. They report frequent diarrhoea (porridge like or steatorrhea) and show patchy, skip lesions of transmural inflammation.
smoking increases risk, and there is a higher risk of cancer

Question 2

Ulcerative Colitis

Answer 2

An episodic inflammatory disease of the colon, commonly with rectal involvement.Biopsy shows shallow, continuous ulcers
presents with gradual onset bloody, mucus like diarrhoea, weigh loss and rectal blood, knee pain
Smoking is protective & there is a sig. increased cancer risk and risk of primary sclerosing cholangitis.

Question 3

Coeliac Disease

Answer 3

A genetic autoimmune condition with onset from middle infancy onwards, Present with pain/discomfort/bloating, constipation/diarrhoea (severely steatorrhoea), fatigue/FTT or vitamin deficiency (A,D,E,K)–> treat with diet
Rx to gliadin (gluten) leading to villus atrophy with increased risk of aden/lymphoma

Question 4

Irritable Bowel syndrome

Answer 4

a functional bowel disorder presenting with chronic abdo pain/discomfort/bloating, with diarrhoea, constipation or both. may onset after an infection, stress or maturation

Question 5

Microscopic colitis

Answer 5

Can be collagenous or lymphatic, diagnosed by characteristic triad: chronic watery diarrhoea, normal colonoscopy but histopathology (lymphocyte inflitration or this + a collagen layer)
Most pts are middle aged women, with a strong association to autoimmune diseases + NSAIDs

Question 6

Adenocarcinoma of the Bowel

Answer 6

70% sporadic, 30% familial
70-75% colon (most sigmoid) 25-30% rectal
present with change in bowel habit (frequency and loose), rectal bleeding, tenesmus and anaemia–> clearer blood, more distal

Question 7

Peutz-jeghers syndrome

Answer 7

A condition associated withmutation of the STK11 gene causing oral, hand and feet pigmentation and gastrointestinal polyps–> may bleed or cause intussuspection

Question 8

Meckel’s Diverticulum

Answer 8

A 3-6cm embryonic true diverticulum present in 2% of the population. Located in the distal ileum –> may contain ectopic gastric/pancreatic cells
Symptoms present recect surgically

Question 9

Epidemiology

Answer 9

Jewish people are the most at risk ethnic group

Question 10

Tumours of the Small intestine

Answer 10

1% of GI tumours, adeno in the duodenum & lymphoma in the ileum (non-hodgkin’s, MALT)

Question 11

Gastric Tumours

Answer 11

intially with dyspepsia, anorexia and discomfort, later weakness/fatigue and bloating after meals, finally abdo pain, N+V, diarrhoea/constipation, weight loss, vomiting or PR blood and dysphagia
Due to H plyori or smoking
Presents v. similar to ulcer

Question 12

Peptic ulcers

Answer 12

Linked to H.Plyori and NSAIDs/Steroids
20% gastric, 80% duodenal, 4% of gastric are due to cancer
Pain (duodenal ulcers epigastric pain is after eating, gastric during) N+V, anorexic/weight loss, Haematemesis, melena and can lead to peritonitis

Question 13

Treatment of Crohn’s

Answer 13

Stop smoking
Glucocorticoids (alt. budesonide)
5-ASA (mesalazine) 2nd line
Azathioprine/methotrexate/mercaptopurine add on for remission
Infliximab for refactory
Metronidazole for peri anal

Question 14

Causes of flattening of small intestine mucosa

Answer 14

Coeliac disease! Milk sensitive enteropathy, tropical sprue (inc giardia), soy protein intolerance, eosinophilic gastroenteropathy, immune deficiency, malnutrition, ischaemia, drugs, irradiation