Gastro

Question 1

Describe UC

Answer 1

continuous, rectum → colon, submuscoal/mucosal ulceration + pseudopolyps.
↓ goblet cells and crypt abscess

Question 2

Describe crohns

Answer 2

Discontinous cobblestone skin lesions mouth → ulcer, terminal ileum, transmural, non-caveating granuloma.

Question 3

For UC when would you give enemas vs systemic steroid

Answer 3

Steroid enemas if only effecting sigmoid + rectum

Need systemic if affecting more of bowel

Question 4

Hx points in UC

Answer 4

Bloody diarrhoea
Abdo pain, urgency + frequency
Wt loss, dehydration, malaise

Question 5

Hx points crohns

Answer 5

Weight loss ****
ABDO PAIN ***
Mouth ulcers
Perirectal pain
Reduced growth in kids

Question 6

RF

Answer 6

DHx: NSAIDs
FHx
Smoking (↑ risk in crohns)

Question 7

INV

Answer 7

Bloods: FBC, U+Es, LFT, CRP, haematinics, p-ANCA (UC)/ASCA(Crohns)
Stool culture + microscopy
Faecal calprotectin
Barium XRAY
SCOPE and Biposy ***

Question 8

Name any signs seen on Abdo XR (one for barium XR)

Answer 8

Lead pipe
Thumbprinting 
String sign (stricture)

Question 9

UC classification - name it

Name important factors

Answer 9

Truelove and Witt’s Criteria

Motions per day, bleeding, temp, pulse, Hb, ESR

Question 10

TX UC

Answer 10

1. Aminosalicylates (Mesalazine)
2. Steroid - local or systemic (for flares)
3. Immunosuppressant - cyclosporine
4. Infliximab
5. Surgery

Question 11

Tx Crohns

Answer 11

1. Azothioprine
2. Budesonide, Pred
3. MTX - instead of ASA
4. Biologics - infliximab
5. Surgery (not curative)

Question 12

Complications of UC

Answer 12

Toxic megacolon (>6cm, >9cm caecum)
Colorectal cancer - frequent scopes - 40s scope yearly

Question 13

Complications of Crohns

Answer 13

Stricture 
Fistula 
Perforation 
Obstruction 
Abscess

Question 14

Extra-Intestinal Disease

Answer 14

APIESAC
A-Apthous ulcers
P-Pyoderma gangrenosum
I - Episcleritis, anterior uveitis
E- Ertythem Nodosum
S- Sacroilitils, sclerosing colangitis 
Arthropathy, Ankylosing spondylitis 
Clubbing

Croshn: malnutrition, gallstones

Question 15

Known IBD and they present with tachycardia what u worried about

Answer 15

Obstruction - ABDO XR, CXR - steroids mask signs of peritonitis

Question 16

Dermitis Herpeticam is a sign in which disease

Answer 16

Coeliacs

Question 17

Which hepatitis is spread feacal oral route

Answer 17

Hep A

Question 18

alphaeto protein is a tumour marker for what cancer

Answer 18

hepatocellular