Gastroenterology - Bowel Issues

Question 1

Agents implicated in microscopic colitis.

Answer 1

Nsaids
PPI
SSRI

Question 2

How often should we do a colonoscopy post IBD diagnosis?

Answer 2

To start 8 years post IBD diagnosis. For colon cancer. To be performed every 1-2 years with ulcerative colitis or patients with Crohn’s disease involving most of the colon.

Question 3

Uc vs Crohn’s disease differentiation

Answer 3

UC
- friability and ulceration in scope
- altered crypt architecture and crypt abscesses
- smoking alleviates symptoms (active smokers has lowest risk, former smokers have highest risk)
- goblet cell depletion

Crohn’s
- skip lesions on scope
- occ. granulomas and transmural
- goblet cell preserved
- associated with fistula
- smoking is a risk factor

Question 4

IBS treatment

Answer 4

For IBS - D
- first line is TCA
- can consider eluxadoline after

For IBS - c
- first line is ssri

Question 5

Mechanism of action of ustekinumab and vedolizumab in Crohn’s

Answer 5

Before giving TNF- alpha inhibitor, check for TB and HBV.

If anti TNF such as infliximab is refractory, then consider ustekinumab which is a anti IL12/23 p40 monoclonal antibody and also vedolizumab which is a alpha4beta7 integrin inhibitor and inhibits monocytes from migrating to the intestinal epithelium.

Question 6

True love and Witt’s criteria

Answer 6

Mild
- bloody stool less than 4
- hr<90bpm
- T<37.5
- Hb > 115
- esr/crp < 20/normal

Moderate
- bloody stool 4 or more and if
- hr<90
- T < 37.8
- Hb > 110
- crp/esr < 30

Severe
Bloody stool 6 or more
Hr>90bpm
T>37.7
Hb < 110
Esr/crp > 30