General

Question 1

3 day old boy presents with no bowel movements, bilious emesis, distended abdomen.

How would you diagnose and manage?

Answer 1

Full thickness rectal biopsy (histology for presence of ganglion cells)

if deficient - Hirschprung’s disease

Pt will often be systemically unwell with a sepsis like picture. Treat (fluid resus) then may need colostomy.

Question 2

25 yo patient 6 month hx of abdominal cramps and episodes of constipation and of diarrhoea accompanied by fever, often self resolving and normal bowel habits resumed until the next episode. Pt has had weight loss due to diarrhoea. O/E, perianal ulcers are present.

1st line Test for disease?

Answer 2

Feacal calprotectin

Indicates the level of neutrophils which have migrated into intestinal mucousa - ie inflammation.

Positive = inflammatory, with this hx - Crohn’s Disease.

Question 3

1st line monotherapy for 1st presentation of CD exacerbation to induce remission.

Answer 3

Predinsolone.

Question 4

30 yo with exacerbations of diarrhoea, abdominal cramps over a period of 12 months. Prednisolone has been taken and now now exacerbations for 6 . What is most appropriate next treatment?

Answer 4

Azathioprine

or

Mercaptopurine

In CD, prednisolone is initially given to induce remission. If this is successful, azathioprine or mercaptopurine monotherapy should be given to maintain remission.

Question 5

30 yo with episodes of self limiting pr bleeding associated with diarrhoea, feeling fever, fatigue and weight loss. Poss anaemic due to pr bleed.

Diagnosis and test.

Answer 5

UC.

Faecal calprotectin - shows infammatory bowel, the hx of pr bleeding and anaemia points towards UC rather than CD.

Question 6

27yo pt 12 month hx of episodic diarrhoes and abdominal cramps. CRP and WCC raised. Feacal calprotectin positive, biopsy shows granulomas and lesions in colon.

Diagnosis?

Answer 6

All signs of IBD, both UC and CD.

Granulomas are unuique to CD.

Question 7

26yo presents with 4 week hx of tenesmus and diarrhoea often associated with fresh blood. Stool cultures are negative. CRP raised, feacal calprotectin positive. Colonoscopy shows isolated proctitis.

What is the most appropriate treatment?

Answer 7

Aminosalycylate

Topical and/or oral

Question 8

67 yo recently admitted to ward from ICU and aggressive treatment with abx. Suddon onset of watery diarrhoea with some pus, dehydration, low BP.

What organism is the most likely cause?

What test can be done?

What is the most likely diagnosis?

What is the treatment?

Answer 8

C Diff

Feacal glutamate dehydrogenase indicates the presence of an overgrowth of flora.

If glutamate dehydrogenase is positive, a toxin test can be done to confirm.

This case is most likely pseudomembranosus colitis due to c diff.

Treat with vancomycin.

Question 9

27yo femal presents with 6 month hx of ongoing constipation. No blood, no particular flare ups. Weight gain, notice change in voice tone and can’t stnad the cold weather. Pulse of 50.

Most likely cause of constipatioin?

Answer 9

Hypothyroidism.

Question 10

35yo presents with 6 month hx of frequent episodes of diarrhoea, often accompanied by fresh blood. No cramps, no recent infections. Feacal glutamate dehydrogenase is negative, colonoscopy reveals hundreds of polyps.

Diagnosis and complication?

Answer 10

Familial Adenomatous Polyposis.

Autosomal dominant. Hundreds to thousands of adenomatous polyps form, and high risk of neoplasm.

Question 11

Whay can extremely constipated pts sometimes present with diarrhoea?

Answer 11

rectum is blocked, but pressure behind is so hight that some watery faeces leaks past, around the blockage and causes diarrhoea.

Question 12

20 yo presents with 12 months hx of episodes of diarrhoea. Stool sample is positive for calprotectin, but negative for toxin. CRP and ESR raised, and Hb is lowered. pANCA is positive.

Diagnosis?

Answer 12

Any bowel inflammation will cause raised calprotectin, but with lack of toxins, it;s not infective diarrhoea.

pANCA is specific for UC

Question 13

20 yo presents with 12 months hx of episodes of diarrhoea. Stool sample is positive for calprotectin, but negative for toxin. CRP and ESR raised, and Hb is lowered. ASCA is positive.

Diagnosis?

Answer 13

Any bowel inflammation will cause raised calprotectin, but with lack of toxins, it;s not infective diarrhoea.

ASCA is specific for CD

Question 14

What are the 4 types of laxative?

Answer 14

• Bulk forming
• Osmotic
• Stimulant
• Surface wetting

Question 15

How do hyperosmotic laxatives work?

Give examples

Answer 15

Increase the amount of water in the LI which stimulates peristalsis.

Laxido

Lactulose

Question 16

How do stimulatory laxatives work?

Give example

Answer 16

Stimulate the mucousa/nerves to induce peristalsis

eg Senna

These are the most effective AND most dangerous laxitives - loss of haustra.