Answer

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BOF: 40

A thirty five year old female has had a right hemicolectomy and resection of 30 cms of terminal ileum for ileocaecal Crohn’s disease. She has persistent diarrhoea, which is not explosive. She does not have abdominal pain, bloating, or loss of weight. Investigations have failed to demonstrate evidence of recurrent Crohn’s disease.

Treatment that would relieve symptoms and give a clue to the underlying diagnosis would be:

a)      Loperamide

b)      Steroids

c)      Cyclical antibiotics

d)      Cholestyramine

e)      Tricyclic antidepressants

Answer:

d)

The patient has had resection of the terminal ileum and the cause of the diarrhoea is likely to be Bile Acid Malabsorption (BAM). Treatment with a Bile Acid Sequestrants such as Cholestyramine would relieve symptoms and point to the diagnosis.

Revision Tip

Revise Crohn's disease KEYS to SUCCESS in Medicine page 251-254

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