GI Disorders

Question 1

Severity of c diff

Answer 1

Non severe - WCC <15, creat <150
Severe - WCC >15, creat >150
Fulminant colitis if hypotension or shock, ileus, toxic megacolon

Question 2

C. Diff indications for surgery

Answer 2

Colonic perforation

Necrosis or full-thickness ischemia

Intra-abdominal hypertension or abdominal compartment syndrome

Signs of peritonitis or worsening abdominal exam despite adequate medical therapy

End organ failure

Question 3

Ulcerative colitis severity

Answer 3

Mild - 4 bowel movement per day, no systemic toxicity, normal ESR/CRP, mild symptoms

Moderate - more than 4 bowel movement per day, mild anaemia, mild symptoms, minimal systemic toxicity, nutrition maintained and no weight loss

Severe - more than 6 bowel movements per day, severe symptoms, systemic toxicity, significant anemia, increased ESR/CRP and weight loss

Question 4

Next step of ulcerative colitis

Answer 4

Repeat blood test to establish severity

Manage with steroid to establish remission acutely - commence on prednisolone (azathioprine)

Prepare for next method of treatment

• immuno-modulators e.g. azathioprine
• blood tests in prep