Symposia

Question 1

What 3 criteria make something diarrhea

Answer 1

1) increased frequency more than 3x daily
2) abnormal consistency
3) large volume of stools (200g/ day)

Question 2

Difference between acute and chronic diarrhea

Answer 2

Acute=  less than 4 weeks, mostly infectious
Chronic= more than 4 weeks, chronic pathology, always investigate

Question 3

Causes of acute diarrhea

Answer 3

Viral: rotavirus, norovirus, enteric adenovirus
Bacterial: salmonella, shigella, campylobacter, S.aureus
Parasitic: cryptosporidium parvum

Question 4

Causes of chronic diarrhea

Answer 4

Colonic: ulcerative & crohns colitis, microscopic colitis, colorectal cancer
Small bowel: coeliac disease, crohn’s disease, bile salt malabsorption, lactose intolerance, small bowel bacterial overgrowth
Pancreatic: chronic pancreatitis, pancreatic cancer, cystic fibrosis
Endocrine: hyperthyroidism, diabetes, addison’s disease, hormone secreting tumours (rare)
Other: drugs, alcohol, factitious (laxatives)

Question 5

Mechanisms of diarrhea

Answer 5

osmotic eg lactose intolerance
steatorrhoea
secretory eg cholera, e.coli
inflammatory eg UC, crohns, infections
neoplastic
ischaemic
post irradiation

Question 6

Effect of smoking on

a) crohns
b) UC

Answer 6

makes crohns worse, makes UC better

Question 7

3 examinations we can do when investigating bowel disorders

Answer 7

feel the abdomen
Digitial Rectal Examination
Rigid sigmoidoscopy

Question 8

What stool tests, blood tests and imaging can we use when investigating bowel disorders

Answer 8

Stool tests: microscopy + culture, faecal elastase, faecal calprotectin
Blood tests: FBC, CRP(inflammatory marker), TTG(coeliac), TFT(thyroid function) B12 (vegan diet, pernicious anemia etc)
Imaging: colonoscopy, CT, video capsule, MRI small bowel

Question 9

Inflammatory bowel disease:

UC vs crohns similarities, differences

Answer 9

UC: only effects colon in continuity, mucosal inflammation, bloody diarrhea

Crohns: effects any part of GI tract, discontinuous, transmural inflammation, deep ulcers and fissures, fistulas and abcesses, abdominal pain and perianal disease, weight loss common, IBS type symptoms

Similarities: both can effect any age (peak 20-40), both can can cause extraintestinal manifestations

Question 10

Effect of appendicectomy on:

a) crohns
b) UC

Answer 10

Appendicectomy is protective for UC

Appendicectomy predisposes person to crohns so it bad for crohns

Question 11

Treatment of severe UC
3 things to avoid when treating severe UC

3 treatments if severe UC fails to respond to steroids

Answer 11

Admit, give hydrocortisone 100mg IV 4x daily, heparin subcutaneous, stool chart, AXR, daily CRP

NSAID’s, opiates, anti-motility agents(eg imodium)

infliximab (anti TNF-alpha drug= anti inflammatory), cyclosporin, colectomy

Question 12

Treatment of mild-moderate UC

Answer 12

Mesalazine (5 ASA, oral or suppository/enema)
Prednisolone
Azathioprine (immunosuppressant= anti inflam)
Biologics: infliximab (anti-TNF), vedolizumab (prevents wbcs sticking to mucosa= anti inflam)
Tyrosine kinase inhibitor: tofacitinib
Surgery

Question 13

Treatment Crohns disease

Answer 13

5 ASA preparations
prednisolone (corticosteroids)
azathioprine
methotrexate (inhibits folic acid metabolism)
nutritional therapy (elemental diet eg shakes)
antibiotics (less common, short term)
biologics: infliximab (anti-TNF), integrin blockers, interleukin blockers
surgery (more common in crohns than UC)