Gastrointestinal Medicine - 2

Question 1

What possible general causes of IBD?

Answer 1

• Food intolerance
• Persisting viral infection/immune activation
• Smoking
• Genetic

Question 2

What is a possible microbiological cause of crohn’s?

Answer 2

infection with mycobacteria (paratuberculosis) after possibly drinking milk with cattle infected with johne’s diseases

UHT kills mycobacteria - pasteurisation does not

Question 3

What can disease in the ileocecal region result in?

Answer 3

Vit b12 malabsorption

Question 4

Where can crohn’s disease affect?

Answer 4

any part of the GI tract even oral

Question 5

What are the ulcerative colitis sites?

Answer 5

starts at the distal part of the bowel (rectum) and moves forward throughout the lage intestine

Question 6

Features of UC

Answer 6

Affects only the colon and rectum (continuous involvement)
Always involves the rectum
Lower rate of anal fissures (25%)
Mucosal inflammation only
Vascular pattern of inflammation
No granulomas
Does not cause obstructions or fistulas
No malabsorption unless severe disease
Serosa normal

Question 7

Features of Crohns

Answer 7

Can affect any part of the GI tract (discontinuous involvement)
Often affects the terminal ileum (30%)
Rectum involved in only 50% of cases
High rate of anal fissures (75%)
Transmural inflammation (through all layers of bowel wall creating cobbled apperance)
Non-vascular pattern of inflammation
Granulomas present on biopsy
Can cause obstruction, fistulas, abscesses
Higher risk of malabsorption
Serosa inflammed

Question 8

What is the appearance of the mucosa in crohns disease?

Answer 8

cobblestone appearance due to linear ulceration seperated by fibrous bands
narrowed lumen
thickened wall

Question 9

What are the common symptoms of ulcerative colitis and crohns?

Answer 9

Abdominal pain
Diarrhea
Rectal bleeding
Extra-intestinal manifestations like arthritis

Question 10

What are the investigations used to identify IBD?

Answer 10

• blood tests
• faecal calprotectiin
• endoscopy
• leukocyte scan
• barium radiography
• bullet endoscopy

Question 11

What biomarker is increased in IBD

Answer 11

• faecal calprotectiin

Question 12

What are the blood tests measuring?

Answer 12

anaemia
CRP - c reactive protein
ESR - erythrocyte sedimentation rate

Question 13

What are complications of ulcerative colitis?

Answer 13

developing carcinoma over time

Question 14

What are the drugs used to treat IBD?

what are examples of each

Answer 14

Steriods - Local or Systemic (immunosuppressive)

5-Aminosalicylic Acid (5-ASA) - Anti inflammatory drugs

Non Steroid immunosuppresants

Anti TNFα therapy

Question 15

What surgery can cure UC?

Answer 15

colectomy

Question 16

What pallative (not curable) surgeries can be used to treat crohn’s disease?

Answer 16

• Remove obstructed bowel segments
• Drain abscesses
• Close fistulae – especially perianal

Question 17

What is the oral manifestion of crohns?

what features does it have and what can trigger it

Answer 17

orofacial granulomatosis

Granuloma formation blocks lymphatics leading to inflammtion/swelling of mouth/face, fissures, and cobbling

can be triggered by benzoate/sorbate/cinnamon (food preservatives and additives)

Question 18

Why does bowel cancer usually mean colonic cancers?

Answer 18

tumours in the SI are unusual and most likely related to lymphma or hormonal conditions

Question 19

What are the symptoms of colonic carcinoma?

why is there sometimes none?

Answer 19

patient may not have symptoms until the tumour completely blocks and the patient presents with obstruction

• anaemia and rectal blood loss due to bleeding from tumour

Question 20

What is the cause of colonic carcinoma?

Answer 20

polyps

• Most carcinomas arise in polyps
• May be pedunculated or flat
• Most will bleed due to irritation and trauma
• Most take 5 years to progress to malignancy

Question 21

What are the medical and familial causes of colonic carcinoma?

Answer 21

• Genetics – p53 in 75% (tumour suppresser gene mutation)
• Ulcerative Colitis
• Intestinal polyps

Question 22

What are the patient controlled causes of colonic carcinoma?

Answer 22

diet high in fat and meat, low in fibre/veg
smoking
excess alcohol
lack of exercise

Question 23

What conditions are polyps high risk for carcinoma?

Answer 23

in large intestine

• Gardiners Syndrome
• Cowden’s Syndrome

Question 24

What conditions are polyps low risk for carcinoma?

Answer 24

in small intestine
peutz-jehgers symdrome

Question 25

What is duke’s classes for colonic carcinoma staging?

Answer 25

A Submucosal
B Muscularis
C Lymph nodes
D Liver

Question 26

What is treatment for colonic carcinoma?

Answer 26

• Surgery
• Hepatic Metastases - if disease has spread to liver then care is palliative
• Radiotherapy
• Chemotherapy

Question 27

What surgeries can be used to treat colon cancer?

Answer 27

resection of the colon with anastomosis

section removed and stoma created for colostomy bag

Question 28

What is used for colonic carcinoma screening?

Answer 28

FIT (faecal immunochemical test) from age 50, 2 year repeat - looks for blood in stool

Endoscopy if FIT positive

Other Screening modalities:
* Barium Enema
* Endoscopy
* CT/MRI Scan
* Carcinoembryonic Antigen (CEA)