Lower GI

Question 1

Irritable bowel syndrome

Answer 1

1. Altered GI motility
2. Visceral hypersensitivity (inc sensory awareness)
3. psychological factors
4. Aphthlous ulcers, abdo pain, diarrhea, unintentional wt loss
   Menstrual cycle association
   Psychological symptoms

Question 2

Complications of Chron’s disease

Answer 2

Strictures –> small bowel obstruction

Tx - conservative management

Question 3

2 types of Volvulus

Answer 3

Cecal - cecum appears kidney shaped mass in LUQ

Colonic - ahaustral collection of gas “bent inner tube” from lower pelvis to beneath the diaphragm

Question 4

Types of Colitis

Answer 4

Infectious
Ischemic
Ulcerative

Question 5

Differential for inflammatory/bloody stool

Answer 5

Colitis
Chron's
IBS + stress
Ulcers
Haemorrhoids

Question 6

Disease associations with Celiac disease

Answer 6

Intestinal lymphoma
Adenocarcinoma
Ulcerative jejunitis
Pancreatitis

Question 7

Pathology of Celiac disease

Answer 7

Villous atrophy
Crypt hyperplasia
Increased intraepithelial lymphocytes

Question 8

Tropical sprue

Answer 8

small bowel overgrowth of aerobic coliform bacteria

Tx: folic acid, tetracycline

Question 9

Diverticulosis

Answer 9

Bacterial overgrowth leads to:

• mucosal damage
• malabsorption

Question 10

Chrons disease

Answer 10

Abdo pain/diarrhea, pain, systemic - upper GI, obstruction
Transmural, fistulas, perianal
ASCA +
Segmental resections fro complications or refractory disease

Question 11

UC

Answer 11

Bleeding and urgency
pANCA +
Diffuse, continuous from the anus up
No ileal involvement
Superficial diffuse ulcerations
Surveillance - 8 years after Dx than 1-2 years after.

Question 12

Rome diagnostic criteria for IBS

Answer 12

Recurrent abdominal pain or discomfort at least 3 days/month in at least 3 months associated with 2 or more of the following:

1. improvement with defecation
2. onset associated with a change in frequency of stool
3. onset associated with a change in form (appearance) of stool