IBD

Question 1

top 6 causes of rectal bleeding

Answer 1

1. Local: anal fissure.
2. Swallowed blood from epistaxis
3. Gastroenteritis (more likely bacterial cause)
   103
4. Acid ulceration: hiatus hernia, peptic ulcer, Meckel’s diverticulum
5. Intussusception (late sign in approx 50% of cases)
6. Inflammatory bowel disease

Question 2

top 5 risk factors of IBD

Answer 2

1. Family history of IBD
2. Family history of autoimmune conditions – thyroid disease, rheumatoid arthritis
3. Parental smoking
4. Bottle feeding
5. Peri anal signs – 50% of paediatric Crohn’s patients will have diagnostic signs on
   inspection

Question 3

features of crohns disease 5

Answer 3

N – No blood or mucus (these are less common in Crohns.)
E – Entire GI tract
S – “Skip lesions” on endoscopy
T – Terminal ileum most affected and Transmural (full thickness) inflammation
S – Smoking is a risk factor (don’t set the nest on fire)

Question 4

features of ulcerative colitis 7

Answer 4

C – Continuous inflammation
L – Limited to colon and rectum
O – Only superficial mucosa affected
S – Smoking is protective
E – Excrete blood and mucus
U – Use aminosalicylates
P – Primary sclerosing cholangitis

Question 5

presentation of suspected IBD in children and teens

Answer 5

1. perfuse diarrhoea
2. abdo pain
3. bleeding
4. weight loss
5. anaemia

*-may be systemically unweel during flares - with fevere malaise and dehydration

Question 6

extra-intestinal features of IBD
-for both -6

Answer 6

1. finger clubbing
2. erythema nodosum
3. pyoderma gangrenosum
4. episcelritis
5. iritis
6. inflammatory arthtis
   7

Question 7

one specific extra-intestinal manifestiation of ulcerative colitis -1

Answer 7

primary sclerosing cholangitis

Question 8

blood tests for IBD 6

Answer 8

Blood tests for:
1. anaemia
2. infection
3. thyroid function
4. kidney function
5. liver function
6. raised CRP

Question 9

useful screening tool for IBD

Answer 9

faecal calprotectin- releaed when iintestines are inflammed
-more than 90% sensitive and speicfic for IBD

Question 10

gold standard investiagion for IBD

Answer 10

endoscopy
-OGD
-colonoscopy

Question 11

imaging for IBD 3

what are they useful for 3

Answer 11

1. US
2. CT
3. MRI

-used to look for complications such as fistulas, abscess and stricitures

Question 12

general management of IBD in children

Answer 12

1. referred to secondary care for specialsit assessment and management -followed up by MDT
2. ESSENTIAL MONITOR GROWTH AND PUBERTAL DEVELOPMENT
3. manage inducing remission and maintaining remission

Question 13

general management of IBD in children

Answer 13

1. referred to secondary care for specialsit assessment and management -followed up by MDT
2. ESSENTIAL MONITOR GROWTH AND PUBERTAL DEVELOPMENT
3. manage inducing remission and maintaining remission

Question 14

management of crohns
-inducing remission 2

Answer 14

1. steroids (oral pred) oral budesonide)
2. immunosuppresants -azthioprine etc

Question 15

management of crohns
-inducing remission 2

Answer 15

1. steroids
2. immunosuppresants

Question 16

immunosuppresants to induce remission in crohns 5

Answer 16

1. azathiprine
2. mercaptopurine
3. methotrexate
4. infliximab
5. adalimumab

Question 17

management of crohns
-maintaining remission
first line 2

Answer 17

1. azathiprine
2. mercaptopurine

*-Treatment is tailored to individual patients based on risks, side effects, nature of the disease and patient preference

Question 18

management of crohns alternatives for maintaining remission 3

Answer 18

1. methotrexate
2. infliximab
3. adalimumab

Question 19

surgery for crohns 1

Answer 19

if only affects distal illeum then possible
-laparoscopic ileo-cecal resection

*-surgery can be used to treat strictures and fistulas secondary to crohns disease

Question 20

management of Ulcerative Colitis
-inducing remission
-mild to moderate disease 2

Answer 20

first line - aminosalicylate (mesalazine oral or rectal)

second line - corticosteroids- pred

Question 21

management of Ulcerative Colitis
induciung remission
severe disease 2

Answer 21

first line IV corticosriods -hydrocort

second line IV ciclopsporin

Question 22

management of Ulcerative Colitis
maintaing remission 3

Answer 22

aminiosalcicylate-mesalazine

azathioprine

mercaptopurine

Question 23

surgery for ulcerative colitis 1

Answer 23

panproctocolectomy - remove colon and rectum

-patient left with EITHER permanet ilesostmy or an ileo-anal anastomosis (J-pouch)

Question 24

describe a J pouch

Answer 24

ileum is folded back on itself and fashioned into a larger pouch that functions like a rectum. This “J-pouch” is then attached to the anus and collects stools prior to the person passing a motion.