Gastrointestinal

Question 1

What is Hirschsprung’s disease?

Answer 1

Congenital aganglionic megacolon…proximal large bowel can become dilated/enlarged

Question 2

IBS definition?

Answer 2

At least 6 months of...
Abdominal pain/discomfort
Bloating
Change in bowel habit
WITH NO RED FLAGS

Question 3

Investigations for IBD?

Answer 3

Faecal calprotectin

Distinguishes between IBD and IBS

Question 4

Diagnosis of IBS?

Answer 4

Negative faecal calprotectin

With symptoms

Question 5

Treatment for diarrhoea prominent IBS?

Answer 5

Loperamide

antimotility

Question 6

Initiate remission in Crohn’s Disease?

Answer 6

Young children = enteral nutrition (due to growth)

OR

Glucocorticosteroid:
Prednisolone
Methylprednisolone
IV Hydrocortisone

Question 7

When to add on drugs for Crohn’s Disease?

Answer 7

For maintenance therapy, if required
OR
2 episodes in < 12 months

Question 8

What drugs to add on for Crohn’s Disease?

Answer 8

Mercaptopurine
OR
Azathioprine

(OR methotrexate)

Question 9

Drugs to induce remission in Ulcerative Colitis?

Answer 9

Sulfasalazine (aminosalicylate)
Topical best

OR
Prednisolone

Question 10

Step 2 drugs to induce remission in UC?

Answer 10

Add prednisolone

AND/OR

Tacrolimus

Then infliximab, or other biologicals if no response

Question 11

Drugs for hospitalised due to UC?

Answer 11

IV corticosteroids
OR
Ciclosporin

Question 12

Maintaining remission in UC?

Answer 12

Sulfasalazine (aminosalicylate)

topical and/or oral

Question 13

When and what to add in maintaining remission UC?

Answer 13

If 2+ exacerbations in < 12 months

Azathioprine/Mercaptopurine

Question 14

Contraindications to prednisolone?

Answer 14

Anything bad happening to the bowels/intestine!?
Intestinal obstruction
Bowel perforation
Recent intestinal anastamoses
Fistulas 
Infection

Question 15

What is dexamethasone?

Answer 15

Corticosteroid

pure glucocorticoid

Question 16

What is prednisolone

Answer 16

Corticosteroid

Both glucocorticoid and mineralocorticoid effects

Question 17

Diagnosis of coeliac disease?

Answer 17

Made on clinical symptoms and positive serology:

IgA tTG or IgA EMA

Question 18

First line investigations for suspected gallstone disease?

Answer 18

LFTs

Abdo USS

Question 19

Second line investigations for gallstone disease?

Answer 19

IF bile duct is dilated, or LFTs are abnormal
(and no gall stones are seen on USS)
then
MRCP
then
Endoscopic ultrasound (EUS)

Question 20

When to arrange emergency surgical admission for gallstones??

Answer 20

Complications:
Cholangitis
Cholecystitis
Pancreatitis

Question 21

Asymptomatic common bile duct stones?

Answer 21

Treated like symptomatic CBD stones

i.e. Need surgery to remove (not urgent)

Question 22

First choice analgesia for gallstones whilst awaiting surgery?

Answer 22

Diclofenac IM 75mg

Opioid IM if not tolerated/contraindicated

Question 23

IBD and gallbladder relations?

Answer 23

PSC linked with UC
(not common in UC, but 50% of PSC have UC)

Gallstones linked with Crohn’s

Question 24

Drug treatment in constipation?

both acute and chronic

Answer 24

1. Bulk-forming laxatives (if opoid induced go to step 2)
   AND/OR
2. Osmotic laxatives
3. Add stimulant laxative

Question 25

Last drug options for chronic constipation?

Answer 25

Prucalopride (for women) 4 week trial to start Lubiprostone - 2 week trial to start

Question 26

Bulk-forming laxatives?

Answer 26

Ispaghula husks Methylcellulose Sterculia

Question 27

Osmotic laxatives?

Answer 27

Lactulose Macrogols Mg Salts

Question 28

Stimulant laxatives?

Answer 28

``` Bisacodyl Dantron Glycerol Senna Docusate sodium ```

Question 29

P450 enzyme inhibitors

Answer 29

``` SICKFACES.COM Group Sodium valproate Isoniazid Cimetidine Ketoconazole Fluconazole Alcohol (binge) Ciprofloxacin Erythromycin Sulfonamides Chloramphenicol Omeprazole Metronidazole Grapefruit juice ```

Question 30

P450 enzyme inducers

Answer 30

``` CRAP GPS Carbemazepine Rifampicin Alcohol (chronic) Phenytoin Griseofulvin Phenobarbitone Sulfonylureas ```