GI - Crohns vs UC

Question 1

Primary modifiable risk factor in Crohn Disease

Answer 1

Smoking

Question 2

Risk factors for Crohn Disease

Answer 2

• family aggregation
• genetic predisposition (HLA-B27 association)
• tobacco smoking

Question 3

Mediated by Th2 cells

Answer 3

Ulcerative colitis

Question 4

Mediated by dysfunctional IL-23 Th17 signaling

Answer 4

Crohn disease

Question 5

Increased defection with bloody diarrhea with mucous

Answer 5

Ulcerative colitis

Question 6

Increased defecation with typically non-bloody, watery diarrhea

Answer 6

Crohn disease

Question 7

Painful defecation with pain in the LLQ, abdominal cramps and tenderness

Answer 7

Ulcerative colitis

Question 8

RLQ pain with palpable abdominal mass and low grade fever

Answer 8

Crohn disease

Question 9

Associated with primary sclerosing cholangitis (PSC)

Answer 9

Ulcerative colitis

Question 10

Extraintestinal manifestations

Answer 10

• pyoderma gangrenosum
• erythema nodosum
• uveitis
• episcleritis
• aphthous stomatitis
• peripheral arthritis
• spondylitis

Question 11

Associated with fistulas (between skin, bladder or between bowel loops)

Answer 11

Crohn disease

Question 12

Complication of ulcerative colitis

Answer 12

• fulminant colitis
• toxic megacolon
• perforation

Question 13

Complications of Crohn disease

Answer 13

• abscesses
• structures (obstructions)
• perianal fissures

Question 14

Patients with ulcerative colitis have an increased risk of which cancers?

Answer 14

• cholangiocarcinoma
• CRC

Question 15

Increased risk of cancers in Crohn disease

Answer 15

• small intestine cancer
• colon cancer
• Non-Hodgkin lymphoma

Question 16

Typically found in the colon and rectum

Answer 16

Ulcerative colitis

Question 17

Typically found in terminal ileum and colon with rectal sparing, but may affect entire GI tract

Answer 17

Crohn disease

Question 18

Continuous inflammation
Friable mucosa
Mucosal ulcerations (deep or superficial)

Answer 18

Ulcerative colitis

Question 19

Discontinuous inflammation (skip lesions)

Answer 19

Crohn disease

Question 20

Cobblestone sign

Answer 20

Crohn disease

Question 21

Crypt abscesses

Answer 21

Ulcerative colitis

Question 22

Loss of haustra (lead pipe sign)

Answer 22

Ulcerative colitis

Question 23

Linear or serpiginous ulcerations

Answer 23

Crohn disease

Question 24

Apthous ulcers

Answer 24

Crohn disease

Question 25

Inflammation confined to mucosa and submucosa

Answer 25

Ulcerative colitis

Question 26

Transmural inflammation

Answer 26

Crohn disease

Question 27

NON-CASEATING granulomas, giant cells, lymphoid aggregates

Answer 27

Crohn disease

Question 28

Creeping fat

Answer 28

Crohn disease

Question 29

First line for ulcerative colitis

Answer 29

5-aminosalicylic acid (mesalamine)

Question 30

First line for Crohn disease

Answer 30

Corticosteroids

Question 31

Hallmark findings of Crohn disease on endoscopy

Answer 31

- discontinuous areas of inflammation - cobblestone appearance of the affected mucosa - mucosal ulcerations

Question 32

Diagnostic test for all patients with suspected Crohn disease or ulcerative colitis

Answer 32

Ileocolonoscopy - about 1/3 of patients with Crohn disease have only small bowel disease and this may not be visible on ileocolonoscopy

Question 33

Raised areas of normal mucosal tissue that result from repeated cycles of ulceration and healing in chronic ulcerative colitis

Answer 33

Pseudopolyps

Question 33

Contraindications to colonoscopy

Answer 33

Current ulcerative colitis flare (high risk of colonic perforation)

Question 34

How often should patients with ulcerative colitis have CRC screening?

Answer 34

Start ileocolonoscopy screening 8 years after diagnosis or at the time of diagnosis of PSC and then every 1-5 years.

Question 35

An extra-intestinal manifestation of Crohn disease involving a small lesion that grows in size to become a painful ulcerated and necrotic on the extensor side of the lower limbs

Answer 35

Pyoderma gangrenosum

Question 36

Severely painful, deep ulcer with irregular, undermined, erythematous, purple (violaceous) edges, central necrosis and pus

Answer 36

Pyoderma gangrenosum

Question 36

Other extra-intestinal manifestations of Crohn disease

Answer 36

- erythema nodosum - enteropathic arthritis - inflammation of the eye (iritis, episcleritis, uveitis)

Question 37

An extra-intestinal manifestation of Crohn disease involving an inflammatory panniculitis that manifests with erythematous and tender nodules and plaques, most commonly on the anterior lower legs.

Answer 37

Erythema nodosum