IBS / IBD

Question 1

What is IBS?

Answer 1

Bowel symptoms for which a cause cannot be found

Question 2

Epidemiology of IBS

Answer 2

Affects around 10-20% of adults

Question 3

Pathophysiology of IBS

Answer 3

Altered motor and sensory function of the GIT

Question 4

Clinical presentation of IBS

Answer 4

Abdominal discomfort
Altered bowel habits
Relief on defecation
Bloating
Sensation of incomplete emptying

Question 5

RFs for IBS

Answer 5

Sexual abuse
Age <50
Female
Pre. enteric infection

Question 6

Method and criteria required for Dx of IBS

Answer 6

ROME criteria

Aldo discomfort > 12 wks which is removed by defecation + 2 of urgency, incomplete evacuation, bloating etc

Question 7

Ix in IBS

Answer 7

FBC
Stool studies
Plain AXR
Flexible sigmoidoscopy
Colonoscopy

Question 8

DDx IBS

Answer 8

Chrons/UC
Coeliac
Colon Ca

Question 9

Management of IBS

Answer 9

Mainly lifestyle modifications

If constipation dominant

• +/- laxatives
• +/- antispasmodics

If diarrhoea dominant

• +/- antidiarrhoeal
• +/-antispasmodics

Question 10

Exclusion criteria for IBS

Answer 10

>40 years
Blood stool
Anorexia
Wt. loss
Diarrhoea at night

Question 11

Differences in pathology between Crohn’s and UC

Answer 11

Crohn’s:

• mouth to anus
• skip lesions
• strictures present
• Granulomas present

UC:

• Rectum and colon
• Contiguous
• No strictures
• No granulomas

Question 12

Epidemiology of UC

Answer 12

100-200/100K
Peak 30s
Smoking protective
TH2 mediated

Question 13

Epidemiology of Crohns

Answer 13

50-100/100K
Peak 20s
Smoking increases risk

Question 14

Systemic symptoms of both Crohns and UC

Answer 14

fever
malaise
anorexia
wt. loss in active disease

Question 15

Symptoms specific to Crohns

Answer 15

Diarrhoea
Abdo pain
Wt. loss
PR normal

Question 16

Symptoms specific to UC

Answer 16

Diarrhoea
Blood and mucus PR
Abdominal discomfort
Tenesmus
Urgency

Question 17

Abdominal signs seen in UC

Answer 17

Fever

Tender distended abdomen

Question 18

Abdominal signs seen in Crohns

Answer 18

Mouth ulcers
Glossitis
Abdominal tenderness
RIF mass
Anal strictures

Question 19

Extra ambominal signs comment to both UC and Cr

Answer 19

Skin: clubbing, erythema nodusum
Eyes: Iritis / conjunctivitis
Joints: arthritis

Question 20

RFs for IBD

Answer 20

+FHx

• smoking
• NSAIDs
• Good hygiene risks chances of CD
• HLAB77 +ve (UC)

Question 21

Some complications of UC

Answer 21

Toxic megacolon
Bleeding
Malignancy

Question 22

Some complications of Crohns

Answer 22

Fistulae
Strictures
Abscesses
Malabsorption

Question 23

Investigations to order in Cr

Answer 23

Bloods: FBC, LFT, CRP/ESR, Haematinics, Cultures
Stool studies
Imaging
Endoscopy

Question 24

Management of Cr

Answer 24

1. Vaccinate against influenza, hep B, HPV, VZV, PPV
2. Severe: admit + IV steroids + Abx + LMWH
3. If no improvement then medical: MTX +/- infliximab or surgery

Question 25

Management of UC

Answer 25

Severe: Admit + IV hydration + NBM + IV steroids + LMWH
Improvement: Switch to oral pred.
No improvement: rescue therapy: medical - ciclosporin + infliximab or surgical