IBD symptoms and complications

Question 1

What are the common symptoms of IBD?

Answer 1

Diarrhoea
Abdominal pain
Fever
Nausea and vomiting
Malaise
Lethargy
Weight loss
Malabsorption
Growth retardation in children

Question 2

Which symptoms as highlighted in IBD symptoms tend to be more associated with Crohn’s disease?

Answer 2

Nausea and vomiting (associated with inflammation in the upper GI)

Weight loss (if inflammation is in the small intestine then lack of absorption can lead to weight loss, however you can feel generally unwell in both conditions and therefore it is possible to experience weight loss in both).

Question 3

Which condition tends to be more disabling?

Answer 3

Crohn’s disease

Question 4

What are some of the symptoms specific to Crohn’s disease?

Answer 4

Abdominal pain (specifically in the lower right quadrant where the terminal ileum is)
Anaemia (loss of blood or generally not eating much)
Palpable masses (feeling a lump- due to swelling)
Small bowel obstructions
Abscesses
Fistulas
Gut perforation

Question 5

What are the main symptoms associated with UC?

Answer 5

Diarrhoea with blood and mucus (up to 20 stools a day)
Abdominal pain
Fever
Constipation (due to narrowing)

Question 6

What percentage of UC relapse each year?

Answer 6

50%

Question 7

In reference to the distinguishable features, which IBD condition has skip areas?

Answer 7

Common in Crohn’s disease
Never occurs in Colitis

Question 8

In reference to the distinguishable features, which IBD condition has cobblestone mucosa?

Answer 8

Common in Crohn’s disease
Rare in Colitis (unless pseudopolyps are present)

Question 9

In reference to the distinguishable features, which IBD condition has transmural involvement?

Answer 9

Common in Crohn’s disease
Occasional in Colitis

Question 10

In reference to the distinguishable features, which IBD condition has rectal sparing?

Answer 10

Common in Crohn’s
Never in Colitis

Question 11

In reference to the distinguishable features, which IBD condition has perianal involvement?

Answer 11

Common in Crohn’s disease
Never in Colitis

Question 12

In reference to the distinguishable features, which IBD condition has fistulas?

Answer 12

Common in Crohn’s disease
Never in Colitis

Question 13

In reference to the distinguishable features, which IBD condition has strictures?

Answer 13

Common in Crohn’s disease
Occasional in Colitis

Question 14

In reference to the distinguishable features, which IBD condition has Granulomas?

Answer 14

Common in Crohn’s disease
Occasional in Colitis

Question 15

What percentage of patients with IBD develop other complications elsewhere in the body? What causes this?

Answer 15

10-20%
This is caused by the over spill of immune cells, which then travels elsewhere in the body

Question 16

What are the complications in the joints and bones?

Answer 16

Arthropies and Osteopenia (loss of bone matrix), pro-inflammatory cytokines cause breakdown in the bone due to activating osteoclasts

Question 17

What are some of the skin complications associated with IBD?

Answer 17

Erythema nodosum
Tender hot and red nodules, which subside over a few days to then leave skin discolouration

Pyoderma gangrenosum
Pustule develops into an ulcer

Question 18

What are the ocular complications associated with IBD?

Answer 18

Episcleritis
Intense burning & itching of blood vessels
involved

Uveitis
Headache, burning red eye, blurred vision

Question 19

What are some of the complications liver associated with IBD?

Answer 19

Sclerosing Cholangitis
Chronic inflammation of the biliary tree
– Leads to progressive fibrosis & biliary
strictures

Question 20

When is the quality of life worse in Crohn’s or Colitis?

Answer 20

Crohn’s disease - unable to remove the small intestine so there are reoccurrences even after surgery

Question 21

What are some of the other risks associated with IBD?

Answer 21

Increased risk of cancer
Increased risk of malnutrition and chronic anaemia (especially Crohn’s disease)
Risk of peronitis

Question 22

What are some of the tests for diagnosing IBD?

Answer 22

• Biochemical
  – Endoscopic
  – Radiological
  – Histological
  – Nuclear medicine based

Question 23

What would some of the history taking that would be required for diagnosis?

Answer 23

• Recent travel
  – Medication
  – Smoking
  – Family history

Question 24

What are some of the symptom details that you would want to record?

Answer 24

• Stool frequency & consistency
  – Urgency
  – Rectal bleeding
  – Abdominal pain
  – Fever

Question 25

What are some of the physical signs you may want to explore?

Answer 25

General well-being – Pulse – Blood pressure – Temperature – Weight loss – Abdomen tenderness or distension (Right iliac fossa mass) – Anus (Oedematous anal tags, fissures or perianal abscesses)

Question 26

What are some of the blood test results would align to IBD?

Answer 26

Anaemia Iron deficiency and or folate deficiency Raised ESR , CRP, WCC Hypoalbuminaemia (protein loss in the gut) LFTs may be abnormal May test for infective diarrhoea

Question 27

What serological tests can be used to distinguish between Crohn's and Colitis?

Answer 27

Saccharomyces cerevisae antibody is present in Crohn's disease p-ANCA antibody is present in Colitis

Question 28

What is the purpose of abdominal radiography?

Answer 28

Helps to assess the disease extent Excludes colonic dilatation Identifies proximal constipation Gives an impression of right iliac fossa mass in Crohn's disease Can show evidence of small bowel dilation

Question 29

What does a sigmoidoscopy involve?

Answer 29

Internal examination of the colon (the lower third) It is used for all patients presenting with diarrhoea Confirms UC diagnosis

Question 30

What is the purpose of a rectal biopsy?

Answer 30

Detects non-specific histological changes

Question 31

What is the purpose of a colonoscopy?

Answer 31

Internal examination of the entire length of the colon Used for mild to moderate disease to assess disease extent Used in addition to a biopsy

Question 32

What are some of the other investigations that may be made in diagnosis?

Answer 32

Double contrast barium enema Inferior to colonoscopy Detect early mucosal changes Small bowel radiology Current standard for assessing small intestine Ultrasound Sensitive & non-invasive Identifies thickened small bowel loops in Crohn's disease Computer tomography & magnetic resonance imaging Evaluates activity & complications of the disease