IBD Clinical

Question 1

What are the main two 2 idiopathic chronic inflammatory diseases ?

Answer 1

Ulcerative Colitis + Crohn’s disease

Question 2

How do Crohn’s and ulcerative colitis differ ?

Answer 2

They differ in pathology and clinical presentation:

Crohn’s
-Diarrhoea, abdominal pain & peri-anal disease

Ulcerative colitis
-Diarrhoea + bleeding

Question 3

Outline the pathogenesis of IBD

Answer 3

Also gut floras

Question 4

What is the best factor in predicting devlopment of IBD ?

Answer 4

Positive family history best established risk factor for disease development

Question 5

What is the genetic basis behind Crohn’s disease ?

Answer 5

NOD2/ CARD15 (IBD-1)
-Encodes a protein involved in bacterial recognition
-Disease susceptibility gene located on chromosome 16q12
-A mutated form of NOD2 is found in 10-20% of Caucasian patients with Crohn’s Disease
-Homozygotes have a much increased risk of disease than heterozygotes

Question 6

Explain the role of the environment in the development of IBDs

Answer 6

Smokigng
-Aggravates Crohn’s disease but protects against Ulcerative colitis

NSAIDs
Diet

Question 7

What are symptoms of ulcerative colitis ?

Answer 7

Diarrhoea + bleeding + mucus
Increased bowel frequency (HOW OFTEN?)
Night rising for bowels
Urgency
Tenesmus
Incontinence
Lower abdo pain (esp. LIF)
(proctitis can cause constipation)

Symptoms determined by Determined by disease extent and severity

Question 8

How is the severity of ulcerative colitis determined ?

Answer 8

Truelove and Witt criteria)
-Severe ulcerative colitis = 30% risk of colectomy

Severe is:
>6 bloody stools/24 hour +1 or more of
=Fever (>37.8°C)
-Tachycardia (>90/min)
-Anaemia (Haemoglobin <10.5g/dl)
-Elevated CRP (ESR)

Question 9

What further assesements of ulcerative colitis should be carried out ?

Answer 9

1) Bloods:
-C-reactive protein (CRP)
-Albumin (a negative acute phase reactant)
-Platelets (thrombocytosis indirect marker)
2) Plain AXR
3) Endoscopy to define extent
4) Histology

Question 10

What is this ?

Answer 10

Ulcerative colitis plain Xray
1) Stool absent in inflammed colon
2) Mucosal oedema / ‘thumb-printing’
3) Toxic megacolon:
-Transverse >5.5cm
-Caecum >9cm

Question 11

What are long term complications of ulceratice colitis ?

Answer 11

Increased risk of colorectal cancer, determined by:
-severity of inflammation
-duration of disease
-disease extent

Extensive colitis (to beyond splenic flexure) at risk and require surveillance after 10 years of disease

Question 12

Where can extra-intestinal effects of ulcerative colitis affect ?

Answer 12

Skin
Joints; Axial, peripheral joints
Eyes
Deranged LFTs
Oxalate renal stones

Question 13

What is Primary sclerosing cholangitis ?

Answer 13

Chronic inflammatory disease of biliary tree
-80% have associated IBD (UC>Crohn’s)
-Most asymptomatic or itch, rigors
-Cholestatic LFTs
-Median time to death/liver transplant 10yrs
-15% get cholangiocarcinoma

Question 14

Explain distribution of disease in Crohn’s disease ?

Answer 14

Can affect any region of GI tract from mouth to anus
-Skip lesions
-Transmural inflammation
-Colonic Crohn’s increasing in incidence

Question 15

What is peri-anal disease ?

Answer 15

Common complication of Crohn’s
-Recurrent abscess formation
-Pain
-Can lead to fistula with persistent leakage
-Damaged sphincters

Question 16

What are Crohn’s symptoms ?

Answer 16

Determined by site of disease:

Small intestine
-Abdominal cramps (peri-umbilical)
-Diarrhoea, weight loss

Colon
-Abdominal cramps (lower abdomen)
-Diarrhoea with blood
-Weight loss

Mouth
-Painful ulcers, swollen lips, angular cheilitis

Anus
-peri-anal pain, abscess

Question 17

What Further assessment should follow Crohn’s sus ?

Answer 17

Clinical exam
-Evidence of weight loss, RIF mass, peri-anal signs

Bloods
-CRP, albumin, platelets, B12 (terminal ileum), iron stores, FBC
-Stage disease extent