Chronic Inflammation of the GIT

Question 1

What is the most common symptom of lower GIT inflammation?

Answer 1

The most common symptom of lower GIT inflammation is diarrhoea.

Question 2

List the two most common causes of lower GIT inflammation.

Answer 2

• Viral infection is the most common cause of lower GIT inflammation.

1 - Norovirus is the most common cause of viral infection affecting the lower GIT.

2 - Campylobacter is the most common cause of bacterial infection affecting the lower GIT.

Question 3

What is the most common cause of acute GIT inflammation?

What is the most common cause of chronic GIT inflammation?

Answer 3

• Norovirus is the most common cause of acute GIT inflammation.
• IBD is the most common cause of chronic GIT inflammation.

Question 4

Why do antibiotics often cause diarrhoea?

Answer 4

Antibiotics often cause diarrhoea because they cause frequent contraction of the lower GIT.

Question 5

How long must diarrhoea last to be considered chronic?

Answer 5

Chronic diarrhoea lasts for 2 weeks or more.

Question 6

List the subcategories of chronic diarrhoea.

Answer 6

Chronic diarrhoea subcategories:

1 - Osmotic.

2 - Secretory.

3 - Inflammatory.

4 - Malabsorptive.

5 - Chronic infection.

6 - Motility disorder diarrhoea.

Question 7

List 2 causes of malabsorptive chronic diarrhoea.

Answer 7

1 - Coeliac disease (because the gluten stays in the bowel, causing water retention).

2 - Pancreatitis (because this reduces the production of enzymes required for digestion).

Question 8

How is malabsorption due to pancreatitis treated?

Answer 8

Malabsorption due to pancreatitis is treated by enzyme replacement, e.g. Creon.

Question 9

List 7 infectious agents that cause lower GI inflammation.

For each infectious agent, give the most common mechanism of transmission.

Answer 9

1 - Salmonella (contaminated foods).

2 - Staphylococcus (contaminated foods).

3 - Campylobacter (poultry).

4 - E. coli (beef).

5 - Vibrio (waterborne transmission and seafood).

6 - C. difficile (contracted following antibiotics or chemotherapy).

7 - Shigella (person to person).

Question 10

When is weight loss considered significant?

Answer 10

Weight loss is considered significant if a patient has lost 10% of their weight within 6 months.

Question 11

List the types of irritable bowel disease (IBD).

Answer 11

IBD includes:

1 - Crohn’s disease.

2 - Ulcerative colitis.

*The pathogenesis of IBD is unknown.

Question 12

List the differences between Crohn’s disease and ulcerative colitis.

Answer 12

1 - Crohn’s disease affects the whole GIT, whereas ulcerative colitis only affects the large bowel.

2 - Crohn’s disease affects all layers of the GIT, whereas ulcerative colitis only affects the mucosa (submucosa, muscularis and serosa are unaffected).

3 - Crohn’s disease usually has a single continuous pattern of spread, whereas Crohn’s disease can be spotted and discontinuous throughout the GIT.

Question 13

What is an enterovesical fistula?

What are the main symptoms of an enterovesical fistula?

Give an example of a cause of enterovesical fistulas.

Answer 13

• An enterovesical fistula is an opening made between the bowel and the bladder.
• It can cause air to be passed through the urethra and recurrent infection.
• Enterovesical fistulas can be caused by Crohn’s disease (as it affects the whole width of the GIT) or diverticulitis.

Question 14

What is the difference between diverticulosis, diverticular disease and diverticulitis?

Answer 14

• When there are no symptoms, it is called diverticulosis.
• When diverticula cause symptoms it’s called diverticular disease.
• If the diverticula become inflamed or infected, causing more severe symptoms, it’s called diverticulitis.

Question 15

What is the difference between diverticulosis, diverticular disease and diverticulitis?

Answer 15

• When there are no symptoms, it is called diverticulosis.
• When diverticula cause symptoms it’s called diverticular disease.
• If the diverticula become inflamed or infected, causing more severe symptoms, it’s called diverticulitis.

Question 16

List the areas of the GIT that are most prone to Crohn’s disease in order from most vulnerable to least.

Answer 16

1 - Terminal ileum.

2 - Colon.

3 - Perianal.

4 - All other areas.

Question 17

List 4 characteristics of GIT affected by Crohn’s disease.

Answer 17

1 - Transmural inflammation.

2 - Skip lesions (patches of lesions rather than continuous lesions).

3 - Non-caseating granulomas.

4 - Ulceration, leading to:

• Fibrosis.
• Stricturing (narrowing).
• Fistula formation.

Question 18

List 4 characteristics of GIt affected by Crohn’s disease.

Answer 18

1 - Transmural inflammation.

2 - Skip lesions (patches of lesions rather than continuous lesions).

3 - Non-caseating granulomas.

4 - Mucosal ulceration, leading to:

• Fibrosis.
• Stricturing (narrowing).
• Fistula formation.

Question 19

How does granuloma formation differ between Crohn’s disease and ulcerative colitis?

Answer 19

• In Crohn’s disease, there are non-caseating granulomas.

- In ulcerative colitis, there is no granuloma formation.

Question 20

List 6 investigations that are carried out in the diagnosis of IBD.

Answer 20

1 - Full blood count (e.g. anaemia).

2 - Urea and electrolytes.

3 - Liver function tests.

4 - C-reactive protein (inflammation).

5 - Stool cultures (infection).

6 - Abdominal x-ray (e.g. for strictures).

Question 21

List 6 investigations that are carried out in the diagnosis of IBD.

Answer 21

1 - Full blood count (e.g. anaemia).

2 - Urea and electrolytes.

3 - Liver function tests.

4 - C-reactive protein (inflammation).

5 - Stool cultures (infection).

6 - Abdominal x-ray (e.g. for strictures).

Question 22

Which drugs are used to treat IBD?

Why?

Answer 22

• Immunosuppressant drugs, e.g. steroids, are used to treat IBD.
• This reduces GIT inflammation, which is caused by the immune response.