IBD

Question 1

Crohn’s risk factors (2)

Answer 1

Being Ashekenazi Jewish

Smoking

Question 2

Crohn’s genetic mutations

Answer 2

NOD2 (CARD15 gene)

Question 3

Where does Crohn’s occur?

Answer 3

Mouth to anus - commonly terminal ileum and ascending colon

Question 4

What are skip lesions?

Answer 4

Patches of lesioned bowel separated by normal bowel as seen in Crohn’s

Question 5

Symptoms of Crohn’s

Answer 5

Diarrhoea, abdo pain, weight loss, constitutional symptoms
Anal and perianal disease
Failure to thrive in children

Question 6

Crohn’s examination features

Answer 6

Few physical signs - weight loss, mouth ulcers, RIF mass/tenderness
Check anus for signs

Question 7

Why are stool tests needed to investigate suspected Crohn’s?

Answer 7

Rule out C.diff or other infective causes

Question 8

What is seen in a severe Crohn’s colonoscopy?

Answer 8

Cobblestoning

Question 9

Medical management of Crohn’s

Answer 9

Glucocorticoids
Antibiotics for anal disease (metronidazole/ciprofloxacin)
Exclusive enteral nutrition
Immunosupressants (azathioprine, methotrexate)
Anti-TNF agents (infliximab, adalimumab)

Question 10

Examples of anti-TNF agents

Answer 10

Infliximab, Adalimumab

Question 11

Reasons for surgery in Crohn’s

Answer 11

Medical therapy failure,
Complications
Failure to thrive
Perianal sepsis

Question 12

Surgery performed in rectum sparing Crohn’s

Answer 12

Subtotal colectomy and ileorectal anastamosis

Question 13

Surgery performed in rectum involving Crohn’s

Answer 13

Panproctocolectomy and end ileostomy

Question 14

Is the J-pouch procedure possible in Crohn’s patients?

Answer 14

No - high risk of recurrence in pouch

Question 15

3 complications of surgery in Crohn’s

Answer 15

Dehydration
Mechanical failure
Recurrence of Crohn’s

Question 16

Positive ASCA is linked with…

Answer 16

Crohn’s

Question 17

Positive pANCA is linked with…

Answer 17

Ulcerative colitis

Question 18

Genetic mutation in Ulcerative Colitis

Answer 18

HLA-DR103 increases severity

Question 19

Smoking is protective against attacks of which type of IBD?

Answer 19

Ulcerative colitis

Question 20

2 things that protect against UC

Answer 20

Smoking & appendicectomy

Question 21

Distribution of UC

Answer 21

Colon only; begins at anorectal junction

Question 22

Which type of IBD has transmural inflammation?

Answer 22

Crohn’s

Question 23

How far through the bowel wall does inflammation in UC go?

Answer 23

Lamina propria only

Question 24

2 Histological features of UC

Answer 24

Crypt abscesses

Goblet cell depletion

Question 25

Granulomas may be seen in which type of IBD?

Answer 25

Crohn's

Question 26

Symptoms of UC

Answer 26

``` **Diarrhoea with blood or mucus** Lower abdo pain? Constitutional symptoms (milder than Crohn's) ```

Question 27

UC examination features

Answer 27

No specific signs - distended/tender abdo tachycardia/fever = SEVERE Blood on rectal exam

Question 28

Blood test features of UC

Answer 28

Raised ESR, CRP, WCC, platelets

Question 29

Gold standard diagnosis of UC?

Answer 29

Colonoscopy with biopsy

Question 30

Why can't colonoscopy be done in severe UC?

Answer 30

Increased risk of perforation - do flexi sig instead

Question 31

Why is abdo X-ray indicated in UC?

Answer 31

Look for colonic dilatation

Question 32

Why is a colonoscopy performed in chronic UC?

Answer 32

Surveillance for dysplasia

Question 33

Medical management of UC (3)

Answer 33

Aminosalicylates Glucocorticoids Anti-TNF agents

Question 34

Examples of aminosalicylates (3)

Answer 34

Mesalazine Sulfasalazine Balsalazide

Question 35

Active moiety of aminosalicylates

Answer 35

5-ASA

Question 36

Indication for surgery in UC? (5)

Answer 36

``` Severe non-responsive Toxic dilatation Haemorrhage Imminent perforation Dysplasia seen on surveillance ```

Question 37

Surgery performed first in UC?

Answer 37

Subtotal colectomy & end ileostomy - follow with further surgery as required

Question 38

Complication of ileo-anal pouch?

Answer 38

Pouchitis - occurs in 1/3