GI problems

Question 1

describe crohn’s disease vs ulcerative colitis

Answer 1

Crohn’s disease

• any part of GI tract
• discontinuous inflammation
• deep ulcers, cobblestone appearance
• transmural inflammation
• inflammatory, fistulising, stricturing, perianal
• worsened by smoking, granulomas may be present

ulcerative colitis

• colon only
• continous inflammation, starting at rectum
• shallow ulcers
• mucosal inflammation
• inflammatory
• smoking is protective

Question 2

four presentations of Crohn’s

Answer 2

inflammatory

• colitis = diarrhea, bleeding
• ileitis = abdo pain
• gastriti/duodenitis = dyspepsia

fistulising
- formation of tract between gut & other organ/vessel

stricturing

• abdo pain & distention
• vomiting
• bowels not opening

perianal

• abscess
• fistula
• anal fissure

Question 3

treatment of IBD

Answer 3

• 5-ASA (mild anti-inflammatory)
• steroids
• immunosupression e.g. azathioprine, 6-mercaptopurine
• biologics = ABs against TNF (e.g. infliximab, adalimumab)

Question 4

consequences of terminal ileum resection

Answer 4

B12 malabsorption
- loss of B12/IF complex receptors

bile salt malabsorption

• released by liver through bile duct, reabsorbed in terminal ileum into enterohepatic circulation
• after resection, loss of bile salts through colon -> irritant -> stimulates water & electrolyte secretion -> secretory diarrhea
• less salts -> fat malabsorption (steatorrhea)

Question 5

• 25y/o woman
• 3 month history of watery diarrhoea
  * 6 times a day, 3 times at night
  * blood
  * lower abdominal cramps
  * weight loss = 5kg (important to know the duration)
• usually bowel habit 1/day
• smoker: 3 cigarettes /day
• on COCP (nothing else

explain the likelihood of infection

Answer 5

• history too long and otherwise is fit and well
• important to exclude C. difficile in recent antibiotics
• course of infection can be longer in immunocompromise

Question 6

• 25y/o woman
• 3 month history of watery diarrhoea
  * 6 times a day, 3 times at night
  * blood
  * lower abdominal cramps
  * weight loss = 5kg (important to know the duration)
• usually bowel habit 1/day
• smoker: 3 cigarettes /day
• on COCP (nothing else

explain the likelihood of coeliac

Answer 6

unlikely due to bleeding

Question 7

• 25y/o woman
• 3 month history of watery diarrhoea
  * 6 times a day, 3 times at night
  * blood
  * lower abdominal cramps
  * weight loss = 5kg (important to know the duration)
• usually bowel habit 1/day
• smoker: 3 cigarettes /day
• on COCP (nothing else

explain the likelihood of irritable bowel syndrome

Answer 7

• unlikely as bowel habit is regular, bleeding

- nocturnal diarrhea

Question 8

• 25y/o woman
• 3 month history of watery diarrhoea
  * 6 times a day, 3 times at night
  * blood
  * lower abdominal cramps
  * weight loss = 5kg (important to know the duration)
• usually bowel habit 1/day
• smoker: 3 cigarettes /day
• on COCP (nothing else

explain the likelihood of inflammatory bowel disease

Answer 8

• possible

- bleeding and diarrhoea are common presenting symptoms

Question 9

• 25y/o woman
• 3 month history of watery diarrhoea
  * 6 times a day, 3 times at night
  * blood
  * lower abdominal cramps
  * weight loss = 5kg (important to know the duration)
• usually bowel habit 1/day
• smoker: 3 cigarettes /day
• on COCP (nothing else

explain the likelihood of cancer

Answer 9

• not usually present in a young person

- however, check family history of polyp syndrome

Question 10

what does a blood test with low albumin and high ferritin indicate

Answer 10

acute phase reaction

Question 11

extra-intestinal manifestations of IBD

Answer 11

• eye = uveitis (uvea layer lies between retina & sclera)
• primary sclerosing cholangitis (Crohn’s)
• joints = ankylosing spondylitis
• skin = erythema nodosum

Question 12

rectal bleeding

- importance of colour and location

Answer 12

black/melaena = upper GI tract, small intestines

bright red, on paper = outlet (e.g. perianal)

bright red, mixed in stool = left colon

dark red = proximal colon, distal small intestines

Question 13

causes of upper GI bleeding

Answer 13

• peptic ulcer disease (risk factors = NSAID, H. pylori)
• varices
• malignancy
• oesophageal cancer
• Mallory-Weiss tear

Question 14

causes of lower GI bleeding

Answer 14

• angiodysplasia
• cancer
• ischemic colitis

Question 15

causes of iron deficiency anaemia

Answer 15

• inadequate dietary intake (vegetarian)
• impaired absorption (coeliac)
• abnormal loss ( overt & occult bleeding)

Question 16

how do you diagnose coeliac disease

Answer 16

antibodies while consuming gluten:
-TTG IgA antibody

histology (gold standard)

• intra-epithelial lymphocytosis
• crypt hyperplasia
• villous atrophy

Question 17

genetics associated with coeliac

Answer 17

• > 99% coeliacs carry either HLA-DQ2, HLA-DQ8

- most people in general pop carry these genes, so test only useful when negative

Question 18

associations with coeliac disease

Answer 18

• dermatitis herpertiformis
• first degree relative with coeliac
• type 1 diabetes

Question 19

treatment for coeliac

Answer 19

• gluten-free diet (no wheat, barley, rye)

- oats = some coeliac cannot tolerate, cross-contamination with wheat possible

Question 20

importance of iron deficiency anaemia in regards to age and gender

Answer 20

• young women w/out GI symptoms = menstrual loss
• young women w GI symptoms = needs investigations
• older women & all men = always investigate (exclude cancer)

Question 21

perianal (Crohns)

Answer 21

• abscess
• fistula
• anal fissure

Question 22

associations with stricturing (Crohns)

Answer 22

• abdominal pain & distention
• vomiting
• bowels opening

Question 23

define fistulising

Answer 23

• formation of tract between gut & another vessel/organ

e. g. SI & skin, rectum & vagina