GI: IBD

Question 1

What are the two types of IBD?

Answer 1

Crohn’s disease

Ulcerative Colitis

Question 2

Which interacting co-factors result in IBD?

Answer 2

Genetics
Environment
Host immune response

Question 3

Which type of IBD has a greater associated genetic link?

Answer 3

Crohn’s

Question 4

Mutations in which gene predisposes IBD?

Answer 4

NOD2 gene on chromosome 16

Question 5

How does smoking affect the two types of IBD?

Answer 5

Aggravates Crohn’s

Protective effect in UC

Question 6

Which cells mediate Crohn’s disease?

Answer 6

TH1 cells

Question 7

Which cells mediate UC?

Answer 7

TH1 + TH2 cells

Question 8

At what age does IBD typically present?

Answer 8

Teens- twenties

Question 9

Which part of the GI tract is affected in Crohn’s disease?

Answer 9

ANY!

Most common in the terminal ileum and colon

Question 10

Which part of the GI tract is affected in UC?

Answer 10

Inflammation begins in the rectum and extends proximally. Affects the colon only

Question 11

What are the 2 main differences between the inflammation in Crohn’s and UC?

Answer 11

Crohns- discontinuous ‘skip lesion’ + transmural

UC- Continuous + confined to the mucosa

Question 12

What would a mucosal biopsy of a Crohn’s patient show?

Answer 12

Deep ulcers and fissures

Cobblestoned mucosal appearance

Question 13

What would a mucosal biopsy of a UC patient show?

Answer 13

Red mucosa which bleeds easily

Pseudopolyps + ulcers in severe disease

Question 14

Which form of IBD is associated with granulomas?

Answer 14

Crohn’s disease

Question 15

Which form of IBD is associated with crypt abscesses?

Answer 15

Ulcerative Colitis

Question 16

How does UC typically present?

Answer 16

Diarrhoea which often contains blood and mucus

Question 17

How many bloody stools per day indicates mild UC?

Answer 17

Less than 4

Question 18

How many bloody stools indicates severe UC?

Answer 18

Greater than 6

Question 19

How does Crohn’s disease affecting the ileum present?

Answer 19

Abdominal pain + weight loss

Question 20

How does Crohn’s disease affecting the colon present?

Answer 20

Diarrhoea, bleeding, pain on defecation

Question 21

What features are associated with perianal disease due to Crohn’s?

Answer 21

Anal tags
fissures
fistulae
abscess formation

Question 22

What blood test results might be expected in a patient with acute Crohn’s disease?

Answer 22

Increased platelet count
Increased ESR
Increased CRP

Question 23

Which investigations undertaken to diagnose IBD?

Answer 23

Sigmoidoscopy + biopsy

Colonoscopy + biopsy

Question 24

Which drugs are given for mild-moderate UC?

Answer 24

First line: Oral 5-ASA, e.g. mesalazine

Second line if response poor: Oral prednisolone

Question 25

Which drug is given for severe UC?

Answer 25

Oral prednisolone

Question 26

Which drugs are given for severe UC with systemic features?

Answer 26

Hydrocortisone Infliximab (anti-TNF) Ciclosporin

Question 27

Which drugs are given to maintain remission in UC?

Answer 27

5-ASA | Azathioprine (immunosuppressant)

Question 28

Which drug is given in mild Crohn's only?

Answer 28

Oral 5-ASA

Question 29

Which drug is given in moderate-severe Crohn's?

Answer 29

Oral prednisolone

Question 30

Which drugs are given to maintain remission in Crohn's?

Answer 30

Azathioprine | Infliximab

Question 31

Which drug is given in severe perianal disease?

Answer 31

Metronidazole

Question 32

How do 5-ASA drugs work? What are the side effects?

Answer 32

Anti-inflammatory | Diarrhoea

Question 33

How do corticosteroids work? What are the side effects?

Answer 33

Anti-inflammatory | Weight gain, hypertension, osteoporosis, growth failure in children

Question 34

What are the side effects of immunosuppressant drugs such as Azathioprine?

Answer 34

Bone marrow suppression Pancreatitis Hepatitis Allergic reaction

Question 35

Which drug should azathioprine never be taken with?

Answer 35

Allopurinol (used to treat gout)

Question 36

How do Anti-tNF drugs work? What are the side effects?

Answer 36

Promote apoptosis of activated T lymphocytes | Increased risk of infection and cancer

Question 37

When is surgery for IBD indicated?

Answer 37

Failure to respond to medications Complications, e.g. obstruction, abscess/fistulae (crohn's) Dysplasia of colon mucosa (cancer)