IBD Clinical

Question 1

clinical presentation of Crohn’s

Answer 1

abdominal pain

peri-anal disease

Question 2

aetiology of IBD

Answer 2

genetic predisposition
mucosal immune system
environmental triggers

Question 3

genetic predisposition of IBD

Answer 3

homozygous twins

early onset indicates family hx - high concordance rates

Question 4

mutated gene in IBD

Answer 4

NOD2/CARD15 (IBD-1) - codes for bacterial recognition and normal mucosa defence

Question 5

involvement of gut flora in ulcerative colitis

Answer 5

altered bacterial flora indispensable to development of colitis

Question 6

innate immunity - role of tight junctions

Answer 6

regulates epithelial permeability

Question 7

overactive effect T cell response

Answer 7

inflammation/disease

Question 8

absence of regulatory T cells

Answer 8

uncontrolled inflammation/aggressive disease

Question 9

immune system response of Crohn’s

Answer 9

Th1

Question 10

immune response of Ulcerative colitis

Answer 10

mixed Th1/Th2/NKTC

Question 11

pathogenesis of IBD

Answer 11

pathogenic bacteria
abnormal microbial competition
defective host contaminant of commensal bacteria
defective hose immunoregulation

reduced antimicrobial activity in Crohn’s

Question 12

environment factors of IBD

Answer 12

smoking - aggravates Crohn’s but protects against ulcerative colitis
NSAIDS

Question 13

ulcerative colitis disease extent

Answer 13

proctitis - rectum
left sided colitis
pan colitis - whole of large bowel

Question 14

course of left sided colitis

Answer 14

rectum to colon, stopping at splenic flexure

Question 15

clinical presentation of ulcerative colitis

Answer 15

diarrhoea and bleeding (red flag! >6)
increased bowel frequency
incontinence 
night rising 
lower abdominal pain (left iliac fossa)

Question 16

history red flags of IBD

Answer 16

recent travel
antibiotics
NSAIDS
family hx
smoking 
skin, eyes, joints

Question 17

determining the severity of ulcerative colitis

Answer 17

truelove and Witt criteria

Question 18

truelove and witt criteria

Answer 18

>6 bloody stools
and 1 or more;
fever
tachycardia (>90BPM)
anaemia (Hb<10.5)
ESR (>30mm/hr)

Question 19

what is ESR

Answer 19

blood test that detects and monitors inflammation in the body

Question 20

tests for IBD

Answer 20

bloods;
CRP
albumin 
AXR
endoscopy
histology

Question 21

what is CRP

Answer 21

C-reactive protein;

a marker of inflammation

Question 22

presentation of AXR with IBD

Answer 22

stool distribution - absent in inflamed colon
mucosal oedema/’cobblestone’
toxic megacolon

Question 23

presentation of endoscopy with IBD

Answer 23

confluent inflammation extending proximally from anal margin to transition zone;
loss of vessel pattern
granular mucosa
contact bleeding

Question 24

histology of ulcerative colitis

Answer 24

affects mucosal layer only;
absence of goblet cells
crypts distortion and abscesses

Question 25

complication of ulcerative colitis

Answer 25

``` increased risk of colorectal cancer extensive colitis (beyond splenic flexure) ```

Question 26

what determines risk of colorectal cancer in ulcerative cancer

Answer 26

severity of inflammation duration of disease disease extent

Question 27

extra-intestinal manifestations of IBD

Answer 27

``` skin joints - axial, peripheral joints eyes deranged LFTs oxalate renal stones ```

Question 28

what is primary sclerosis cholangitis

Answer 28

chronic inflammatory disease of biliary tree | 80% patients have associated IBD (UC>Crohn's)

Question 29

symptoms of PSC

Answer 29

``` asymptomatic or itch, rigors cholestatic LFTs (raised ALP + GGT) ```

Question 30

Crohn's - peri-anal disease

Answer 30

recurrent abscess formation can lead to fistula with persistent leakage damaged sphincters causes pain

Question 31

disease phenotypes of Crohn's

Answer 31

stenosis inflammation fistula

Question 32

Crohn's symptoms - small intestine

Answer 32

abdominal cramps diarrhoea weight loss

Question 33

Crohn's symptoms - colon

Answer 33

abdominal cramps (lower abdomen) diarrhoea with blood weight loss

Question 34

Crohn's symptoms - mouth

Answer 34

painful ulcers swollen lips angular chielitis

Question 35

Crohn's symptoms - anus

Answer 35

peri-anal pain | abscess

Question 36

tests for Crohn's

Answer 36

``` bloods; CRP albumin platelets vitamin B12 ferritin ``` colonoscopy

Question 37

histology of Crohn's

Answer 37

granuloma +/- caseating

Question 38

tests for small bowel

Answer 38

barium swallow small bowel MRI technetium-labelled white cell scan