Inflammatory bowel disease

Question 1

Characteristic features of Crohn’s (crow’s NESTS)

Answer 1

• no bleeding
• entire GI tract can be affected
• skip lesions on endoscopy
• terminal ileum most common/transmural inflam
• smoking is a RF
• weight loss
• stricture & fistulas

Question 2

characteristic features of UC (U-C-CLOSEUP)

Answer 2

• continuous inflammation
• limited to colon & rectum
• only superficial mucosa affected
• smoking is protective
• excrete blood & mucus
• use aminosalicylates
• primary sclerosis cholangitis

Question 3

Presentation (typical of bowel inflammation)

Answer 3

• diarrhoea
• abdominal
• blood
• weight loss

Question 4

When is faecal calprotectin released

Answer 4

Inflamed intestines

Question 5

1st line inducing remission crohn’s

Answer 5

Steroids

Question 6

Additive to 1st line inducing remission Crohn’s if 1st line on its own doesn’t work

Answer 6

• azathioprine
• mercaptopurine
• methotrexate
• infliximab
• adalimumab

Question 7

1st line immunosuppressants maintaining remission Crohn’s

Answer 7

• azathioprine

- mercaptopurine

Question 8

2nd line maintaining remission Crohn’s (chemotherapeutic immunosuppressant & 2 monoclonal Abs)

Answer 8

• methotrexate
• infliximab
• adalimumab

Question 9

When to perform surgery in Crohn’s

Answer 9

If only ileum is affected

Question 10

1st line mild-moderate UC inducing remission

Answer 10

• aminosalicylate
• mesalazine
• oral/rectal

Question 11

2nd line mild-moderate UC inducing remission

Answer 11

Corticosteroids

Question 12

1st line severe UC inducing remission

Answer 12

• IV corticosteroids

Question 13

2nd line severe UC inducing remission (immunosuppressant calcineurin inhibitor)

Answer 13

• IV ciclosporin

Question 14

UC maintains remission

Answer 14

• aminosalicylates
• azathioprine
• marcaptopurine

Question 15

How is surgery for UC performed and what is removed

Answer 15

• ileo-anal anastomosis (J-pouch)

- colon & rectum

Question 16

IBD gold standard Ix

Answer 16

endoscopy

Question 17

ophthalmic symptoms of IBD

Answer 17

• iritis
• uveitis
• episcleritis

Question 18

dermatological symptoms of IBD

Answer 18

• erythema nodosum

- pyoderma gangrenosum

Question 19

MSK symptoms IBD

Answer 19

• arthritis
• osteoporosis
• ankylosing spondylitis

Question 20

renal symptoms of IBD

Answer 20

nephrolithiasis

Question 21

haematological symptoms IBD

Answer 21

• anaemia

- thromboembolism

Question 22

race vulnerable to IBD

Answer 22

Ashkanazi Jewish

Question 23

enzyme activity to be checked before azathioprine to reduce chances of mylosuppression

Answer 23

thiopurine methyltransferase (TPMT)

Question 24

UC biopsy

Answer 24

• crypt abscess

- decreased goblet count

Question 25

Crohn's biopsy

Answer 25

granulomas

Question 26

classic appearance of UC on barium enema

Answer 26

lead pipe