Gastroenterology, Hepatology

Question 1

Why does someone with Coeliacs disease need a pneumococcal vaccine?

Answer 1

Due to functional hyposplenism

Question 2

Ulcerative Colitis: Presentation?

Answer 2

Bloody or mucous diarrhoea (stool frequency related to severity of disease).

Tenesmus and urgency.

Crampy abdominal pain before passing stool, weight loss, fever.

Symptoms of extra GI manifestations (Uveitis, renal calculi, arthropathy)

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Bare minimum answer:

Blood, Abdo pain, Tenesmus, Weight loss, Arthropathy (Exta GI symptom).

“BAT AW”

or

“BAT WAFFLE”

Blood, Abdo pain, Tenesmus, Weight loss, Arthropathy, Frequency, Fever, Lethargy, Erythema Nodosum.

Question 3

Ulcerative Colitis: Investigations?

Answer 3

Bedside: stool sample: culture to RO infectious colitis. Faecal calprotectin for severity.

Bloods: FBC (↓Hb, ↑ WCC), ↑ ESR or CRP, ↓ albumin, cross-match if severe blood loss, LFT, blood cultures

Imaging: AXray: to RO Toxic megacolon

Specialised: Barium enema OR Sigmoidoscopy and rectal biopsy

Question 4

Ulcerative colitis. Management?

Answer 4

Conservative:

Advice: Patient education and support. Mitigate progression. Counsel on complications.

Monitor: Hb, albumin, ESR, Diarrhoea frequency.

Medical:

1. Sulphasalazine (5-aminosalicylic acid) or rectal steroids.
2. Oral Steroids
3. Immunosuppression: Azathrioprine

Advice:

Surgical: Proctolectomy with ileostomy

Question 5

Ulcerative colitis: Complicaitons?

Answer 5

Hemorrhage, Toxic megacolon, Perforation, Colonic carcinoma.

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THC P

Question 6

Ulcerative colitis. Acute eacerbation treatment?

Answer 6

-Medical:

IV fluids

IV steroids (hydrocortisone)

IV Abx

LMWH

Parenteral nutrition including Vitamin D3.