Y3 - GI

Question 1

Which gastroenteritis’ produce haemolytic anaemia?

Answer 1

EColi and Shigella both produce Shiga Toxin which destroys RBC and results in Haemolytic uraemic syndrome

Question 2

How would you manage Gastroenteritis generally?

Answer 2

• microscopy, culture, sensitivities of faeces
• Fluid challenge!!!
  
  • rehydration solutions like dioralyte if tolerated
  • if not, give IV fluids
• slowly introduce light diet
• stay off work/school 48 hours after last V/D

Question 3

How does Crohns present? (on investigations too)

Answer 3

• RIF mass/pain (commonly ileocaecal)
• blood in stool
• malabsorption (ileum is site of b12 absorption too)
• Smoking makes it worse!
• skip lesions anywhere from mouth to anus
• Histology = transmural inflammation, fissures, ulcers = cobblestone appearance
• Colonosocpy + Biopsy = non caseating granuloma

Question 4

How does UC present? on investigations too

Answer 4

• bloody mucous diarrhoea, bloating
• Smoking is protective
• continuous submucosal inflammation from rectum extending proximally
  
  • if just rectal+sigmoid colon = proctitis
• Histology = pseudopolyps, crypt abscess, goblet cell hypoplasia
• AXR = lead pipe colon, mural thickening and thumbprinting
• Complications = toxic megacolon

Question 5

What investigations would you do for IBD?

Answer 5

• faecal calprotectin
• Stool cultures to rule out infective colitis
• CT for complications
• FBC, U&Es, CRP
• Crohns:
  
  • diagnostic = colonoscopy + biopsy
    
    • OGD/capsule endoscopy/flexi sigmodioscopy etc
  • Barium swallow for fistulas/strictures etc
• UC:
  
  • Flexi sigmodioscopy for bloody diarrhoea
  • AXR
  • biopsy/histology
    *