diarrhoea

Question 1

what is diarrhoea

Answer 1

increased freq (>3x day)
loose or liquid
increased vol (>200g/day)
change in stool consistency

Question 2

other conditions to be aware of when diagnosing diarrhoea

Answer 2

faecal incontinence
functional bowel disorders eg IBS
change from normal baseline

Question 3

acute or chronic diarrhoea

Answer 3

acute is less than 4 weeks 
mostly infectious and self limiting
investigate after a week 
chronic is more than 4 weeks, chronic pathology 
always investigate

Question 4

causes of acute diarrhoea

Answer 4

viral -rota, Nora, enteric adenovirus
bacterial - salmonella, shigella, campylobacter, S aureus
parasitic - C parvum, G lambila, E histolytica

Question 5

causes of chronic diarrhoea

Answer 5

colonic - ulcerative and Crohn’s, colitis, colorectal cancer
small bowel - coeliac, Crohn’s, bile salt malabs, lac int, bac overgrowth
pancreatic - chronic panc, panc cancer, CF
endocrine - hypothyroidism, diabetes, Addison’s, hormone secreting tumours
other - drugs, alcohol, factitious

Question 6

mechanisms of diarrhoea

Answer 6

osmotic eg lac int
steatorrhoea
secretory eg cholera, e coli, gut hormones
inflammatory eg UC, chrohn's, infections
neoplastic
ischaemic
post irradiation

Question 7

investigations for diarrhoea

Answer 7

stool tests (microscopy, culture, faecal elastase and calprotectin)
blood tests (eg FBC, CRP, TTG, TFTs, B12)
Imaging - colonoscopy, CT, MRI, video capsule

Question 8

what is the endoscopic appearance of ulcerative colitis

Answer 8

red, inflamed and blistered

Question 9

endoscopic appearance of Crohn’s disease

Answer 9

linear ulceration
patchy erythema
apthous ulcers

Question 10

what is ulcerative colitis

Answer 10

continuous mucosal inflammation of the colon
no granulomas
affect rectum and variable extent of colon
relapsing and remitting course

Question 11

what is Crohn’s disease

Answer 11

discontinuous and often granulomatous

transmural inflammation affecting any part of GI tract

Question 12

signs of UC

Answer 12

bloody diarrhoea, rectal bleeding, mucus, faecal urgency, abdominal pain, nocturnal defecation
often insidious onset
extra intestinal manifestations

Question 13

how is UC diagnosed

Answer 13

history and exam
stool cultures + CDT
faecal calprotectin, CRP, FBC, Albumin, flexible colonoscopy

Question 14

who is UC most common in

Answer 14

any age (mostly young)
relapsing course
smoking inc risk
appendectomy before 20 protective

Question 15

how is severe UC treated

Answer 15

admit 
hydrocortisone
heparin 
stool chart 
AXR
daily CRP 
avoid NSAIDs, opiates, anti-motility agents

Question 16

how is severe UC treated when it fails to respond to steroids

Answer 16

infliximab
(cyclosporin)
colectomy

Question 17

how is mild to mod UC treated

Answer 17

mesalazine (oral or topical)
prednisolone - reducing course 
azathioprine
biologics - anti TNF, a4B7 integrin blocker, tyrosine kinase inhibitor
surgery

Question 18

what is the prevalence of crohn’s disease

Answer 18

any age (peak in teens/early adulthood)
equal in M and F
smoking
prev appendectomy
FH
infectious gastroenteritis 
inc risk

Question 19

what are the symptom’s of Crohn’s disease

Answer 19

wide spectrum
chronic diarrhoea
IBS
abdo pain 
WL
anaemia
growth failure 
blood +/- mucus in stools
perianal disease
extra intestinal manifestations

Question 20

what is Crohn’s disease related to

Answer 20

inflammatory disease
stricturing disease
fistulating disease
perianal disease

Question 21

how is Crohn’s treated

Answer 21

Prednisolone/Budesonide -corticosteroids
Azathioprine/6-Mercaptopurine - purine analogue
Methotrexate- inhibit folic acid metabolism
nutrition (elemental diet)
ABs
Biologics
surgery

Question 22

what biologic drugs are used to treat IBDs?

Answer 22

infliximab
adalimumab - anti TNF
vedolizumab - a4B7 integrin blocker
Ustekinumab -IL-12 and IL-23 inhibitor

Question 23

what is inflammatory bowel disease

Answer 23

UC and Crohn’s disease