IBD

Question 1

In IBD, what is the strongest indication for first line infliximab?

Answer 1

Fistulising Crohn’s disease

Question 2

What is first line treatment for mild Crohn’s disease?

Answer 2

Oral corticosteroid

Second line 5-ASAs

Question 3

What two skin conditions are most commonly associated with IBD?

Answer 3

Erythema nodosum

Pyoderma gangrenosum

Question 4

What parts of the GI tract do Crohn’s and UC affects?

Answer 4

Crohns - whole GI tract, most commonly terminal ileum and perianal. Transmural inflammation.
UC - limited to rectum and colon, involves only mucosa

Question 5

Name 4 extraintestinal manifestations of IBD.

Answer 5

Uveitis
Arthritis and ankylosing spondylitis
Skin - erythema nodosum, pyoderma gangrenosum
Hepatobiliary - PSC, autoimmune hepatitis

Question 6

Most extra-intestinal manifestations of IBD correlate with disease activity. Which three manifestations characteristically do not?

Answer 6

Three Ps - PSC, pyoderma gangrenosum, small (‘petite’) joint/axial arthritis

Question 7

A large bowel biopsy is taken in a patient suspected to have inflammatory bowel disease. Biopsy shows neutrophil infiltration, transmural inflammation, and non-caseating granulomas.

Answer 7

Crohn’s disease

Question 8

A large bowel biopsy is taken in a patient suspected to have inflammatory bowel disease. Biopsy shows neutrophil infiltration, transmural inflammation, and non-caseating granulomas.

Answer 8

Lactulose - is catabolised by bacteria to acidify contents of colon, reducing ammonia absorption
Rifaximin - kills ammonia-producing bacteria