IBD - crohns + UC

Question 1

where is there inflammation in crohns

Answer 1

in ALL layers, down to the serosa
- why prone to strictures, fistulas + adhesions

can be anywhere from mouth to anus

Question 2

most commonly affected part of bowel in crohns

Answer 2

terminal ileum

Question 3

Crohns presentation

Answer 3

late adolescence/early adulthood
- non-specific - weight loss, lethargy
- diarrhoea (!non-bloody)
- abdo pain
- perianal disease - skin tags, ulcers

Question 4

crohns investigations

Answer 4

colonoscopy = ix of choice

raised inflam markers
increased faecal calprotectin
aneamia
low vit B12 + vit D

Question 5

IBD extra-intestinal features

Answer 5

arthritis
erythema nodosum
pyoderma gangrenosum
osteoporosis

episcleritis (crohns)
uveitis (UC)

clubbing
PSC (UC)

Question 6

crohns histology

Answer 6

inflammation in all layers from mucosa to serosa

goblet cells
granulomas

Question 7

crohns findings on small bowel enema

Answer 7

(v sensitive+specific for exam terminal ileum)

strictures - “Kantor’s sign”
proximal bowel dilation
“rose thorn” ulcers
fistulae

Question 8

inducing remission in crohns

Answer 8

glucocorticoids - oral, topical or IV

2nd = mesalazine (5-ASA)

azathioprine may be used as an add on med but NOT as monotherapy

Question 9

maintaining remision in crohns

Answer 9

azathioprine or meracaptopurine
–> !!! +TPMT activity must be assessed before starting

2nd = methotrexate

stop smoking !!!

Question 10

smoking + IBD

Answer 10

makes crohns worse

may help UC

Question 11

management of stricturing terminal ileal disease

Answer 11

ileocaecal resection

Question 12

crohns perianal abscess mx

Answer 12

incision + drainage combined with Abx

Question 13

perianal fistulae

Answer 13

an inflammatory tract or connection between the anal canal + perianal skin

Question 14

perianal fistulae investigation

Answer 14

MRI !!!!

• can see if abscess + see if fistula is simple or complex (high, passes through or above muscle layers)

Question 15

management of perianal fistulae

Answer 15

symptomatic -> oral metronidazole

complex fistulae = draining seton (piece of surgical string left in for weeks to keep it open)

Question 16

complications of crohns

Answer 16

perianal fistulae
small bowel cancer
colorectal cancer

osteoporosis

Question 17

gall stones and mouth ulcers are commoner in which IBD

Answer 17

crohns

Question 18

skip lesions

Answer 18

crohns

(not continuous inflammation like seen in UC, has skips)

Question 19

inflammation in UC

Answer 19

always starts at rectum + never spreads beyond ileocaecal valve
- none beyond submucosa

continuous disease - no skip lesions

Question 20

histology in UC

Answer 20

crypt abscesses
- neutrophils migrate through walls of glands

depletion of goblet cells + mucin

Question 21

crohns on endoscopy

Answer 21

Deep ulcers, skip lesions -> ‘cobble-stone’ appearance

Question 22

UC on endoscopy

Answer 22

Widespread ulceration with preservation of adjacent mucosa which has the appearance of polyps** (‘pseudopolyps’)**

Question 23

UC on barium enema

Answer 23

• loss of haustrations
• superficial ulceration
• pseudopolyps

drainpipe colon
- longstanding disease, colon is narrow + short

Question 24

commonest site for UC

Answer 24

rectum (UC always starts here)

• never spreads beyond ileocaecal valve

Question 25

initial presentation of UC

Answer 25

bloody diarrhoea urgency abdo pain - L lower quad tenesmus - feeling of need to poo even tho empty

Question 26

investigations for UC

Answer 26

colonoscopy + biopsy - for diagnosis severe colitis = AVOID COLONOSCOPY, risk of **perforation** --> * **flexible sigmoidoscopy** *

Question 27

factors increasing risk of colorectal cancer in UC

Answer 27

disease duration >10yrs patients with pancolitis onset before 15yrs old unremitting disease poor compliance to tx

Question 28

risk stratification for colonoscopy surveillance in UC patients

Answer 28

low risk = 5yrs follow up - left sided colitis - <50% colon intermed = 3yr - active inflamm changes - fam hx of colorect ca high risk = 1yr - PSC - fam hx colorect ca <50yrs - stricture or dysplasia in past 5yrs

Question 29

things that can trigger UC flares

Answer 29

stress meds - NSAIDs, Abx **cessation** of smoking !

Question 30

classification of UC flares

Answer 30

mild - <4 stools daily, no systemic disturbance, normal CRP mod - 4-6 stools, minimal systemic disturbance severe - >6stools, containing blood - systemic - **fever**, tachycardia, abdo tenderness, anaemia --> **admit to hospital**