Small and Large bowel disorders

Question 1

What are the 2 major IBDs

Answer 1

Crohns and Ulcerative Colitis

Question 2

What gene is linked to the develpment of Crohn’s disease

Answer 2

CARD15/NOD2 gene on chromosome 16

Question 3

Where is there the greatest prevalence of IBD

Answer 3

Developed countries where there is improved sanitation

Question 4

Smoking is protective in Ulcerative Colitits. True or False

Answer 4

True

Question 5

Smoking is protective in Crohn’s disease. True or False

Answer 5

False

Question 6

What is the incidence of Crohns in the developed world

Answer 6

7 in 100,000

Question 7

What is the incidence of Ulcerative colitis in the developed world

Answer 7

12 in 100,000

Question 8

What disease is increasing in prevalence

Answer 8

Crohn’s disease

Question 9

What is the immune response in Crohn’s disease

Answer 9

Th1 driven

release of TNF alpha and interferon gamma

Question 10

What is the immune response in Ulcerative colitis

Answer 10

Th2 driven

increased release of proinflammatroy cytokines including IL-5

Question 11

Give characteristic features of Crohns which are absent in Ulcerative Colitis

Answer 11

Skip lesions (non-continuous fashion) 
Ileocaecal is the most common area to be affected 
Full thickness inflammation
deep ulcers 
cobblestone appearance 
may cause fistula and abscess

Question 12

Give characteristic features of UC which are absent in Crohn’s

Answer 12

Involves the rectum and extends in a confluent manner to involve the sigmoid colon and rectum
Only colonic mucosa is involved
Inflammation is confined to the mucosa
higher incidence of colorectal carcinoma

Question 13

What is the histological hallmark of Crohn’s disease

Answer 13

Giant cell granuloma

Question 14

What is the histological hallmark of UC

Answer 14

Acute and chronic inflammatory cells and abscesses

Question 15

What are the common presentations of Crohn’s disease

Answer 15

Abdominal pain  
diarrhoea 
Weight loss 
malabsorption
anorexia 
malaise

Question 16

What is the common presentations of UC

Answer 16

Bloody diarrhoea
tenesmus
abdominal pain

Question 17

How is the severity of UC determined

Answer 17

By the frequency, degree of blood loss in stools, pule and temperature

Question 18

What are some complications of IBD

Answer 18

Toxic megacolon
Perforation
Cancer

Question 19

What could be used to investigate a patient who is too unwell to undergo endoscopy or abdominal CT

Answer 19

Radiolabelled white cells scan

Question 20

What is the first line treatment of Crohn’s disease

Answer 20

Oral prednisolone for 4-6 weeks

Question 21

What is the main drug used to treat Ulcerative Colitis

Answer 21

5ASA

Question 22

What is the main drug used to treat Ulcerative Colitis

Answer 22

5ASA

Question 23

Why are patients with IBD predisoposed to metabolic bone disease

Answer 23

The use of steroids

Question 24

What can steroids cause in children

Answer 24

Growth retardation

Question 25

What percentage of ileal crohn’s patients will have at least one operation

Answer 25

90%

Question 26

When is surgery for UC most common

Answer 26

In the first 5 years after diagnosis

Question 27

What is microscopic colitis

Answer 27

Collagenous colitis and lymphocytic colitis

Question 28

Who is most likely to get microscopic colitis

Answer 28

Patients with coeliac disease, autoimmune disorders and those taking PPIs and NSAIDs

Question 29

On what side of the colon are changes most commonly seen in microscopic colitis

Answer 29

right

Question 30

What age do patients present with IBS

Answer 30

Any age

Question 31

How is the diagnosis of IBS made

Answer 31

Having excluded organic diseases with the same symptoms

Question 32

What are the 3 categories for IBS

Answer 32

c-IBS - constipation
d-IBS - diarrhoea
m- IBS - mixed

Question 33

What are the main symptoms of IBS

Answer 33

Cramping abdominal pain
Rectal mucus loss
Incomplete evacuation

Question 34

What can be used to treat patients with IBS

Answer 34

Antispasmodics
Tricyclic antidepressants in low dose
Occasional patients need hypnotherapy or CBT

Question 35

What can be used to treat patients with IBS

Answer 35

Antispasmodics
Tricyclic antidepressants in low dose
Occasional patients need hypnotherapy or CBT

Question 36

What is the least vulnerable vessel to ischaemia

Answer 36

Coeliac vessel

Question 37

What are 4 causes of gut ischaemia

Answer 37

Arterial thromboembolism
Venous insufficiency
Profound hypotension
Vasculitis

Question 38

What is acute small bowel ischamia

Answer 38

A rare medical emergency characterised by severe abdominal pain with minimal physical signs

Question 39

In terms of ABGs, what is common in acute small bowel ischaemia

Answer 39

Metabolic acidosis

Question 40

What is the management for acute small bowel ischaemia

Answer 40

Aggressive resuscitation
analgesia
correction of acidosis

Question 41

When does the pain typically start in chronic intestinal ischaemia

Answer 41

30 mins after eating and can last 4 hours

Question 42

What is the gold standard test for chronic intestinal ischaemia

Answer 42

Angiography

Question 43

What might be seen on an Abdo X ray in Ischaemic colitis

Answer 43

Thumb printing at the splenic flexure (mucosal oedema)

Question 44

When does acute radiation enteritis occur

Answer 44

Early weeks after first radiotherapy

Question 45

What are the symptoms of acute radiation enteritis

Answer 45

Vomiting
Pain
diarrhoea