Lower GI

Question 1

What are the main features of irritable bowel syndrome?

Answer 1

Pain. (Relieved by defecation)
Bloating
Change in bowel habit (cons and or diarr) +mucus.

Question 2

Investigations for irritable bowel syndrome

Answer 2

FBC
ESR/CRP
Coeliac screeen (tTG antibodies)

Red flags: wt loss, blood In stool, FH of Ca and onset over 60.

Question 3

What’s the treatment for remission in ulcerative colitis,?

Answer 3

Localised : rectal (topical) aminosalicylates
Wide spread: oral aminosalicylates

2nd line oral steroids (Pred)

Severe colitis should be treated in hospital with IV steroids.

Question 4

What are the symptoms of diverticulitis?

Answer 4

Pain LIF
Bloody stool - painless, 
Anorexia, nausea and vomiting 
Diarrhoea 
Fever, raised WCC and CRP

Question 5

Which inflammatory marker correlates with disease activity in crohns?

Answer 5

CRP

Question 6

What are this histology differences in UC and Crohns?

Answer 6

Uc - submucosa only, crypt abscesses, depletion of goblet cells and mucin,
Plus pseudopolyps
Radio - loss of haustations (lead pipe), narrow and short colon (due to inflammation)

Crohns - mucosa to serosa, increased goblet cells and granulomas present.
Plus cobble stone and skip lesions,and deep ulcers
Radio - strictures (kantors string sign), rose thorn ulcers, fistula

Question 7

Test in GP to distinguish between IBS and IBD?

Answer 7

Faecal calprotectin

Question 8

What is peutz-jeghers syndrome?

Answer 8

AD condition, with hamartomatous polyps in GI tract (high risk of GI cancer)
Also get pigmentation on lips, face, palm and soles.
GI bleeding.
GI obstruction (eg intussusception)

Question 9

WhAt is melanosis coli?

Answer 9

Pigmentation of the bowel wall, caused by laxative abuse (eg senna)

Question 10

What’s the difference between mesentric ischemia and ischemic colitis?

Answer 10

MI - small bowel, embolism, sudden, high mortality

IC - large bowel, transient, less severe, conservative management (often splenic flexture)

CT is the investigation of choice

Question 11

What’s the disgnositic tests used in coeliacs disease?

Answer 11

Immunology ( Ttg) and jejunal biopsy (villous atrophy, crypt hyperplasia, more lymphocytes)

Question 12

What scope should you do in acute colitis?

Answer 12

Flexi sig

Not colonoscopy! - pain, perforation, can get biopsy on flexi sig

Question 13

Management of acute colitis

Answer 13

Exclude: infection, TB, and c. Diff 
AXR
Rehydrate 
Steroid 
LMWH
5 ASA