Crohn's & UC

Question 1

What is the cytokine profile of Crohn’s?

Answer 1

Th-1, IFN-gamma

Question 2

What is the cytokine profile of ulcerative colitis?

Answer 2

Th-2, IL5 IL13

Question 3

In which disease might you find a right iliac fossa mass?

Answer 3

Crohn’s

Question 4

What is the definition of Crohn’s?

Answer 4

Chronic inflammatory and ulcerating condition of the GI tract that can affect anywhere from the mouth to the anus

Question 5

Where does Crohn’s most commonly affect?

Answer 5

Most common in the terminal ileum and colon

Question 6

What might Crohn’s disease present with?

Answer 6

Abdominal pain
Small bowel obstruction
Diarrhoea
Bleeding PR
Anaemia
Weight loss

Question 7

Which disease is characterised by chronic transmural inflammation?

Answer 7

Crohn’s

Question 8

How is the diagnosis of inflammatory bowel disease made?

Answer 8

Endoscopy and mucosal biopsy

Question 9

Which disease IBD is characterised by skip legions?

Answer 9

Crohn’s

Question 10

Which IBD is characterised by granulomatous inflammation?

Answer 10

Crohn’s

Question 11

What do the ulcers of Crohn’s disease typically look like?

Answer 11

Knife-life, fissuring ulcers

Question 12

What are some of the complications of Crohn’s disease?

Answer 12

Perforation 
Stricture
Malabsorption
Fistula
Anal disease
Bowel obstruction
Malignancy

Question 13

What is the characteristic appearance of the mucosal remodelling due to fissuring ulcers?

Answer 13

Cobblestoning

Question 14

Where in the colon does ulcerative colitis affect?

Answer 14

The rectum, extends proximally

Question 15

What are some of the symptoms of ulcerative colitis?

Answer 15

Diarrhoea + bleeding
Increased bowel frequency
Urgency
Tenesmus
Incontinence
Night rising
Lower abdo pain (esp. LIF)

Question 16

What is the Truelove and Witt criteria for severe ulcerative colitis?

Answer 16

>6 bloody stools/24 hour
\+
1 or more of
Fever (>37.8°C)
Tachycardia (>90/min)
Anaemia (Haemoglobin 30mm/hr)

Question 17

Other than the abdomen and anus, where might other signs of IBD manifest?

Answer 17

Skin, joints, eyes

Question 18

What is the definition of toxic megacolon when assessing on a plain AXR?

Answer 18

Dilatation of colon:
Transverse > 5.5cm
Caecum > 9cm

Question 19

What changes occur in the intestinal mucosa in ulcerative colitis?

Answer 19

Crypt distortion and abscess formation

Absence of goblet cells

Question 20

What is the aberrant immune response in Crohn’s?

Answer 20

Persistent activation of T-cells and macrophages (failure to switch off)
Excess proinflammatory cytokine production

Question 21

Which two layers is ulcerative colitis confined to?

Answer 21

Mucosa and submucosa

Question 22

Which IBD is primary sclerosing cholangitis associated with?

Answer 22

UC > Crohn’s

Question 23

What are some examples of peri-anal disease associated with Crohn’s?

Answer 23

Recurrent abscess formation
Pain
Can lead to fistula with persistent leakage
Damaged sphincters

Question 24

What do the ulcers of ulcerative colitis look like?

Answer 24

Limited to submucosa
Wide/broad based
Superficial horizontal undermining ulcer

Question 25

Which IBD is development of colorectal cancer associated with and why?

Answer 25

UC | Chronic inflammation leads to epithelial dysplasia and then carcinoma

Question 26

What are some of the complications of UC?

Answer 26

Blood loss Electrolyte disturbance (hypokalaemia) Colorectal cancer Anal fissure

Question 27

Which disease might treatment with 5ASA (mesalazine) be useful in?

Answer 27

Ulcerative colitis

Question 28

What is the mechanism of action of 5ASA?

Answer 28

Topical effect Anti-inflammatory properties Reduces risk of colon cancer

Question 29

What are some of the side effects of 5ASA?

Answer 29

Diarrhoea | Idiosyncratic nephritis

Question 30

Which steroids might be used to treat IBD?

Answer 30

Prednisolone | Budesonide

Question 31

What are some of the side effects of steroid use?

Answer 31

``` Weight gain Diabetes Hypertension Neuropsychiatric Cataracts Growth failure Osteoporosis Acne Thinning of skin ```

Question 32

When is immunosuppression therapy considered?

Answer 32

When more potent suppression of inflammation required

Question 33

What are some of the side effects of immunosuppression with azothiaprine?

Answer 33

Pancreatitis Leucopaenia Hepatitis Small risk of lymphoma, skin cancer

Question 34

How long does azothiaprine take to have effect?

Answer 34

16 weeks

Question 35

What is the mechanism of anti-TNF therapy?

Answer 35

Promotes apoptosis of activated T lymphocytes

Question 36

When, according to NICE guidelines, is anti-TNF therapy indicated in Crohn's disease?

Answer 36

As part of long term strategy, including immune suppression, surgery, supportive therapy In fistulating disease

Question 37

What is the danger in resection of small bowel to treat Crohn's?

Answer 37

It is not curative | May result in "short-gut" syndrome which requires life long parenteral nutrition

Question 38

What surgical options are there for ulcerative colitis?

Answer 38

Permanent ileostomy or Restorative proctocoloectomy and pouch