Gi Systems - Chronic bowel Disorders

Question 1

Coeliac disease is disorder of what?
Occurs where?

Answer 1

Intolerance to Gluten

Occurs in small intestine

Question 2

Gluten causes what symptom specifically?

Answer 2

Bloating

Question 3

Diverticulosis?

Answer 3

Asymptomatic small pouches

Question 4

Diverticular?

Answer 4

Symptomatic Small pouches

Symptoms: Diarrhoea, Constipation, Abdominal pain, Rectal bleeding

Question 5

Acute Diverticulitis?

Answer 5

Inflamed/infected pouches

Severe abdominal pains, fever, bleeding

Question 6

Complicated acute Diverticulitis?

Answer 6

Abscess, Perforation, Fistula, Obstruction, Sepsis, Haemorrhage

Question 7

Treating Diverticular?

Answer 7

Paracetamol, Bulk forming laxative - Fibre increase

Question 8

Crohn’s disease how it looks?

Answer 8

Affects Whole Gi tract but patchy deep ulcerations/thickened walls etc

Question 9

Why does Crohn’s disease lead to malnutrition?

Answer 9

Less surface area to absorb due to the ulcers

Question 10

Acute treatment for Crohn’s?

Answer 10

Monotherapy:
Prednisolone, Methylprednisolone or IV Hydrocortisone

Question 11

Disteal ileal, ileocaecal or right sided disease treatment?

Answer 11

If monotherapy w/ prednisolone, Methylprednisolone or IV Hydrocortisone

Use Budesonide if doesn’t work ^

Question 12

2nd line for acute crohns?

Answer 12

Sulfasalazine or Mesalazine

Less side effects but less effective

Question 13

What is classed as acute crohns?

Answer 13

First flare up in 12 months

Question 14

If pt has 2+ flare ups in 12 months?

Answer 14

Add Azathioprine or Mercutopurine

If contraindicated: use Methotrexate

Severe: Monoclonal Antibodies

Question 15

Maintenance treatment of Crohn’s

Answer 15

Encourage Stop smoking

Monotherapy: Azathioprine or Mercatopurine

Methotrexate if monotherapy contraindicated or used as acute treatment

Question 16

Post surgery in crohns disease?

Answer 16

Azathioprine + Metronidazole

If metronidazole not tolerated:
Azathioprine alone

Question 17

Diarrhoea caused in Crohn’s treatment?

Answer 17

Loperamide
Codeine
Colestyramine

Question 18

What to avoid in ulcerative colitis?

Answer 18

Loperamide
Codeine
Colestyramine

Question 19

Fistulating Crohn’s disease if Asymptomatic?

Answer 19

Leave alone

Question 20

Symptomatic Fistulating Crohn’s disease

Answer 20

Metronidazole +/- Ciprofloxacin for 1month

Not 3 months due to peripheral neuropathy

Question 21

Maintenance of Fistulating Crohn’s disease?

Answer 21

Azathioprine or Mercartopurine

If not responding:
Monoclonal antibody infliximab
(Atleast 1 year of treatment)

Question 22

Ulcerative Collitis symptoms?

Answer 22

Bloody diarrhoea
Abdominal pain
Defecation urgency

Question 23

What complications can ulcerative colitis lead to?

Answer 23

Colerectal cancer

Secondary Osteoporosis

Venous thromboembolism

Toxic Megacolon

Question 24

5 different types of ulcerative colitis?
(Progressive as you go)

Answer 24

1) Proctitis
2) Proctosigmliditis
3) Distal/left sided
4) Extensive colitis
5) Pancolitis

Question 25

First three stages of Ulcerative Collitis acute treatment?

Answer 25

Think -> close to rectum still

So use suppositories

Foam prep if or difficult retaining liquid

Question 26

Why avoid loperamide or codeine in ulcerative colitis?

Answer 26

Can cause TOXIC MEGACOLON

Which is a Big infection as they slow down gastric emptying and it builds in colon

Question 27

Proctitis or the “Tip” of colon treatment?

Answer 27

Topical aminosalicylates

If no improve after 4wks: oral aminosalicylates

Still no improvement: Corticosteroids
(4-8wks)

Question 28

If aminosalicylates contraindicated?

Answer 28

Topical/ oral corticosteroids for 4-8wks

Question 29

Proctosigmoiditis and left sided ulcerative colitis treatment?

Answer 29

Topical Aminosalicylates

High dose oral aminosalicylate

If not topical/oral corticosteroids

*Ensure to stop topical treatment when offering oral corticosteroid upgrade

Question 30

Extensive ulcerative colitis treatment?

Answer 30

Way too high up for just topical

Therefore both Topical aminosalicylate and High dose oral aminosalicylate

If no change STOP topical aminosalicylate and do:

High dose aminosalicylate + oral corticosteroids for 4-8wks

(2 ORALS!)

Question 31

Severe ulcerative colitis treatment?

Answer 31

Life threatening -> Emergency

As soon as pt arrived in hospital:
- IV Hydrocortisone or Methylprednisolone

Question 32

In severe ulcerative colitis, if IV steroids in hospital is contraindicated?

Answer 32

Use IV Ciclosporins or surgery

Question 33

If symptoms haven’t helped within 72hrs of hospital emission for severe ulcerative colitis?

Answer 33

IV Steroid + IV Ciclosporin + Surgery

If Ciclosporin contraindicated:
- Infliximab

Question 34

Severe Ulcerative Colitis maintenance treatment?

Answer 34

Oral Aminosalicylate OD (once daily is most effective but risk of toxicity)

*Don’t use steroids due to side effects

Question 35

Severe proctitis or proctosigmoiditis?

Answer 35

Rectal and/or Oral aminosalicylate

Question 36

Severe left sided or extensive Ulcerative Colitis?

Answer 36

Low dose oral aminosalicylates

Question 37

Aminosalicylates monitoring needed?

Answer 37

Nephrotoxic - before, 3months, annual
Hepatotoxic - monthly for first 3 months
Blood disorder - monthly for first 3m

Perform Blood count

IF SIGNS OF BLOOD DYSCRASIA: STOP!

Question 38

Aminosalicylates are contraindicated in what?

Answer 38

Salicylate Hypersensitivity

Question 39

Sulfasalazine colour contact lens what colour?

Answer 39

Orangey-Yellow