Colorectal

Question 1

what biologic can be used in IBD?

Answer 1

Infliximab is a popular choice in managing complex peri anal crohns. It is absolutely vital that all sepsis is drained prior to starting therapy.

Question 2

what class of drug should be avoided in IBD?

Answer 2

NSAIDs - they can precipitate symptoms

Question 3

in which IBD is smoking protective?

Answer 3

UC

Question 4

what is seen radiologically as a “lead pipe colon”?

Answer 4

UC

Question 5

what is seen radiologically as “apple core appearance”?

Answer 5

Crohn’s

Question 6

what is seen radiologically as a “coffee bean sign”?

Answer 6

volvulus

Question 7

what is the definition of IBD?

Answer 7

chronic relapsing-remitting diseases characterised by acute, non-infectious inflammation of the gut. idiopathic in origin. mainly consists of Crohn’s and Ulcerative Colitis.

Question 8

what are the common symptoms between Crohn’s and UC?

Answer 8

increased risk of Cancer (UC - colonic, Crohn’s - large and small bowel)
weight loss
fatigue and malaise
risk of toxic megacolon
associated with arthritis (RA), ankylosing spondylitis and sacroiliitis, uveitis and iritis

Question 9

define toxic megacolon

Answer 9

colon is >5.5cm
can be caused by IBD or C. diff.
accompanied by abdominal distension (bloating), and sometimes fever, abdominal pain, or shock

Question 10

location of Crohn’s

Answer 10

discontinuous skip lesions anywhere in the GIT
can get perianal disease and mouth ulcers
transmural granulomatous inflammation

Question 11

Crohn’s appearance

Answer 11

cobblestoning on colonoscopy

apple-core on X-Ray

Question 12

features of Crohns’s

Answer 12

fistulas (abnormal connections)
strictures (narrowing leading to obstruction)
abscesses (perianal and intra-abdominal)
malabsorption

Question 13

location of UC

Answer 13

continuous disease starting in the rectum and advancing proximally until the terminal ileum
can get rectal disease
mucosal inflammation +/- pan-colonic inflammation

Question 14

UC appearance

Answer 14

crypt abscesses

lead pipe colon

Question 15

features of UC

Answer 15

faecal urgency/ incontinence
tenesmus
bloody stool and PR mucus
adhesions

Question 16

medical management of UC

Answer 16

mesalazine (2-4g/day)
topical 5-ASA derivative 
prednisolone steroid 
azathioprine for recurrent attacks
ciclosporin/infliximab (anti-TNF antibody) acutely for steroid-refractory disease if severe

Question 17

medical management of Crohn’s

Answer 17

mesalazine (4g/day)
prednisolone/budesonide if unresponsive
metronidazole, azathioprine and anti-TNF factor antibodies under consultant supervision

steroids are not used for more than three months as there is an increased risk of sepsis and mortality in CD

Question 18

surgical management of UC

Answer 18

panproctocolectomy is curative of UC

restorative proctocolectomy with ileal pouch to anus anastomosis is common

Question 19

surgical management of Crohn’s

Answer 19

non-curative in Crohn’s but is used to repair strictures and fistulae

Question 20

liver disease associated with IBD

Answer 20

autoimmune hepatitis (UC)
gallstones (CD)
sclerosing cholangitis (UC>CD)

Question 21

DDx for IBD

Answer 21

IBS
coeliacs disease 
anal fissure (very painful)
diverticulitis
colitis 
colonic tumour 
ovarian tumour 
endometriosis 
C. diff

Question 22

ABC of IBS

Answer 22

IBS is a diagnosis of exclusion
Abdo pain
Bloating
Change in bowel habits

Question 23

IBS symptoms

Answer 23

chronic (>6 months) recurrent abdominal pain/ discomfort plus 2 of:
relief by defecation, altered stool form, altered bowel frequency
can also get urgency, incomplete evacuation, abdominal bloating and PR mucus

Question 24

IBS management

Answer 24

symptomatic control –> diet & lifestyle, CBT or pharmacotherapy
laxatives for constipation (must increase water intake)
bulking agent or codeine (for diarrhoea)
colic/ bloating –> oral antispasmotics (e.g. mebeverine)
visceral hypersensitivity –> amitriptyline

Question 25

what symptoms would make you suspect coeliac disease?

Answer 25

diarrhoea plus weight loss or anaemia (especially iron or B12)

Question 26

pathophysiology of coeliac disease

Answer 26

small bowel T-cell immune response to gluten leading to villous atrophy and malabsorption

Question 27

what must be done before a gluten screening blood test ?

Answer 27

the pt must have had gluten in their diet for the 6 weeks prior

if positive then a biopsy must be done

Question 28

treatment and complications of coeliac disease

Answer 28

life-long gluten avoidance

increased risk of malignancy (lymphoma) if pt continues to eat gluten

other complications include anaemia, osteoporosis, hyposplenism, neuropathies and dermatitis herpetiformis

Question 29

appendicitis presentation

Answer 29

umbilicus pain (visceral peritoneum) initially that localises to the RIF (parietal peritoneum)
RIF tenderness, low-grade fever, tachycardia and anorexia
+ve Rovsing’s sign (pain in RIF when palpating the LIF)

Question 30

acute diverticulitis

Answer 30

.inflammation of diverticular
left sided severe, cramping abdominal pain with nausea, constipation and diarrhoea

complications - strictures and obstruction, fistula, abscesses, haemorrhage

Question 31

intestinal obstruction

Answer 31

.small bowel - early faecal vomiting, late constipation, valvulae conniventes
large bowel - early absolute constipation, late vomiting, presence of haustration

Question 32

ileus

Answer 32

a painful non-mechanical form of obstruction

due to C. diff, IBD or gallstone ileus

Question 33

ileostomy

Answer 33

usually RIF
sprouted
more liquidly (contains digestive enzymes and is alkaline)
high frequency of discharge, more likely to cause electrolyte problems

Question 34

colonostomy

Answer 34

usually LIF
flush with the skin
faecal discharge

Question 35

what makes a good anastomoses?

Answer 35

good blood supply
good seal -ends are of equal length
not under tension