IBD and IBS stuff

Question 1

A man presents with mouth ulcers, losing weight and steatorrhea. What syndrome is he likely to have?

Answer 1

Malabsorption syndrome.

Question 2

What are the common causes of malabsorption syndrome in the UK?

Answer 2

Coeliac disease
Bile salt malabsorption
Exocrine pancreatic deficiency
Small bowel bacterial overgrowth
Cystic fibrosis
Lactase deficiency
Giardiasis
Lymphatic obstruction
Post gastric surgery.

Question 3

What does pale, malodorous, large quantitiy stools suggest?

Answer 3

Malabsorption

Question 4

What does oil droplets floating in the water of the toilet suggest?

Answer 4

Fat malabsorption.

Question 5

What class of causes is suggested if someone has nocturnal diarrhoea, faecal incontinence, significant weight loss and continuous rather than intermittent symptoms?

Answer 5

An organic cause

Question 6

Symptoms of bloating and diarrhoea worsened by milk suggests…

Answer 6

lactase deficiency

Question 7

Symptoms of bloating and diarrhoea after a fatty meal suggests…

Answer 7

Pancreatic insufficiency.

Question 8

Which malabsorption is suggested by chelitis (cracks at angles of mouth), oral ulcers, dry skin, lack lustre hair and bruising?

Answer 8

Vitamin malabsorption

Question 9

What is the most likely cause of microcytic anaemia

Answer 9

Iron deficiency.

Question 10

What bloods would you do with a man with mouth ulcers, losing weight and pale malodorous stools?

Answer 10

Full blood count
ESR, CRP
Liver function tests (impaired in alcohol abuse, liver disease, gall stone disease)
Renal function (dehydration)
Bone profile – levels may be abnormal with vitamin D deficiency
Haematinic screen (measurement of vitamin B12, folate, iron, ferritin and TIBC )
Clotting profile
Thyroid function tests
Coeliac antibodies (tissue transglutaminase,)

Question 11

Pancreatic function test

Answer 11

Faecal elastase

Question 12

Test for bile salt malabsorption.

Answer 12

75SeHCAT test: following ingestion of a natural analogue of bile acid (taurocholic acid), the retained fraction is assessed by a gamma camera seven days later. Values of less than 15% suggest bile salt malabsorption.

Question 13

Purpose of doing a small bowel follow through study, small bowel enema.

Answer 13

Helps to delineate the small bowel mucosal pattern (flocculation may be seen in coeliac disease, terminal ileal disease may be seen in Crohn’s disease)

Question 14

Purpose of doing small bowel biopsy

Answer 14

(mucosal / villous atrophy seen in coeliac disease)

Question 15

Purpose of doing a jejunal aspirate or glucose hydrogen breath test

Answer 15

Positive results are seen with bacterial overgrowth.

Question 16

Purpose of doing a DEXA scan in context of malabsorption syndrome

Answer 16

DEXA bone density scan for osteoporosis (coeliac disease)

Question 17

Special test for lactose malabsorption

Answer 17

Lactose hydrogen breath test

Question 18

What is the long term treatment for coeliac disease

Answer 18

Gluten free diet, haemophilus influenza B vaccine and pneumococcal vaccine.

Question 19

Treatment for bile salt malabsorption

Answer 19

Cholestyramine - a bile salt binding agent that reduces diarrhoea.

Question 20

Treatment for pancreatic exocrine dysfunction.

Answer 20

Supplementation of pancreatic enzymes in the form of Creon or Pancrex.

Question 21

Treatment for bacterial overgrowth of the small intestine.

Answer 21

Two weeks of antibiotics therapy with either metronidazole, ciprofloxacin or tetracycline. Some may need repeated courses or rotating courses.

Question 22

A common immune complication of coeliac disease

Answer 22

Splenic dysfunction or hyposplenia.

Question 23

What vaccinations are recommended for splenic dysfunction secondary to coeliac disease

Answer 23

Neisseria meningitis group C, pneumococcus (Streptococcus pneumoniae), Haemophilus influenza type B, and influenza (both seasonal and pandemic). The first three of these vaccinations are included in the standard schedule for children in the UK.

Question 24

Of Crohns and UC, which is more likely to present with bloody diarrhoea?

Answer 24

UC

Question 25

Of Crohns and UC, which is more likely to feature tenesmus?

Answer 25

UC

Question 26

Of Crohns and UC, which is more likely to feature gallstones?

Answer 26

Crohn’s

Question 27

Of Crohns and UC, which is more likely to be associated with primary sclerosing cholangitis?

Answer 27

UC

Question 28

Of Crohns and UC, which is more likely to be associated with renal oxalate stones?

Answer 28

Crohn’s

Question 29

Of Crohn’s and UC, which is more likely to be associated with large-joint arthritis, sacroilitis and pyoderma gangrenosum?

Answer 29

UC