GI week: IBD, GORD, bowel obstruction, diverticulitis, GI cancer

Question 1

Among the following diseases, which would give transudate/exudate

• Liver failure (cirrhosis)
• Heart failure
• Kidney failure
• Pancreatitis
• Infection
• Neoplasm
• TB

Answer 1

Transudate: liver, heart, kidney failure

Exudate: Pancreatitis, Infx, Neoplasm, TB

Question 2

What are some extra-intestinal manifestations of IBD?

Which ones are more common in UC?

Answer 2

• Pyoderma gangrenosum
• Iritis
• Erythema nodosum
• Sclerosing cholangitis
• Ankylosing spondylitis
• Clubbing

More common in UC: Pyoderma gangrenosum, sclerosing cholangitis, ankylosing spondylitis

Question 3

Is UC or Crohn’s more common

Answer 3

UC

but incidence of Crohn’s now rising due to everything being disinfected so immune systems nowadays are weaker

Question 4

Crohn’s/UC tend to cause pain more commonly in RIF/LIF

Answer 4

Crohn’s: RIF

UC: LIF

Question 5

Crohn’s/UC have:

• skip lesions/uniform
• superficial inflammation/transmural damage

Answer 5

Crohn’s: skip lesions, transmural damage

UC: uniform, superficial inflammation

Question 6

Crohn’s/UC have more blood/mucus in stool

Answer 6

Crohn’s: more mucus

UC: more blood

Question 7

Most common type of upper GI cancer

Answer 7

Adenocarcinoma

Question 8

If someone has no stool found in a DRE, but is not passing stool, what should be suspected?

Answer 8

Bowel obstruction

Question 9

Systematic approach to AXR

Answer 9

1. Projection
2. Patient Details
3. Technical Adequacy (should include hemidiaphragms down to symphysis pubis & hernia orifices)
4. Obvious Abnormalities
5. Systematic Review (easiest to start from rectum and go backwards)
   - Large and small bowel
   - Diameter of the bowel
   - Bowel Wall Thickness
6. Other – foreign bodies, bones etc

Question 10

Maximum diameter of small bowel

Answer 10

3cm

Question 11

Maximum diameter of large bowel

Answer 11

6cm (except caecum which can be up to 9cm)

Question 12

Difference between valvula conniventes and haustra

Which is in small/large bowel

Answer 12

• Valvula conniventes (goes all the way across) - SMALL BOWEL
• Haustra (doesn’t go all the way across) LARGE BOWEL

Question 13

Presentation of bowel obstruction

Answer 13

1. Pain (crampy)
2. Distension
3. Vomiting
4. Constipation
5. Lack of bowel sounds/tinkling bowel sounds

Question 14

What normal condition may cause dilation and radiological appearance of small bowel obstruction?

Answer 14

Post-operative ileus (disruption of normal movement of intestines)

Question 15

Is small or large bowel obstruction more common

Answer 15

Small bowel obstruction more common

Question 16

What features may be found in AXR of patient with IBD

Answer 16

• Often normal

- May have signs of inflammation

Question 17

Signs of bowel inflammation on AXR

Answer 17

• thickened bowel wall
• thumbprinting (from thickening of haustral folds
• mucosal islands (white patches on black bowel)

Question 18

Where does pain from diverticulitis normally occur

Answer 18

LIF

Question 19

Symptoms of diverticulitis

Answer 19

• LIF pain
• fever
• nausea
• constipation or diarrhoea
• bleeding in stools

Question 20

Complications of diverticulitis

Answer 20

• peritonitis (from perforation)
• abscess formation (from perforation)
• fistula in bladder/ vagina (affected colon adheres to other organs in pelvic cavity)
• bowel obstruction

Question 21

Risk factors for chronic mesenteric ischaemia

Answer 21

PVD/IHD risk factors

• smoking
• hypertension
• high cholesterol
• diabetes
• family history

Question 22

Risk factors for acute mesenteric ischaemia

Answer 22

Sources of emboli

• a fib
• recent MI
• cardiac valvular disease

Question 23

Most common cause of lower GI bleeding

Answer 23

Diverticular disease

Question 24

Which type of IBD is highly associated with primary sclerosing cholangitis

Answer 24

UC

Question 25

Which cancer is associated with H pylori?

How to treat this cancer

Answer 25

Gastric MALT lymphoma

Treat with H pylori eradication