Gut

Question 1

extra-intestinal manifestations of IBD

Answer 1

A PIE SAC (extra-intestinal manifestations of IBD)

Aphthous ulcers, ankylosing spondylitis

Pyoderma gangrenosum
Iritis
Erythema nodosum

Sclerosing cholangitis
Arthritis, ankylosing spondylitis (HLA B27)
Clubbing

Question 2

causes of diarrhoea

Answer 2

On SOME MONdays, I get diarrhoea (causes of diarrhoea)

Secretory (HIV – hormonal, infections [E. coli, S. aureus, V. cholera], villous adenoma)
Osmotic (LMS – lactose intolerance, magnesium antacids, gastric surgery)
Motility, abnormal intestinal (TIBS – thyrotoxicosis, IBS)
Exudative (CIBD – colon cancer, IBD)

Malnutrition Of Nutrients (many different causes)

Question 3

causes of upper GI bleeding

Answer 3

MVP in a CAVE (causes of upper GI bleeding)

Mallory-Weiss syndrome
Varices (esophageal, gastric)
Peptic ulcer  MORE COMMON CAUSE (acute with erosion, chronic)

Carcinoma (+ polys, other tumours of gastric)
Amyloidosis
Vascular (FAV – aortoenteric fistula, angiodysplasia, vascularities, other vascular anomalie)
Esophagitis (erosive, ulcerative)

Apart from peptic ulcers, others are less common cause

Question 4

causes of lower GI bleeding

Answer 4

CHAD [more common] for MUSIG Chair [less common] (causes of lower GI bleeding)

Colonic carcinoma, polyp
Haemorrhoids, or anal fissure
Angiodysplasia
Diverticular disease

Meckel’s diverticulum
Upper GI (massive) bleeding
Small bowel disease (eg. tumour, diverticula, intussusception)
Inflammatory bowel disease
Galbladder bleeding (“haemobilia”)

Colon (ischaemic colitis, solitary colonic cancer)

Question 5

Features of ulcerative colitis

Answer 5

Features of ulcerative colitis
Mnemonic: ULCERS IN Abdomen
U Ulcers (mucosal and submucosal)
L Large intestine (rectum always involved. May extend proximally to involve entire colon)
C Clubbing
E Extra-intestinal manifestations
R Remnants of old ulcers (pseudopolyps)
S Stools bloody
I Inflamed, red, granular mucosa and sub mucosa
N Neutrophil invasion
A Abscesses in crypts

Question 6

Complications of ulcerative colitis

Answer 6

Complications of ulcerative colitis
Mnemonic: How To Perform GI Colonoscopy
H Haemorrhage
T Toxic megacolon
P Perforation
G Gallstones
C Colorectal carcinoma (in those with extensive disease for > 10 years)

Question 7

Morphology and symptoms of Crohnʼs disease

Answer 7

Morphology and symptoms of Crohnʼs disease
Mnemonic: CHRIS Has Too Much Diarrhoea and Abdominal pain
C Cobblestone appearance of mucosa
H High temperature
R Reduced lumen/Rose-thorn ulcers
I Intestinal fistulae/Ileo-caecal region commonly involved (40% of cases)
S Skip lesions

H Hyperplasia of mesenteric lymph nodes
T Transmural inflammation (all layers, may ulcerate)
M Malabsorption
D Diarrhoea (watery)
A Abdominal pain

Question 8

Chronic diarrhoea

Answer 8

Chronic diarrhoea  
Mnemonic: 5 Cʼs  
Inflammatory causes of chronic diarrhoea include:  
C  	Crohnʼs disease  
C  	Ulcerative Colitis

Question 9

Malabsorptive causes of chronic diarrhoea include:

Answer 9

Malabsorptive causes of chronic diarrhoea include:  
Mnemonic: 3C's
C  	Cystic fibrosis  
C  	Coeliac disease  
C 	Cowʼs milk intolerance

Question 10

Features of Stillʼs disease

Answer 10

Features of Stillʼs disease

Adult-onset Still’s disease is a rare (< 1.5 per 100,000) systemic inflammatory disease. The classic presentation is the triad of persistent high spiking fever, joint pain and a distinctive salmon-colored rash. Serum ferritin, a protein that binds iron, is elevated

Mnemonic: STILLS  
S	Spiking illness/Severe malaise  
T	There could be myalgia/arthralgia  
I 	Increased size of liver/spleen  
L 	Lose weight, anaemia  
L 	Looks like malignancy  
S 	Salmon-pink rash