Causes of GI inflammation

Question 1

What is irritable bowel syndrome?

Answer 1

Common functional disorder of the bowel.

Question 2

What are the signs and symptoms of IBS?

Answer 2

Recurrent abdominal pain, which improves with defaecation.
There is a change in bowel habit, i.e. increased or decreased frequency.
Clinical diagnosis.

Question 3

What is the conservative treatment of IBS?

Answer 3

Education and avoidance of triggering factors, e.g. decrease stress.

Question 4

What is the medical treatment of IBS?

Answer 4

Depends on symptoms.

Antimuscarinics, laxatives, stool softeners, antispasmodics and antidepressants may play a role.

Question 5

What are the complications of IBS?

Answer 5

Depression and anxiety.

Question 6

What is appendicitis?

Answer 6

Inflammation of the appendix that presents with pain that can originate in the umbilical region before migrating to the right iliac fossa.

Question 7

What investigations are conducted for suspected appendicitis?

Answer 7

Diagnosis is clinical.
Bloods: FBC, U&Es, CRP.
Ultrasound.
Pregnancy test in females of child-bearing age to rule out ectopic pregnancy.

Question 8

What is the treatment for appendicitis?

Answer 8

Surgical excision.

Question 9

What is a complication of appendicitis?

Answer 9

Peritonitis.

Question 10

What is gastritis?

Answer 10

Inflammation of the stomach lining, may be acute or chronic.

Question 11

What are the causes of acute gastritis?

Answer 11

Stress.
NSAIDs.
Uraemia.
Alcohol.
Burns: Curling's ulcer.

Question 12

What are the different types of chronic gastritis?

Answer 12

Type A: autoimmune (autoantibodies are present to parietal cells), presents with pernicious anaemia, occurs in the funds or body of the stomach.
Type B: most common, associated with Helicobacter pylori infection.

Question 13

What investigations are conducted for suspected gastritis?

Answer 13

Investigate for H. pylori infection.
Bloods: anaemia and H. pylori.
Urinalysis.
Blood test- measures antibodies to H. pylori.
Carbon isotope-urea breath test.
Endoscopy with biopsy of stomach lining.
Stool microscopy and culture- may detect trace amounts of H. pylori.

Question 14

What is the treatment for gastritis?

Answer 14

Triple therapy to eradicate H. pylori: proton pump inhibitor with amoxicillin 1g and clarithromycin 500mg or metronidazole 400mg and clarithromycin 250mg, taken twice daily.
Step-wise approach to treating gastritis:
-Mild: antacids or H2 receptor antagonists.
-Moderate/severe: PPI.

Question 15

What are the complications of gastritis?

Answer 15

Peptic ulcers, anaemia (from bleeding ulcers), stricture formation, mucosa-associated lymphoid tissue (MALT) lymphoma.

Question 16

What is ulcerative colitis?

Answer 16

Relapsing remitting autoimmune condition that is not associated with granulomas. It affects the colon and rarely the terminal ileum (backwash ileitis).

Question 17

What are the signs and symptoms of ulcerative colitis?

Answer 17

Pyrexia.
Pseudopolyps.
Lead pipe radiological appearances.
Bloody diarrhoea.
Proctitis.

Question 18

What are the investigation conducted for suspected UC or Crohn’s disease?

Answer 18

Bloods: FBC and platelets, U&Es, LFTs and albumin, ESR and CRP.
Colonoscopy (with biopsy): diagnostic.
Radiology: small bowel follow through (diagnostic) and abdominal x-ray (for toxic megacolon and excluding perforation).

Question 19

What is the treatment for ulcerative colitis?

Answer 19

Conservative: patient education; smoking has been shown to be protective but is not advised.
Medical: corticosteroids, 5-aminosalicylic acid (5-ASA) analogues (sulfasalazine), mesalazine, 6-mercaptopurine, azathioprine.
Surgical: colectomy.

Question 20

What are the complications of ulcerative colitis?

Answer 20

Toxic megacolon, increased incidence of colon cancer, primary sclerosis cholangitis and osteoporosis (from steroid use).

Question 21

What is Crohn’s disease?

Answer 21

Disordered response to intestinal bacteria with transmural inflammation. It may affect any part of the GI tract but often targets the terminal ileum. It is associated with granuloma formation.

Question 22

What are the signs and symptoms of Crohn’s disease?

Answer 22

Weight loss, abdominal pain (with palpable mass), diarrhoea, fever, skip lesions, clubbing, cobblestone mucosa, fistula formation, fissure formation and linear ulceration.

Question 23

What is the treatment for Crohn’s disease?

Answer 23

Conservative: smoking cessation, low residue diet may be encourage but usually diet is normal.
Medical: corticosteroids, infliximab, 5-ASA analogues (sulfasalazine), azathioprine, methotrexate.
Surgical: remove strictured or obstructed region of bowel.

Question 24

What are the complications of Crohn’s disease?

Answer 24

Stricture formation, fistula formation, obstruction, pyoderma gangrenosum, anaemia and osteoporosis.