IBD clinical

Question 1

Difference between Crohn’s and UC clinical presentation?

Answer 1

Crohn’s: abdominal pain and perianal disease

UC: bleeding and diarrhoea

Question 2

Best established risk for IBD disease development?

Answer 2

Family history

Question 3

Gene linked with Crohn’s

Answer 3

NOD2/CARD15

Question 4

Th cells and Crohn’s/UC

Answer 4

Crohn’s is a Th1 mediated disease

UC is mixed: Th1/Th2 mediated disease/NKTC

Question 5

Smoking and crohn’s

Answer 5

Smoking aggravates Crohn’s - Andrew should not smoke

Smoking protects againts UC

Question 6

Inflamamtion is limited to mucosa and submucosa?

Answer 6

UC

Crohn’s is transmural

Question 7

Proctitis

Answer 7

Proctitis = inflammation of the rectum only

Pancolitis: inflammation of the whole large intestine

Question 8

Determining severity of UC?

Answer 8

Determined by DISEASE EXTENT + SEVERITY:
Diarrhoea + bleeding
Increased bowel frequency (HOW OFTEN?)
Urgency
Tenesmus
Incontinence
Night rising (this will be why we always have to ask lol)
Lower abdo pain (esp. LIF)
(proctitis can cause constipation)

Question 9

Truelove and Witt Criteria for severe ulcerative colitis?

Answer 9

>6 bloody stools/24 hour
\+
1 or more of
  Fever (>37.8°C)
  Tachycardia (>90/min)
  Anaemia (Haemoglobin 30mm/hr)

(FATE)

Question 10

What will a plain AXR show in UC?

Answer 10

Stool distribution:
Absent in inflammed colon

Mucosal oedema / ‘thumb-printing’

Toxic megacolon:
Transverse >5.5cm
Caecum >9cm

Question 11

Endoscopy appearance of UC?

Answer 11

Granular mucosa
Contact bleeding
Loss of vessel pattern

Question 12

Increased chance of which type of cancer in UC?

Answer 12

Increased chance of colo-rectal cancer

Question 13

What does extensive colitis?

Answer 13

Extensive colitis (to beyond splenic flexure) is risk for colorectal cancer and require surveillance after 10 years of disease

Question 14

PSC is associated with UC. Give some symptoms?

Answer 14

Most asymptomatic OR itch, rigors

Question 15

Cancer associated with PSC?

Answer 15

Cholangiocarcinoma