Crohn's and UC

Question 1

Bloody diarrhoea, urgency, tenesmus and LLQ pain. Are these symptoms associated more with Crohn’s or UC?

Answer 1

UC

Question 2

Occasionally bloody diarrhoea, weight loss, peri-anal pathologies, right iliac fossa mass. Are these symptoms associated more with Crohn’s or UC?

Answer 2

Crohn’s

Question 3

What are the 2 gold standard investigations for UC?

Answer 3

Colonoscopy + biopsy

Barium enema

Question 4

What is the risk associated with colonoscopy in UC? What is the alternative?

Answer 4

Risk of perforation in severe colitis.

Flexible sigmoidoscopy as alternative

Question 5

Superficial inflammation that does not penetrate deeper than the submucosa is found in [Crohn’s or UC?]

Answer 5

UC

Question 6

Deep inflammation that spans the mucosa to the serosa is found in [Crohn’s or UC?]

Answer 6

Crohn’s

Question 7

Are crypt abscesses seen in Crohn’s or UC?

Answer 7

UC

Question 8

Is depletion of goblet cells seen in Crohn’s or UC?

Answer 8

UC

Question 9

Is loss of haustrations seen in Crohn’s or UC?

Answer 9

UC

Question 10

Are pseudopolys seen in Crohn’s or UC?

Answer 10

UC

Question 11

What is drainpipe colon? Is it seen in Crohn’s or UC?

Answer 11

Short and narrow colon

Seen in UC

Question 12

How are mild, moderate and severe flares of UC distinguished?

How can mild/moderate flares be sub-divided depending on which areas of the colon are affected by disease?

Answer 12

Mild = <4 stools/day
Moderate = 4-6 stools/day
Severe = >6 bloody stools/day +/- systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)

Mild/Moderate can be subdivided into:

• Proctitis
• Proctosigmoiditis / Left-sided disease
• Extensive disease

Question 13

What are the treatment options to induce remission in a mild/moderate UC proctitis?

Answer 13

1 - Topical aminosalicylate
2 - Add oral aminosalicylate after 4 weeks
3 - Add corticosteroid (topical or oral) if resistant

Question 14

What are the treatment options to induce remission in a mild/moderate UC proctosigmoiditis/left-sided disease?

Answer 14

1 - Topical aminosalicylate
2 - Add oral aminosalicylate (high dose) +/- topical corticosteroid after 4 weeks
3 - Stop topical therapy, begin oral aminosalicylate and oral corticosteroid

Question 15

What are the treatment options to induce remission in a mild/moderate UC with extensive disease?

Answer 15

1 - Topical aminosalicylate and oral aminosalicylate (high dose)
2 - Stop topical therapy, use oral aminosalicylate and oral corticosteroid.

Question 16

How may remission be maintained in following a mild/moderate UC proctitis or proctosigmoiditis flare?

Answer 16

3 options:
Topical aminosalicylate alone
Oral and topical aminosalicylate together
Oral aminosalicylate alone (less effective)

Question 17

How may remission be maintained following a left-sided or extensive mild/moderate UC flare?

Answer 17

Oral aminosalicylate (low, maintenance dose)

Question 18

How would you try to induce remission in a severe flare of UC?

Answer 18

Always admit to hospital

1 - IV corticosteroids
2 - Add IV ciclosporin
3 - Surgery

Question 19

How would you maintain remission of UC in someone who has had a severe flare, or has had >/= 2 flares in a year?

What should be done before initiating the correct treatment?

Answer 19

Oral azathioprine or oral mercaptopurine

TPMT should be assessed before

Question 20

Is CRP raised in Crohn’s and UC? If so, what are the implications in each pathology?

Answer 20

UC - raised CRP indicates severe flare

Crohn’s - is raised with disease activity

Question 21

What are the 2 gold-standard investigations for Crohn’s disease?

Answer 21

Colonoscopy + biopsy

Small bowel enema

Question 22

Is an increase in goblet cells seen in Crohn’s or UC?

Answer 22

Crohn’s

Question 23

Are granulomas seen in Crohn’s or UC?

Answer 23

Crohn’s

Question 24

Is primary sclerosing cholangitis associated with UC or Crohn’s?

Answer 24

UC

Remember uC and psC both have “C”

Question 25

What does Kantor’s string sign show? Is it seen in Crohn’s or UC?

Answer 25

Strictures

Seen in Crohn’s

Question 26

Are rose thorn ulcers seen in Crohn’s or UC?

Answer 26

Crohn’s

Question 27

Are fistulae seen in Crohn’s or UC?

Answer 27

Crohn’s (due to transmural inflammation)

Question 28

What drugs can be used to induce remission in Crohn’s?

Answer 28

Glucocorticoids (topical/oral/IV) 1st line

5ASA (mesalazine) 2nd line

Question 29

What complication of Crohn’s would indicate the use of Infliximab?

Answer 29

Fistulating disease

Question 30

What is the investigation of choice for peri-anal fistulae in Crohn’s?

What is it important to determine when investigating?

How would it be treated?

Answer 30

MRI

Whether it is simple, or complex (involving muscle).

Metronidazole 1st line
Draining seton if complex

Question 31

How would a peri-anal abscess be treated in Crohn’s?

Answer 31

Incision and drainage

Antibiotics

Question 32

What is 1st and 2nd line treatment for maintaining remission in Crohn’s?

What must be done before initiating treatment?

Answer 32

Oral azathioprine or oral mercaptopurine 1st line
Oral methotrexate 2nd line

TPMT levels must be assessed.

Question 33

Are obstructions more likely to occur in Crohn’s or UC?

Answer 33

Crohn’s due to transmural inflammation causing adhesions

Question 34

Are gallstones and renal stones associated more with Crohn’s or UC?

Answer 34

Crohn’s

Question 35

Is a histological cobble-stone appearance of bowel seen in Crohn’s or UC?

Answer 35

Crohn’s

Question 36

Is there a greater risk of colorectal cancer with Crohn’s or UC?

Answer 36

UC