2. Inflammatory Bowel Diseases

Question 1

Types of inflammatory bowel diseases (2)

Answer 1

Crohn's disease (CD)
Ulcerative colitis (UC)

Question 2

Aetiology of IBDs (4)

Answer 2

Immunological
Psychological
Smoking
Genetics

Question 3

Cause of Crohn’s

Answer 3

Granulomatous inflammation/non-caseous granulomas

Question 4

Reasons for granulomatous inflammation/non-caseous granulomas (2)

Answer 4

Food intolerance

Persisting viral infection/immune activation

Question 5

Most commonly affected body parts for Crohn’s (2)

Answer 5

Proximal colon

Terminal ileum

Question 6

Feature of Crohn’s

Answer 6

Skip lesions may be present (oral/anal symptoms - top and tail)

Question 7

Features of UC (5)

Answer 7

Ulcers just in mucosa
Continuous along colon
More bleeding than Crohn's
Absence of goblet cells, distortion of crypts
Flat and vascular - not much swelling

Question 8

Definition of granuloma

Answer 8

Build-up of immune and epithelioid cells

Question 9

Differences between UC and Crohn’s - UC (7)

Answer 9

Disease continuous
Rectum always involved
Anal fissures - 25%
Ileum involved - 10%
Mucosa granulomatous and ulcers present
Vascular
Normal serosa

Question 10

Differences between UC and Crohn’s - Crohn’s (7)

Answer 10

Disease discontinuous
Rectum involved 50%
Anal fissures - 75%
Ileum involved - 30%
Mucosa cobbled and fissures present
Non-vascular
Inflamed serosa

Question 11

Crohn’s vs UC - continuous disease or not

Answer 11

Crohn’s - disease discontinuous

UC - disease continuous

Question 12

Crohn’s vs UC - rectum involvement

Answer 12

Crohn’s - involved 50%

UC - always involved

Question 13

Crohn’s vs UC - anal fissures

Answer 13

Crohn’s - 75%

UC - 25%

Question 14

Crohn’s vs UC - ileum involvement

Answer 14

Crohn’s - involved 30%

UC - involved 10%

Question 15

Crohn’s vs UC - mucosa presentation

Answer 15

Crohn’s - cobbled and fissures present

UC - granulomatous and ulcers present

Question 16

Crohn’s vs UC - vascularity

Answer 16

Crohn’s - non-vascular

UC - vascular

Question 17

Crohn’s vs UC - serosa presentation

Answer 17

Crohn’s - serosa inflamed

UC - serosa normal

Question 18

Microscopic features of UC (3)

Answer 18

Mucosal
Vascular
Mucosal abscesses

Question 19

Microscopic features of Crohn’s (3)

Answer 19

Transmucosal
Oedematous
Granulomas

Question 20

UC symptoms (7)

Answer 20

Diarrhoea
Abdominal pain
PR bleeding
Bile motions
Mucus
Urgency
Tenesmus

Question 21

Crohn’s symptoms (6)

Answer 21

Colonic disease (same as UC)
Small bowel disease (pain, obstruction, malabsorption)
Mouth disease (OFG)

Question 22

Vitamins involved in malabsorption (3)

Answer 22

Iron
Vitamin B12
Folate

Question 23

OFG clinical features (5)

Answer 23

Lip swelling
Angular cheilitis
Cobblestoning
Ulceration
Gingivitis

Question 24

IDB investigations (3)

Answer 24

Blood tests (anaemia, CRP, ESR)
Faecal calprotectin
Endoscopy
(leukocyte scans, barium studies, bullet endoscopy)

Question 25

Complications of UC (4)

Answer 25

Carcinoma
Perforation
Bleeding
Toxic megacolon

Question 26

Complications of Crohn’s (2)

Answer 26

Obstruction

Abscess formation

Question 27

Drugs involved in medical treatment of IBDs (5)

Answer 27

Systemic steroids (prednisone)
Local steroids (rectally administered)
Anti-inflammatories (5-ASAs - mesalazine)
Non-steroid immunosuppressants (azathioprine)
Anti-TNFa therapy (infliximab)

Question 28

Surgical treatment of IBDs results in

Answer 28

A stoma/bag

Question 29

Surgical treatment of UC

Answer 29

Colectomy - cures UC

Question 30

Surgical treatment of Crohn’s (4)

Answer 30

Palliate symptoms
Remove obstructed bowel symptoms
Drain abscesses
Close fistulae (especially perianal)
Usually only when acute problems manifest

Question 31

Characterisation of OFG

Answer 31

Persistent enlargement of soft tissues of mouth, lips and area around the mouth

Question 32

Oral ulcers are worse when

Answer 32

UC is worse