IBD and IBS stuff Flashcards
A man presents with mouth ulcers, losing weight and steatorrhea. What syndrome is he likely to have?
Malabsorption syndrome.
What are the common causes of malabsorption syndrome in the UK?
Coeliac disease Bile salt malabsorption Exocrine pancreatic deficiency Small bowel bacterial overgrowth Cystic fibrosis Lactase deficiency Giardiasis Lymphatic obstruction Post gastric surgery.
What does pale, malodorous, large quantitiy stools suggest?
Malabsorption
What does oil droplets floating in the water of the toilet suggest?
Fat malabsorption.
What class of causes is suggested if someone has nocturnal diarrhoea, faecal incontinence, significant weight loss and continuous rather than intermittent symptoms?
An organic cause
Symptoms of bloating and diarrhoea worsened by milk suggests…
lactase deficiency
Symptoms of bloating and diarrhoea after a fatty meal suggests…
Pancreatic insufficiency.
Which malabsorption is suggested by chelitis (cracks at angles of mouth), oral ulcers, dry skin, lack lustre hair and bruising?
Vitamin malabsorption
What is the most likely cause of microcytic anaemia
Iron deficiency.
What bloods would you do with a man with mouth ulcers, losing weight and pale malodorous stools?
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,)
Pancreatic function test
Faecal elastase
Test for bile salt malabsorption.
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.
Purpose of doing a small bowel follow through study, small bowel enema.
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)
Purpose of doing small bowel biopsy
(mucosal / villous atrophy seen in coeliac disease)
Purpose of doing a jejunal aspirate or glucose hydrogen breath test
Positive results are seen with bacterial overgrowth.
Purpose of doing a DEXA scan in context of malabsorption syndrome
DEXA bone density scan for osteoporosis (coeliac disease)
Special test for lactose malabsorption
Lactose hydrogen breath test
What is the long term treatment for coeliac disease
Gluten free diet, haemophilus influenza B vaccine and pneumococcal vaccine.
Treatment for bile salt malabsorption
Cholestyramine - a bile salt binding agent that reduces diarrhoea.
Treatment for pancreatic exocrine dysfunction.
Supplementation of pancreatic enzymes in the form of Creon or Pancrex.
Treatment for bacterial overgrowth of the small intestine.
Two weeks of antibiotics therapy with either metronidazole, ciprofloxacin or tetracycline. Some may need repeated courses or rotating courses.
A common immune complication of coeliac disease
Splenic dysfunction or hyposplenia.
What vaccinations are recommended for splenic dysfunction secondary to coeliac disease
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.
Of Crohns and UC, which is more likely to present with bloody diarrhoea?
UC
Of Crohns and UC, which is more likely to feature tenesmus?
UC
Of Crohns and UC, which is more likely to feature gallstones?
Crohn’s
Of Crohns and UC, which is more likely to be associated with primary sclerosing cholangitis?
UC
Of Crohns and UC, which is more likely to be associated with renal oxalate stones?
Crohn’s
Of Crohn’s and UC, which is more likely to be associated with large-joint arthritis, sacroilitis and pyoderma gangrenosum?
UC
