IBD

Question 1

What are the differences between ulcerative colitis crohn’s disease?

Answer 1

1. Crohn’s affects whole of gut while UC restricted to large bowel
2. Skip lesions in CD while continuous in UC
3. Lesions span entire gut wall in CD vs mucosa/submucosa only in UC
4. Fistula formation in CD due to above, no fistula involvement in UC

Question 2

What is the aetiology of IBD?

Answer 2

genetic susceptibility + bacterial insult + cytokines

Question 3

What is the most common symptom in CD if small bowel is affected?

Answer 3

abdominal pain

Question 4

What is the most common symptom in CD if large bowel is affected?

Answer 4

bloody diarrhoea (the same symptom is observed in UC)

Question 5

A patient with crohn’s disease has nutritional deficiency. Why is this?

Answer 5

Likely that duodenum is affected, which is the main site for absorption e.g. folate, iron

Question 6

Why is it important to ask about opening bowels during the night in a GI history?

Answer 6

It distinguishes between functional disease e.g. IBS and organic disease e.g. IBD

Question 7

Which blood markers would be deranged in IBD?

Answer 7

High WCC, low Hb, low albumin (absorbed from duodenum, perhaps less prominent in UC), high CRP

Question 8

A patient has a month-long history of bloody diarrhoea. A sigmoidoscopy has been conducted and is found to show no pathological changes. Which diagnosis can be ruled out?

Answer 8

Ulcerative colitis because UC originates from the distal colon whereas CD can appear anywhere along the tract.

Question 9

What is the treatment for IBD? Is the same treatment used in both UC and CD?

Answer 9

Same treatment strategy for both. Step-up treatment (triangle scheme). 1. First step/mild: 5-ASAs, abx 2. 2nd step/moderate: Oral corticosteroids, immunomodulators e.g. methotrexate, azathioprine, cyclosporine 3. Final step/severe: Biologics 4. Surgery (curative in UC but lifelong stoma)

Question 10

A 24 year old is diagnoses with crohn’s disease. What would you be worried about given their age?

Answer 10

Cancer risk, therefore to avoid risk perform surgery

Question 11

How can fistulas be diagnosed?

Answer 11

MRI

Question 12

Which inflammatory marker is a useful tool in IBD?

Answer 12

faecal calprotectin= inflammatory marker of GI tract, raised in IBD but not IBS, and can be useful to monitor progress with treatment

Question 13

Which drugs can raise faecal calprotectin levels?

Answer 13

NSAIDs, antidepressants, omeprazole

Question 14

Fistulae is a feature of?

Answer 14

crohn’s

Question 15

Cobblestone mucosa is a feature of?

Answer 15

crohn’s

Question 16

Three symptoms of UC?

Answer 16

diarrhoea, tenesmus, abdo discomfort, blood + mucous PR

Question 17

Two symptoms of crohn’s?

Answer 17

diarrhoea
abdo pain
weight loss

Question 18

Two signs of crohn’s?

Answer 18

RIF mass
anal/rectal strictures
abdo tenderness
Ulcers, glossitis

Question 19

Two signs of UC?

Answer 19

fever

tender, distended abdomen

Question 20

Describe three extra-abdominal features of both UC and crohn’s

Answer 20

SKIN- finger clubbing, erythema nodosum, pyoderma gangrenosum

Eyes- iritis, conjunctivits, episcleritis

Joints- arthritis, ankylosing spondylitis, scaroiliitis

Question 21

Two complications of UC?

Answer 21

toxic megacolon
bleeding
malignancy
strictures- obstruction

Question 22

Two complications of crohn’s?

Answer 22

fistulae
strictures
abscesses
malabsorption

Question 23

Investigations for UC?

Answer 23

bloods
stool- exclude infection
imaging- AXR, CXR, CT
ileocolonoscopy + biopsy

Question 24

Describe two features of blood results in UC

Answer 24

FBC- low Hb, incr WCC
LFT- low albumin
CRP raised

Question 25

Two drugs to treat UC?

Answer 25

5-ASA, prednisolon, azathioprine, infliximab

Question 26

What are the investigations for crohn’s disease?

Answer 26

Almost identical to UC!

Question 27

What is megacolon?

Answer 27

diameter>5.5cm or caecum >9cm

Question 28

How can chronic inflammation seen in IBD be distinguished from infective colitis?

Answer 28

no architectural changes in infective, high plasma cell infiltration in IBD not seen in infection

Question 29

What is back-wash illeitis?

Answer 29

severe ulcerative colitis where ileum and caecum are involved

Question 30

What are the microscopic features of ulcerative colitis?

Answer 30

crypt architectural changes, changes restricted to mucosa and submucosa, little/no fibrosis, no granulomas

Question 31

What is the treatment of ulcerative colitis?

Answer 31

Mesalazine/5-ASA (these are the same thing)

Question 32

What is the treatment of severe relapse of ulcerative colitis?

Answer 32

azathiprine/6MP + steroids

Question 33

What are the difference between crohn’s and UC pathology?

Answer 33

Broadly similar, however pattern of distribution differs. Crohn’s- patchy inflammation, transmural inflammation, and GRANULOMAS!!! (epithelioid macrophages). Distal inflammation in UC.

Question 34

What is the treatment of crohn’s disease?

Answer 34

Azathioprine, 6-mercaptopurine, methotrexate, biologics- infliximab

Question 35

Is mesalazine used in both crohn’s and UC?

Answer 35

only in UC!

Question 36

First line treatment for inducing remission of crohns?

Answer 36

Glucocoticoid: IV hydrocortisone
2nd line: budesonide
3rd line: 5-ASA

Question 37

First line treatment for maintaining remission of crohn’s?

Answer 37

azathioprine or mercaptopurine

Question 38

What are three long term complications of crohn’s?

Answer 38

small bowel cancer
colorectal cancer
osteoporosis