IBD

Question 1

INFLAMMATORY DIARRHOEA

i) name three characteristics seen in the bowel in UC
ii) name three reasons that inflammation in the colon gives you diarrhoea? at what time is this worse?
iii) name three other causes of inflam diarrhoea

Answer 1

i) inflammation, ulceration and necrosis

ii) inflamation disrupts mucosal integrity > inflam mediators cause secretion
- thick abnormal mucosa doesnt absorb well - poor abs of nutrients and water
- diarrhoea all the time but worse when eating

iii) bacterial/parasitic infections such as campylobacter, shigella, salmonella, c diff, e coli, giardia
- ischaemic
- chemical/radiation

Question 2

IBD

i) what is it? what are the two subtypes?
ii) which type only affects the colon and starts distally?
iii) which one can affect any part of the GI tract and charac by skip lesions?
iv) which one affects mucosa/submucosa only? which affects full thickness bowel wall?

Answer 2

i) chronic inflammatory disease of GI tract
- CD and UC

ii) colon/distal = UC
iii) any part of GI and skip lesions = CD
iv) muc/submuc = UC, full thickness = CD

Question 3

ULCERATIVE COLITIS

i) what is a very common symptom?
ii) when may abdo pain be felt? is it severe?
iii) name two things that may be seen only in severe attacks?
iv) do you get mouth ulcers, abdo massses and peri anal disease?

Answer 3

i) bloody diarrhoea
ii) mild abdo pain before defacation
iii) pyrexia and WL in severe attacks
iv) uncommon

Question 4

CROHNS DISEASE

i) is bloody or non bloody diarrhoea more common?
ii) what kind of abdominal pain is seen?
iii) name four other common symptoms
iv) is perianal disease common?

Answer 4

i) non bloody diarrhoea (if affecting distal colon will be bloody)
ii) severe colicky abdo pain
iii) weight loss, pyrexia, apthoid mouth ulcers, abdo mass
iv) yes - complex

Question 5

IBD AETIOLOGY

i) what is a big component?
ii) where is there a dysfunction?
iii) does smoking make CD worse or better?
iv) does it affect men or women more?

Answer 5

i) familial/complex
ii) mucosal barrier > body launches an inflammatory response
iii) makes it much worse
iv) M=F

Question 6

OSMOTIC DIARRHOEA

i) what is poorly absorbed?
ii) how can this type of diarrhoea be stopped?
iii) name three osmotic laxatives
iv) what type of malabsorption may be seen?

Answer 6

i) poor absorption of solutes and therefore liquid
- inhibit salt and water reabsorption

ii) completely stops if you dont eat (dont have osmotic solutes in lumen)
iii) laxido, movicol, lactulose
iv) specific malabs eg cant absorb bile salts, lactose etc all cause same problem

Question 7

COELIAC DISEASE

i) what is it driven by? what is damaged?
ii) where is most damage seen?
iii) name three antibodies that may be involved
iv) how does all damage resolve?
v) is it more common in men or women?

Answer 7

i) dietary gluten (wheat and barley)
- damages small bowel mucosa

ii) proximal intestine eg jejunum and tails off in distal small bowel (ileum)
ii) TTG, anti endomysial, anti gliadin
iv) exclude gluten from the diet
v) F>M

Question 8

COELIAC DISEASE DIAGNOSIS

i) how can it be screened for?
ii) what is the gold standard diagnostic test
iii) how is it dx in paeds?
iv) what type of diarrhoea do you get? why?

Answer 8

i) serology eg TTG screen
ii) biopsy is gold standard
iii) good hx, positive serology, positive HLA typing > dont need biopsy/gastroscopy
iv) osmotic diarrhoea due to reduced surface area for absorption

Question 9

BACTERIAL COLITIS

i) what type of diarrhoea will bacteria such as campylobactor or salmonella cause?
ii) what type of diarrhoea will cholera/ecoli cause
iii) what type of diarrhoea does lactose intolerance cause?

Answer 9

i) inflammatory
ii) secretory (only caused by toxogenic bacteria)
iii) osmotic - not abs so stays in gut and causes osmotic diarrhoea