MICA cases Flashcards
A patient presenting with painless rectal bleeding, do they need investigation?
Rectal bleeding must be investigated unless there is a good evidence clinically for haemorrhoids
What other things should be asked about with rectal bleeding?
weight loss, change in bowel habit, tenesmus and the presence of mucus in the stool
What are the top differential for painless rectal bleeding?
Carcinoma of the colon
Haemorrhoids
What conditions are associated with an increased risk of colorectal carinoma?
Peutz-Jeghers syndrome
Familial adenomatous polyposis (FAP)
Ulcerative colitis
What is FAP?
Hundreds to thousands of adenomatous polyps lining the colon
Autosomal dominant
When might you do a CXR in a gastro pt?
Staging after confirmed GI tumor
What are dukes criteria for staging?
Dukes A – tumour confined to bowel wall
Dukes B – tumour has gone through wall but not into nodes
Dukes C – tumour involving regional nodes
Dukes D – distant metastases are present
Dukes stage histologically affects prognosis – i.e. 90% alive at 5 years Dukes A, reducing to 10% for Dukes D.
In who should a diagnosis of IBS be considered?
patients who have either abdominal pain or bloating or change in bowel habit for a minimum of six months
What initial tests should be done to exclude other differentials other than IBS?
FBC
ESR
CRP
Coeliac serology
What dietary advice is give to those with IBS?
Regular meals Restrict carbonated drinks Increase water intake Reduce caffeine intake Discourage use of sweetners in IBS with diarrhoea Increase oats and linseeds
What are some treatments for IBS?
CBT low dose TCA for abdo pain Loperamide for dirrhoea Hypnotherapy Antispasmodic agents
PR bleeding, weightloss and diarrhoea - apart from bloods what investigations?
AXR
Stool cultures
Flexible sigmoidoscopy
What are some extra-intestinal manifestations of UC related to colitis?
Erythema nodosum Aphthous ulcers Episcleritis Anterior uveitis Acute arthropathy
What are some extra-intestinal manifestations of UC not related to colitis?
Sacroiliiitis /Ankylosing spondylitis
Primary sclerosing cholangitis
Which of the following tests may help diagnosis of the lower back pain?
85-95% Caucasian patients with axial spondyloarthropathy are positive for HLA-B27
Lower back and sacro-iliac XR
MRI lumbar spine and sacro-iliac joints
What is first line management of acute sever colitis?
IV Hydrocortisone
What is next management if unresponsive to initial UC treatment?
IV ciclosporin
Infliximab
What is infliximab?
biologic which suppresses the TNF-alpha and should only be considered if intravenous ciclosporin is contra-indicated or inappropriate
What are contraindications to ciclosporin?
hypertension and renal impairment
How is mild UC defined?
fewer than 4 stools a day with no systemic disturbance and normal CRP and ESR
How is moderate UC defined?
4-6 stools a day with minimal systemic disturbance
How is severe US defined?
more than 6 stools a day and evidence of systemic disturbance
What is used to induce remission in sever UC?
IV corticosteriods
Oral in mild/moderate
Young female with diarrhoea at weight loss - differentials?
Coeliac
Hyperthyroidism
Crohn’s
How is a diagnosis of coeliac disease confirmed?
Small bowel biopsy, which is most easily obtained during an OGD
IgA tTG serology is reasonably accurate (>95%), it is not sufficient
When is HLA genotyping used to diagnosis coeliac?
patients who have put themselves onto a gluten free diet before small bowel biopsies were obtained
What happens when a GF diet is adhered to?
Small bowel changes completely resolve
Why is a bone density scan recommended in pts. with coeliac disease?
osteopenia / osteoporosis is very common in patients who are newly diagnosed with coeliac disease
Why is first degree relative screening recommended in coeliac?
10% of their relatives will have / develop coeliac disease
