Disorders of the Upper GI Tract

Question 1

Lower GI tract disorders can be divided into:

Answer 1

inflammatory
infective
structural
functional
neoplastic
other

Question 2

Give examples of lower GI tract inflammatory disorders.

Answer 2

inflammatory bowel disease

microscopic colitis

Question 3

Give examples of lower GI tract infective disorders.

Answer 3

C difficile

E coli

Question 4

Give examples of lower GI tract structural disorders.

Answer 4

diverticular disease
haemmorrhoids
fissures

Question 5

Give examples of lower GI tract functional disorders.

Answer 5

irritable bowel syndrome

Question 6

Give examples of lower GI tract neoplastic disorders.

Answer 6

colonic polyps

colon cancer

Question 7

examples of inflammatory bowel disease

Answer 7

ulcerative colitis

Crohn’s disease

Question 8

ulcerative colitis

Answer 8

limited to colonic mucosa, superficial, continuous, always involves the rectum, no granulomas M=F

Question 9

Crohn’s disease

Answer 9

Patchy chronic transmural granulomatous inflammation, tendency to form fistula or strictures
F>M

Question 10

types of ulcerative colitis

Answer 10

proctitis
proctosigmoiditis
distal colitis
extensive colitis 
pancolitis

Question 11

types of crohn’s disease

Answer 11

ileocolitis
ileitis
gastroduodenal crohn's
jejunoileitis
crohn's (granulomatous) colitis
perianal crohn's

Question 12

symptoms of colitis

Answer 12

bleeding
mucus
urgency
diarrhoea

Question 13

perianal symptoms

Answer 13

anal pain
leakage
difficulty passing stool

Question 14

symptoms of small bowel disease

Answer 14

abdominal pain
weight loss
tiredness/lethargy
diarrhoea
abdominal mass

Question 15

Extraintestinal manifestations of inflammatory bowel disease

Answer 15

arthritis: peripheral, axial (ankylosing spondylitis)
skin: erythema nodosum, pyoderma gangrenosum
eyes: Anterior uveitis
Episcleritis/Iritis
liver: autoimmune hepatitis

Question 16

what genes contribute to IBD?

Answer 16

NOD2
HLA
ATG
II23R

Question 17

aetiology of IBD

Answer 17

combination of an impaired mucosal immune response to the gut microbiota in a genetically susceptible host

Question 18

what is dysbiosis?

Answer 18

an imbalance between the types of organism present in a person’s natural microflora, especially that of the gut, thought to contribute to a range of conditions of ill health

Question 19

general management of inflammatory bowel disease

Answer 19

induce/ maintain clinical remission + improve QoL, heal mucosa, decrease hospitalisation/surgery, minimise complications

Question 20

treatment therapies for inflammatory bowel disease

Answer 20

steroids
5 ASA
immune suppressants
biologic therapy 
other (diet, FMT, AB, probiotics)

Question 21

how do steroids work as a treatment for IBD?

Answer 21

Diffuse and bind in nucleus to Glucocorticoid Responsive Elements (GRE) > interact with specific DNA sequences > Increase anti-inflammatory gene products, block pro-inflammatory genes

Question 22

mode of delivery of steroids for IBD?

Answer 22

IV
orally
rectal enemas

Question 23

describe the use of steroids for IBD

Answer 23

Short term
As a bridge to other therapy/interventions
In acutely unwell patients

Question 24

side effects of steroid use for IBD treatment

Answer 24

growth retardation, cataracts, glaucoma, immunosuppression, diabetes, osteoporosis, myopathy, sleep/mood disturbance, psychosis, acne, hirsutism, oedema, hypertension, neuropathy

Question 25

how do 5 ASA work as a treatment for IBD?

Answer 25

Inhibition of pro-inflammatory cytokines (IL-1 and TNF-a ), inhibition of the lipo-oxygenase pathway i.e. prostaglandin and leukotrienes, scavenging of free radicals, inhibition of NF-kB/ TLR via PPAR-gamma induction (perioxisome proliferator activated
receptor-gamma)

Question 26

mode of delivery of 5 ASA for IBD?

Answer 26

orally

rectal

Question 27

side effects of 5 ASA

Answer 27

intolerance, diarrhoea, renal impairment, headache, malaise, pancreatitis, pneumonitis

Question 28

how does azathioprine act as an immune suppressant?

Answer 28

6-TG interferes with adenine and guanine ribonucleotide production > reduced number of B and T lymphocytes, IG and IL >
Another pathway potentially results in apoptosis of T cells

Question 29

side effects of azathioprine

Answer 29

allergic reaction, GI disturbances, hepatotoxicity, infection, pancreatitis, bone marrow suppression, malignancy

Question 30

when administering azathioprine, check for?

Answer 30

Thiopurine, Methyltransferase (TPMT), Hep B/C, HIV, Chicken pox, Vaccinations, TB, Frequent bloods on starting, Maintenance bloods

Question 31

mechanism of methotrexate

Answer 31

Interferes with DNA synthesis & cell reproduction
Increased adenosine levels (anti-inflammatory)
Increased apoptosis of peripheral T cells

Question 32

how long for methotrexate to work? how often should it be taken?

Answer 32

3 months

weekly

Question 33

when administering methotrexate, check for?

Answer 33

Hx re liver abnormalities, monitor LFTs, FBC, advise NO pregnancy, folic acid supplements

Question 34

side effects of methotrexate

Answer 34

Rash, Nausea, mucositis, Diarrohea, Bone marrow suppression, Hypersensitivity pneumonitis, ^ liver enzymes, Hepatic fibrosis/cirrhosis, Known abortifacient

Question 35

list examples of biologics used for IBD treatment

Answer 35

infliximab
adalimumab
golimumab

Question 36

mechanism for biologics used in IBD treatment

Answer 36

anti TNF alpha

Question 37

side effects of biologics

Answer 37

opportunistic infections, site reaction, neutropenia, infection, demyelinating disease, HF, cutaneous reactions, malignancy, autoimmunity

Question 38

combination therapy for IBD

Answer 38

AZA/ 6MP and aTNF

Question 39

dietary therapy for IBD

Answer 39

Liquid therapy diet
Increased use in children
As effective as steroids
Use in  small bowel Crohns disease
Weeks

Question 40

what is Rigler’s sign?

Answer 40

when air is present on both sides of the intestine; a Rigler’s sign is present when air is present on the inside and the outside