GI flashcards

Question 1

describe the changes in the gut wall in crohn’s

Answer 1

transmural granulamatous inflamm
PATCHY BUT ALL THE WAY THROUGH THE WALL
GRANULOMATOUS (non-caseating)
skip lesions

Question 2

where can crohn’s changes be found?

and where in particular..

Answer 2

anywhere in the gut (mouth to anus)

esp terminal ileum + prox colon

Question 3

describe typical presenting Sx of Crohn’s

Answer 3

- diarrhoea
urgency 
(get up at 5am - go 5/6 times in the next 40mins)
abdo pain
wt loss
failure to thrive
'fine one minute - deathly the next'
fever / malaise  / anorexia

Question 4

describe some complications of crohn’s

Answer 4

Bowel: SBO / perforation / malabsorption (esp terminal ileum - b12). / abcess formation / fistulae / colon Ca
Anal - fissures / fistulae
Systemic - fatty liver / osteomalacia

Question 5

what blood tests would you request in a suspected crohn’s pt?

Answer 5

FBC - anaemia (could be anaemia of chronic disease / iron def / folate def..) - raised WCC/ raised platelets
Raised ESR
Raised CRP
negative pANCA

Question 6

name 1 eye, 1 joint, 1 skin and 1 hepatic manifestation of IBD

Answer 6

eye - uveitis / episcleritis

joint - enteropathic athritis / spondyloarthropathies

Question 7

describe the features of IBD-associated enteropathic arthritis and it’s management

Answer 7

10-15% of patients with IBD 
ASx arthritis predominantly affecting lower limb joints
HLA-B27 spondyltiis often also occurs 
JOINT SX MAYBE PREDATE BOWEL SX
Mx: 
 sulfasalazine
?steroids?
TNF-a Infliximab

Question 8

describe where UC can be found in the gut

Answer 8

Ulcerative colitis can affect the rectum alone (proctitis), can extend proximally to involve the sigmoid and descending colon (left-sided colitis), or may involve the whole colon (extensive colitis)

Question 9

descibe the microscopic changes in crohn’s

Answer 9

transmural inflammation
increase in chronic inflamm cells
lymphoid hyperplasia
granulomas

Question 10

decribe the microscopic changes in UC

Answer 10

inflammation in lamina propria
crypt abcesses
goblet cell depletion

Question 11

describe the macroscopic chnages in Crohn’s

Answer 11

involved bowel thickened + narrowed
cobblestone appearance - deep fissures
apthoid ulceration - early stage

Question 12

describe the macroscopic changes seen in UC

Answer 12

reddened inflamed mucosa
bleeds easily (friable..)

Question 13

what tests other than bloods would you request in suspected Crohn’s?

Answer 13

Stool (ESSENTIAL IF DIARRHOEA) - culture including C diff assay
Faecal calprotectin will be raised in active colonic disease (released from intestine whenever there’s inflammation..)
**Ileocolonscopy + biopsy
Small bowel imaging - eg barium follow through

Question 14

how might you monitor disease activity in Crohns?

Answer 14

1. faecal calprotectin

2. Hb / WCC / inflamm markers (CRAP / ESR / platelet count

Question 15

outline medical management of crohn’s (think of the principles….)

Answer 15

1. INDUCE REMISSION
   - if 1st pres / single exac in 12/12 - glucocorticoid eg. IV hydrocortison / Oral Pred
   - If 2nd in 12/12 - add Azathioprine. BUT FIRST - ASSESS TMPT levels
   - enteral nutrition
   - infliximab (anti-tnf a)
2. MAINTENANCE
   - azathioprine / MTX / infliximab
   - stop smoking
   - monitor for osteopenia / porosis
   PERIANAL DISEASE
   - MRI + EUA
   - oral Abx (cipro)
   - Infliximab

Question 16

when does crohn’s present..

Answer 16

bimodal distribution
first peak 20-30
second peak 60-70

Question 17

how to distinguish between CD + UC on:

1. macrocytically
2. microcytically
3. on barium

Answer 17

macro:
- CD - skip lesions / rectal sparing
- UC - continuous / non-rectal sparing
micro:
- CD - increased goblet cells, transmural inflammation
- UC - decreased goblet cells, inflammation limited to lamina propria (only mucosal disease)
on barium:
- CD - rose thorn ulcers (deep linear ulcers)
- UC - loss of haustrations / lead pipe colon

Question 18

describe the primary Sx of UC

Answer 18

** bloody diarrheoa**
episodic / chronic diarrhoea +/- blood / mucus
crampy abdo discomfort
bowel frequency relates to severity..
TOBUM
tenesmus
ooh (colicky pain)
bloody diarrhoea
urgency 
mucus

Question 19

give some differential diagnoses of IBD..

Answer 19

GE / TB / IBS / coeliac / diverticulitis

Question 20

outline the Truelove-Willis criteria for the severity of UC

Answer 20

Severe (>6 bowel motions / day, + large amounts of rectal bleeding + increased ESR)
Moderate (4-6 bowel motions /day - moderate amounths of blood)
Mild (<4 motions /day - low amounts of blood)

Question 21

describe some RFs for UC

Answer 21

Fam Hx IBD / recent NSAID use

Question 22

outline some complications of UC

Answer 22

double risk of colon Ca
Steroid Tx - osteoporosis
Opiates / antispasmodics (eg. loperamide) toxic megacolon (diameter >6cm)
venous thrombosis

Question 23

Investigations for UC?

Answer 23

investigations:
FBC - anaemia of Chronic disease
U&Es
LFTs - associated with PSC
Faecal calprotectin (raised NB - not raised in IBD)
**colonoscopy with multiple biopsies**
malabsorption..?

Question 24

Management of UC?

think of principles!!

Answer 24

INDUCING REMISSION
Mild-moderate
1. Oral mesalazine (topical if procto/sigmoiditis)
2. if no improvement in 4/52 - add oral pred
3. if no improvement in 4/52 - add oral tacrolimus
SEVERE:
1. admit + IV hydrocortisone + IV fluids
2. add IV ciclosporin
COLECTOMY IS CURATIVE - consider if toxic megacolon / > 8 stools per day