Diverticular + IBD

Question 1

RF for diverticular

Answer 1

Low fibre diet
Increasing age
Smoking
NSAIDs

Question 2

Mechanism of diverticular

Answer 2

Muscle hypertrophy + increased intraluminal pressure
Mucosa patches are pushed out through colonic wall
95% in sigmoid colon

Question 3

Symptoms of diverticular

Answer 3

Altered bowel habit, colicky L sided abdo pain, nausea, flatulence
Symptoms improve with defecation + worsen with eating
Acute: can cause guarding in LIF. Fever, malaise, nausea
Abscess: swinging fever + pelvic pain

Question 4

Signs of perforated diverticular

Answer 4

Ileus, peritonitis, shock

Question 5

Investigations + what they show for diverticular

Answer 5

CXR - shows pneumoperitoneum
AXR - shows ileus, dilatation, obstruction
CT scanning for abscess

Question 6

Management of diverticular

Answer 6

High fibre diet +- antispasmodics (mebeverine)
Acute: oral abx (co-amoxiclav + metronidazole)
Bulk forming laxatives

Question 7

Complications of diverticular

Answer 7

Fistula
Haemorrhage - sudden + painless
Post infective stricture can cause colon obstruction
Ischaemic colitis

Question 8

Peak age + RF of Crohns

Answer 8

Strong FHx, peak at 15-30 + 50-70
Common in caucasians
Smoking
NSAIDs exacerbate

Question 9

Peak age + RF of UC

Answer 9

Peak at 15-25 + 55-65
Fam hx
NSAIDs
COCP
Risk decreased in smokers

Question 10

Mechanism of Crohns

Answer 10

Transmural granulomatous inflammation affecting all GI tract
Skip lesions

Question 11

Mechanism of UC

Answer 11

Autoimmune triggered by colonic bacteria

Causes inflammation + ulcers from rectum upwards

Question 12

S+S Crohns

Answer 12

Diarrhoea (bloody)
Abdo pain 
Weight loss 
Periods of exacerbation + remission 
Mouth, skin, eyes + joint problems 
Anaemia, fever + hypotension in exacerbations

Question 13

Pathological findings of Crohns

Answer 13

Gallstones

Cobble stone appearance

Question 14

S+S UC

Answer 14

Bloody diarrhoea, colicky abdo pain, urgency, tenesmus

Joint, skin + eye problems

Question 15

Signs of IBD

Answer 15

A PIE SAC
Aphthous ulcers 
Pyoderma gangrenosum 
Iritis 
Erythema nodosum 
Sclerosing cholangitis 
Arthritis 
Clubbing

Question 16

Investigations for IBD

Answer 16

Faecal calprotectin - positive
Endoscopy
Raised CRP, low Hb, low albumin, raised WCC + ESR

Question 17

Crohns treatment

Answer 17

Monotherapy: prednisolone or budesonide 
2nd: 5-ASA (mesalazine)
Add in thiopurine 
Methotrexate next 
Infliximab if severe

Question 18

UC treatment

Answer 18

Aminosalicylates to induce remission 
Prednisolone to induce remission 
Thiopurines 2nd line 
Ciclosporin for severe, rapid onset 
Infliximab to induce remission

Question 19

Mechanism of coeliac disease

Answer 19

IgA immune mediated, inflammatory systemic disorder
Provoked by gluten
HLA-DQ2
Gliadin induces epithelial cells to express IL-15 which activates CD8+ intraepithelial lymphocytes

Question 20

RF for coeliac disease

Answer 20

T1DM
Autoimmune thyroid 
FH
Downs 
Turner's

Question 21

S+S coeliac

Answer 21

Persistent unexplained GI/ abdo S+S
Faltering growth 
Weight loss 
Apthous mouth ulcers 
Angular stomatitis 
Iron, B12 or folate deficiency 
Steatorrhoea 
Abdo pain/ cramping 
Raised LFTs
Anaemia 
Dermatitis herpetiformis

Question 22

Investigations for coeliac

Answer 22

Autoantibodies - IgA tissue transglutaminase
Anaemia
Raised LFTs
Biopsy shows subtotal villous atrophy + crypt hyperplasia

Question 23

Complications of coeliac disease

Answer 23

Nutrient deficiencies 
Osteoporosis 
GI cancer risk 
Ulcerative jejunitis 
Neuropathies

Question 24

Histology for Crohns

Answer 24

Rose thorn ulcers
Increased goblet cells
Cobblestone appearance