Gastro

Question 1

Important questions to ask in inflammatory bowel disease?

Answer 1

Abdo pain and bloating- association with food and defection
Stool frequency and consistency
Blood/mucous
Urgency, incontinence, tenesmus
Weight loss and appetite
Fevers
Apthous ulcers/rash/arthralgia/eye symptoms

Question 2

Important examination in IBD?

Answer 2

Look at face- especially in and around mouth and in conjunctiva for anaemia
Then abdomen
Legs for erythema nodosum/Pyoderma gangrenosum

+ DRE for perianal disease in UC

Question 3

Investigations in IBD?

Answer 3

Stool microscopy and culture (if diarrhoea)
Faecal calprotectin in GP
FBC, UEs, LFTs, clotting, CRP
AXR to rule out toxic megacolon in UC
Flexi sig/colonscopy with biopsies
CT/bowel contrast studies if considering stricture/fistula/obstruction

Question 4

Differential diagnosis for Crohns?

Answer 4

Yersinia, TB, lymphoma, coeliac disease

Question 5

Ddx for UC

Answer 5

IBS, ischaemic colitis, infection (campylobacter)

Question 6

General principles of management of IBD?

Answer 6

Flare managed with PO/IV steroids
Nutritional support
Psychological support

Question 7

How would you manage acute flare requiring hospitalisation?

Answer 7

IV steroids
Calcium supplementation (+/- PPI) whilst on steroids
IV fluids as required
VTE prophylaxis

Biologic screen if failing to manage with steroids-> Infliximab

Question 8

How would you decide when you escalate to Infliximab in an IP?

Answer 8

Use TRAVIS criteria at 3 days.

Question 9

Why use azathioprine and infliximab?

Answer 9

Azathioprine reduces chance of developing antibodies against infliximab .

Question 10

Why avoid opioids in IBD?

Answer 10

Slow down the bowel and increase risk of perforation

Also masks stool frequency and cannot accurately assess for improvement

Question 11

Management of OP UC?

Answer 11

Mesalazine as first line (oral and topical).

Azathioprine -> Biologic therapy

Question 12

Monitoring required in Azathioprine

Answer 12

Check TPMT level prior to starting. Weekly FBC for 4 weeks then 3 monthly (can cause BM suppression)

Question 13

Which surgical option is generally used for UC and when would it be used?

Answer 13

Subtotal colectomy with ileostomy (usually curative)

Emergency surgery for complications, failed medical treatment, cancer

Question 14

Why would surgery be performed in Crohns disease?

Answer 14

Obstruction from strictures, fistulae and failure to respond to medical therapy.

Question 15

Management of Crohns in OP setting

Answer 15

Usually azathioprine/biologics

Question 16

What is the link between colon cancer and IBD?

Answer 16

Increased risk in patients with pan colitis and PSC.
Offer surveillance if UC (with more than proctitis) or Crohns with more than one segment affected.
Surveillance increases with time since diagnosis. 3 yearly colonoscopy after 10 years, 2 yearly 10-20 years, yearly after 30 years

Question 17

Name the associations of IBD?

1. Mouth (1)
2. Skin (2)
3. Joint (2)
4. Eye (2)
5. Liver (1)

Answer 17

1. Apthous ulcers in Crohns
2. Erythema nodosum, pyoderma gangrenosum
3. Large joint arthropathy
   Seronegative arthritis
4. Episcleritis and uveitis
5. PSC in UC