IBD

Question 1

What is ulcerative colitis?

Answer 1

A relapsing remitting conditon that is not associated with granulomas (tissue produced in response to infection/inflammation)

It only affects the colon and is characterised by a continous band of inflammation

Question 2

How does UC present?

Answer 2

Weight loss

Abdominal pain

Bloody diarrhoea

Question 3

What are the clinical features of UC?

Answer 3

Stool frequency - >6 stools/day with blood

Fever

Tachycardia

ESR/CRP raised

Anaemia (due to blood loss)

Albumin low

Question 4

How is UC investigated?

Answer 4

Bloods

Stool sample

AXR

Colonoscopy + biopsy

Question 5

How is UC diagnosed?

Answer 5

Based on presence of clinical features

AXR - Mucosal thickening, colonic dilatation

Sigmoidoscopy - Inflammed mucosa

Rectal biopsy - Goblet cell depletion, crypt abscesses

pANCA - Perinuclear antineutrophilic cytoplasmic antibody (+ve in 75% of UC patients)

Question 6

How is UC managed?

Answer 6

Out patient:

1) 5ASA - Mesalazine given rectally to increase time between flare ups and reduce length of flare ups
2) Steroids - Hydrocortisone
3) Immunosuppression - Methotrexate, Infliximab

Hospital:

1) Steroids
2) Anticoagluation
3) Rest

Question 7

What is Chron’s disease?

Answer 7

A disordered response to intestinal bacteria with transmural inflammation

Can affect any part of the GI tract, but most commonly affects terminal Ileum

Associated with Granuloma formation

Question 8

How does Chron’s disease present?

Answer 8

1) Weight loss
2) Abdominal pain + palpable mass
3) Diarrhoea with blood
4) Fever

Question 9

What are the clinical signs of Chron’s disease?

Answer 9

1) Abdominal tenderness
2) Mass in right iliac fossa
3) Cobblestone mucosa
4) Perianal fistula
5) Clubbing
6) Erythema Nodosum

Question 10

How is Chron’s investigated?

Answer 10

1) Blood
2) Stool
3) Sigmoidoscopy + biopsy (can see microscopic granulomas)
4) Colonoscopy (assess disease extent, visualise cobblestoning mucosa)
5) MRI

Question 11

How is Chron’s diagnosed?

Answer 11

Bloods:

Lowered Haemoglobin

Lowered albumin

Raised ESR

Raised CRP

Raised WCC

Stool:

Calprotectin (>200 is elevated above normal)

Sigmoidoscopy + biopsy - Diagnostic

Question 12

How is Chron’s disease managed?

Answer 12

Conservative:

• Stop smoking
• Low residue diet

Medical:

• Hydrocortisone (Steroids)
• 5 ASA’s - induction and maintenance of remission (5ASA’s)
• Methotrexate (Immunosuppressants)

Surgical:

• Remove strictured or obstructed part of bowel

Question 13

What are the pathological appearances of IBD?

Answer 13

UC:

• Inflammation of colon in continous patch
• Depletion of Goblet cells
• No granulomas
• Inflammed mucosa
• Crypt abscesses

Chron’s:

• Transmural inflammation
• Granulomas
• Fissures + linear ulceration
• Peri-anal fistulas

Question 14

What are the general classes of drugs used to treat IBD?

Answer 14

1) 5ASA’s (aminosalicylates)
2) Steroids
3) Immunosuppressants
4) Biologics

Question 15

What are the common complications of IBD?

Answer 15

1) Colonic carcinoma
2) Small bowel obstruction
3) Toxic dilatation of colon

Question 16

What are the indications for surgery in IBD?

Answer 16

1) Failure of medical management
2) To relieve obstructive symptoms
3) Management of fistulae
4) Management of abscesses