IBD, IBS and Coeliac

Question 1

Diagnosis of IBS

Answer 1

Considered if patient has one of the following for 6 months (ABC)
Abdo pain
Bloating
Change in bowel habit

Positive if
Abdo pain relieved by defacation
Altered bowel frequency stool form

Question 2

IBS investigations

Answer 2

FBC, ESR/CRP, coeliac screen (tissue transglutimase antibodies)

Question 3

IBS management

Answer 3

First line
pain:mebeverine
constipation: laxatives, avoid lactulose
diarrhoea: loperamide

Second line
low dose tricyclic antidepressant

Question 4

Risk of relapse of Chrohn’s disease is increased by

Answer 4

Smoking

Question 5

Gold standard for coeliac diagnosis

Answer 5

Endoscopic intestinal biopsy (must continue to eat gluten otherwise villous atrophy may not be present)

Question 6

Endoscopic intestinal biopsy findings in coeliac

Answer 6

Villous atrophy
Crypt hyperplasia
Increased intraepithelial lymphocytes
Lamina propria infiltration with lymphocytes

Question 7

Malnutrition is defined as BMI >

Answer 7

18.5 OR
unintentional weight loss >10% over 3-6 months OR
BMI >20 and 5% weightloss over 3-6 months

Question 8

what is ERCP

Answer 8

endoscopic retrograde colangeopancreatrography
uses x ray and an endoscope to treat liver, gallbladder, bile ducts and pancreas

Question 9

achalasia pathophys

Answer 9

ganglion cell degeneration causing failure of relaxation of the lower oesophageal sphincter and loss of peristalsis in distal oesophagus

Question 10

key X-ray achalasia finding

Answer 10

bird beak appearance at lower oesophageal sphincter

Question 11

achalasia investigations

Answer 11

oesophageal manometry: excessive LOS tone doesn’t relax on swallowing
barium swallow: grossly expanded oesophagus and bird beak
xray: bird beak and fluid level

Question 12

ulcerative colitis symptoms

Answer 12

bloody diarrhoea
urgency
tenesmus
LLQ abdo pain

Question 13

ulcerative colitis age occurence

Answer 13

15-25
55-65

Question 14

ulcerative colitis diagnosis

Answer 14

colonoscopy and biopsy finding red, raw mucosa that bleeds easily

Question 15

about ___ of people with IBD have anaemia

Answer 15

2/3rds

Question 16

risk of colorectal cancer higher in ulcerative colitis or chrons disease?

Answer 16

ulcerative colitis

Question 17

most appropriate investigation for h pylori

Answer 17

13c urea breath test

Question 18

deranged LFTs and secondary amenorrhoea

Answer 18

autoimmune hepatitis

Question 19

what medication may increase the risk of Chrohn’s disease relapse

Answer 19

NSAIDS

Question 20

H Pylori management

Answer 20

PPI + amoxicillin (or metronidazole) + clarithomycin

Question 21

What indicates a worse prognosis of Chrohns?

Answer 21

perianal disease

Question 22

what percentage of people with Chrohns also have osteoporosis?

Answer 22

30%

Question 23

is psoriasis in Chrohns related to disease activity?

Answer 23

No

Question 24

What laxative should be avoided in IBS?

Answer 24

Lactulose

Question 25

Red flag symptoms in IBS

Answer 25

1/ rectal bleeding 2/ unexplained weight loss 3/ family history bowel or ovarian cancer 4/ onset after 60

Question 26

What laxative can be used in IBS if other laxatives have not worked for 12 month?

Answer 26

?

Question 27

What foods should be avoided in IBS?

Answer 27

Insoluble fibres: bran and wholemeal bread

Question 28

Mild flare of UC criteria

Answer 28

>4 stools daily no systemic disturbance normal ERS and CRP

Question 29

Moderate flare of UC criteria

Answer 29

4-6 stools a day miminal systemic disturbance

Question 30

Severe flare of UC criteria

Answer 30

>6 stools a day containing blood systemic disturbance

Question 31

A family history of Chrohns disease is present in around ___% of all patients

Answer 31

25%-40%

Question 32

The risk of Chrohns is increased __x after a bout of gasteroenteritis

Answer 32

4

Question 33

what drug is used to maintain remission in left sided or extensive ulcerative colitis

Answer 33

Oral and reactal aminosalicylate: mesalazine

Question 34

treatment of severe flare of ulcerative colitis

Answer 34

admit to hospital IV corticosteroids

Question 35

mild/moderate distal (proctitis) UC flare treatment

Answer 35

topical (rectal) aminosalicylate

Question 36

mild/moderate extensive UC flare treatment

Answer 36

oral and rectal aminosalicylates

Question 36

severe relapse or >2 in past year treatment

Answer 36

oral thiopurines: azathioprine or oral mercaptopurine

Question 37

2nd line mild/moderate flare UC treatment

Answer 37

add oral corticosteroids (prednisolone)

Question 38

,Chrohns vs UC differences 1. bloody diarrhoea 2. weight loss 3. abdo pain 4. colorectal cancer

Answer 38

1. UC 2. Chrohns 3. Chrohns 4. UC

Question 39

Coeliac investigations

Answer 39

low ferritin and folate

Question 40

Oral aminosalycisate side effects

Answer 40

acute pancreatitis diarrhoea nausea vomiting