Diseases of the GIT

Question 1

The difference between where in the GI ulcerative colitis and chrons disease are seen

Answer 1

UC only affects the colon. Usually starts in the rectum, can stay local or extend to involve entire colon. Inflammation is continuous.

CD most commonly involves end of small intestine and start of colon. May affect any part of GI tract (“mouth to anus”) in a patchy pattern (“skip lesions”).

Question 2

The difference between which layers of the bowel wall are inflamed in ulcerative colitis and chrons disease

Answer 2

UC only inflames the inner mucosal layer of the bowel

CD has transmural inflammation of the bowel wall (all layers are inflamed)

• can result in fistula formation (abnormal connection between 2 compartments)
• mucosal ulceration seen leads to fibrosis and fistulas

Question 3

Which condition has characteristic granulomas - ulcerative colitis or Chrons?

Answer 3

Chrons has non-caseating granulomas

Granulomas absent in UC

Question 4

What is perianal disease

Answer 4

Fistulas and abscesses around the perineum (rectum)

Common in Chrons (rare in UC)

Question 5

IBD encompasses

Answer 5

UC and Chron’s

Question 6

IBD investigations

Answer 6

History and exam
Bloods
- anaemia due to chronic blood loss/inflammation, 
 or iron/B12 malabsorption
- leucocytosis (raised WBC)
- raised CRP
Stool - rule out C diff, other pathogens
Abdominal X-ray - stenosis & dilation of lumen  in CD

Further investigation
Biopsy - histology
Colonoscopy, sigmoidoscopy - image ulceration
Abdominal CT scan - localise pathology

Question 7

Chrons treatment

Answer 7

Immuno-suppressants (Azathioprine)
Anti-TNFa antibodies (Infliximab)

Segmental resection

Question 8

Ulcerative colitis treatment

Answer 8

Anti-inflammatories (aminosalicylates)
Steroids

Colectomy/hemicolectomy, elective panproctocolectomy (remove all of the colon, rectum and anus) with ileo-anal pouch (ileum joined to anus)

Question 9

Gastroenteritis =

Answer 9

inflammation somewhere in GIT

Question 10

Gastroenteritis =

Answer 10

inflammation somewhere in GIT due to infection

Question 11

Most common bacterial cause of infective diarrhoea

Answer 11

campylobacter (mainly in meat)

Question 12

Main cause of acute diarrhoea

Answer 12

infection

Question 13

Most common symptom of acute inflammation in the GIT

Answer 13

diarrhoea

Question 14

The 4 types of diarrhoea

Answer 14

secretory
hypermotility
defective ion transport
osmotic

Question 15

Difference between acute and chronic diarrhoea

Answer 15

acute infective diarrhoea (gastroenteritis) - less than 2 weeks
chronic - more than 2 weeks

Question 16

Difference between acute and chronic diarrhoea

Answer 16

acute diarrhoea - less than 2 weeks

chronic - more than 2 weeks

Question 17

Coeliac disease =

Answer 17

Inappropriate immune response to gluten.

Patients with active coeliac disease have immunoglobulin (Ig)A and IgG antibodies that are specific for the autoantigen tissue transglutaminase.

Question 18

Causes of chronic diarrhoea

Answer 18

Inflammatory:
IBS

Malabsorptive:
coeliac disease
acute pancreatitis

Question 19

Common presentation of IBD

Answer 19

diahorreoa for over 2 weeks (chronic)
abdominal pain - can be worse after eating
blood in stool

Question 20

Gastro-oesophageal reflux disease (GORD) =

Answer 20

chronic symptoms or mucosal damage produced by the abnormal reflux of gastric acid into the oesophagus

Question 21

Symptoms of GORD

Answer 21

heartburn 
regurgitation 
dysphagia 
cough 
hoarseness 
chronic earache

Question 22

Causes of GORD

Answer 22

Main 2: Obesity and hiatus hernia (most commonly sliding)
Also:
drugs lowering tone of lower oesophageal sphincter
pregnancy
zollinger ellison syndrome (gastrin secreting tumour)

Question 23

What is heartburn and what causes it

Answer 23

• characterised by retrosternal discomfort or burning sensation
• Intermittent symptom following eating, exacerbated by exercise and lying
• oesophageal reflux

Question 24

What is the difference between a sliding hiatus hernia and a rolling hiatus hernia

Answer 24

Rolling - Gastrooesophageal junction (normally in the abdomen) migrates up through oesophageal hiatus and to sit in the thorax
Sliding - Gastric fundus pops through the oesophageal hiatus and sits in the thorax

Question 25

The outcomes of GORD

Answer 25

Oesophagitis
Oesophageal stricture (oesohogeal lumen narrowing - causes dysphagia)
Barett’s metaplasia
Oesophageal adenocarcinoma (throat cancer)

Question 26

What is the link between Barett’s metaplasia and oesophageal adenocarcinoma

Answer 26

BM pre-disposes to OAC (30-120x more likely)

OAC has an 8% 5 year survival rate

Question 27

What is Barett’s metaplasia

Answer 27

Oesophageal metaplasia.

Lots of reflux the normal oesophageal stratified squamous epithelium > simple columnar (more like what’s in stomach).

Question 28

GORD treatment

Answer 28

Weight loss
Decrease alcohol
Avoid food/alcohol near bedtime

PPIs
H2 blockers
Antacids to up pH
Alginates (gaviscon) to coat mucosa

Anti-reflux surgery ‘fundoplication’
Repair hiatus hernia

Question 29

GORD diagnosis

Answer 29

Gold standard - endoscopy; however can have reflux w/o inflammation. Do pH monitoring to check if this is the case (in which case the patient is a ‘NERD’, non-erosive reflux disease)
pH monitoring - probe to oesophogeal junction for 24hr & monitor acidity

Question 30

Common symptoms of Chron’s disease

Answer 30

abdominal pain - cramp or constant pain
prolonged non-bloody or bloody diarrhoea
blood in stool
fever 
fatigue 
abdominal tenderness

Question 31

Common symptoms of Ulcerative colitis

Answer 31

rectal bleeding
diarrhoea 
blood in stool
abdominal pain
malnutrition
arthritis and spondylitis (inflammation of the vertebra)

Question 32

Risk factors for Chron’s disease

Answer 32

white ancestry
15-40 or 60-80
family history

Question 33

Risk factors for Ulcerative colitis

Answer 33

enteritis - associated with 50% relapses
IBD family history
genetic susceptibility - HLA-B27 gene locus