Gastroenterology

Question 1

What is ulcerative colitis?

Answer 1

Inflammation involving any part of the large intestine ranging from the rectum only (proctitis) and projecting proximally to a varying degree to the entire colon (pancolitis). Inflammation seen is diffuse, continuous and confined to the mucosa.

Question 2

What are the complications associated with UC?

Answer 2

• Benign strictures
• Adenocarcinoma (3-5%)
• Perforation
• Toxic megacolon
• Primary sclerosing cholangitis
• GI bleed

Question 3

What are the main symptoms of UC associated with the colon?

Answer 3

• Rectal Bleeding
• Diarrhoea
• Blood in stool
• Abdominal Pain
• Bloating
• Tenesmus
• Urgency
• Incontinence

Question 4

What drugs are used in the treatment of UC?

Answer 4

5-ASA derivatives (e.g. sulfasalazine, mesalazine)
Corticosteroids
Thiopurines (e.g. azothioprine, mercaptopurine)

Question 5

What is the treatment goal of UC?

Answer 5

To induce and maintain remission

Question 6

What is the role of the 5-ASA derivatives?

Answer 6

Usually used to maintain remission (decreases yearly relapse rate from 60% to 15%)

Question 7

What is the role of corticosteroids in UC?

Answer 7

To remit acute disease, especially if severe or first attack, have a limited role in maintenance therapy

Question 8

How should UC drugs be administered?

Answer 8

Dependent on the extent of disease

• Suppositories for Proctitis
• Enemas for Proctosigmoiditis
• Oral for Pancolitis

Question 9

What drugs are used to induce remission of UC?

Answer 9

5-ASA derivatives, corticosteroids, immunosuppresive

Question 10

What drugs are used to maintain remission of UC?

Answer 10

5-ASA and immunosuppressives (steroid sparing)

Question 11

What is required for a diagnosis of UC?

Answer 11

Sigmoidoscopy with mucosal biopsy and negative stool cultures (to rule out infectious colitis)

Question 12

What is the definitive treatment for UC?

Answer 12

Colectomy - will not get recurrence after surgery

Question 13

What is Crohn’s disease?

Answer 13

Crohn’s disease (CD) is a disorder of unknown aetiology characterised by transmural inflammation of the GI tract. CD may involve any or all parts of the entire GI tract from mouth to perianal area, although it is usually seen in the terminal ileal and perianal locations. Unlike ulcerative colitis (UC), CD is characterised by skip lesions (where normal bowel mucosa is found between diseased areas).

Question 14

What are the three most common causes of small bowel obstruction in order?

Answer 14

Adhesions
Incarcerated hernias
Malignancy

Question 15

What are the three most common causes of large bowel obstruction in order?

Answer 15

Malignancy
Diverticulitis
Volvulus

Question 16

What is intususseption?

Answer 16

Where part of the small bowel folds into the lumen of an adjacent part causing a bowel obstruction

Question 17

What is the macroscopic appearance of Crohn’s Disease?

Answer 17

Distribution: Ileum ± colon
Presents in skip lesions and a cobblestone appearance
Stricture is common
Wall appears thickened

Question 18

What is the macroscopic appearance of UC?

Answer 18

Distribution: colon only
Presents as diffuse, continuous inflammation
Rarely causes strictures
Wall appears thin

Question 19

What are the 4 cell types in the stomach and what do they produce?

Answer 19

Mucous cells - Mucus
Parietal cells - HCl
Chief cells - Pepsinogen
Enteroendocrine cells - Gastrin

Question 20

What are the three interchangable names for the circular folds in the small intestine?

Answer 20

Plicae circulaes
or
Valvulae conniventes
or
Kerckring folds

Question 21

Barrett’s oesophagus is associated with an increased risk of what?

Answer 21

Oesophageal adenocarcinoma

Question 22

What changes occur in Barrett’s oesophagus?

Answer 22

Metaplasia of the non-keratinising squamous epithelium of the oesophagus to abnormal columnar epithelium containing intestinal metaplasia.

Question 23

What are the diagnostic criteria for diagnosis of Barrett’s oesophagus?

Answer 23

Endoscopic evidence of columnar lining in oesophagus above the gastroeosophageal junction
AND
Histological evidence of intestinal metaplasia (goblet cells) in biopsies from the columnar epithelium

Question 24

What are the three islet cell types in the pancreas and what do they release?

Answer 24

Alpha cells - Glucagon
Beta cells - Insulin
Delta cells - Somatostatin

Question 25

What are the causes of acute pancreatitis?

Answer 25

Idiopathic
Gallstones
EtOH
Trauma
Steroids
Mumps/Malignancy
Autoimmune
Scorpions/Spiders
Hyperlipidaemia/Hypercalcaemia
ERCP
Drugs

Question 26

What are the presenting symptoms of acute pancreatitis?

Answer 26

Abdominal pain (predominant feature)
Radiation to back
Nausea
Vomiting

Question 27

What are the examination findings of acute pancreatitis?

Answer 27

Fever
Tachycardia
Epigastric tenderness
Abdominal distention
Anorexia

Jaundice may be seen in the setting of gallstone pancreatitis

Question 28

What drugs are associated with pancreatitis?

Answer 28

Thiopurines (azothioprine, mercaptopurine)
Sulfonamides (sulfasalazine)
Tetracyclines
Oestrogens
Furosemide
Corticosteroids

Question 29

What are the risk factors for cholelithiasis?

Answer 29

Obesity

Age

Question 30

What are the frequencies of the two types of gallstones?

Answer 30

Cholesterol stones - 80%

Pigment stones - 20% (contain calcium bilirubinate)

Question 31

What is Charcot’s triad?

Answer 31

Charcot’s triad is indicative of ascending cholangitis and consists of:
Jaundice
Fever
RUQ pain

Question 32

What is Reynold’s pentad?

Answer 32

Charcot’s triad (RUQ pain, fever, jaundice)
AND
Hypotension
Decreased conscious state/confusion

Question 33

What is the pathogenesis of a gallstone ileus?

Answer 33

Repeated inflammation causing a cholecysoenteric fistula (usually duodenal) which allows a large gallstone to enter the small intestine which impacts near the ileocecal valve