Inflammatory Bowel Disease

Question 1

What is more prevalent, UC or Crohn’s?

Answer 1

Both have equal prevalence

Question 2

What tends to appear later on in life, UC or Crohn’s?

Answer 2

UC - 30’s

Crohn’s - 20’s

Question 3

What does smoking increase the risk of, UC or Crohn’s?

Answer 3

Crohn’s

Protective in UC

Question 4

Which is TH2-mediated, UC or Crohn’s?

Answer 4

UC

Crohn’s is TH1/TH17-mediated

Question 5

Backwash ileitis occurs in which condition, UC or Crohn’s?

Answer 5

UC

Question 6

Which commonly is associated with strictures, UC or Crohn’s?

Answer 6

Crohn’s

Question 7

Which condition affects the mucosa and forms crypt abscesses, UC or Crohn’s?

Answer 7

UC

Crohn’s = transmural inflammation

Question 8

Which condition has a cobblestone mucosa (when describing ulceration), UC or Crohn’s?

Answer 8

Crohn’s

Question 9

In which condition can you get granulomas, UC or Crohn’s?

Answer 9

Crohn’s

Question 10

In which condition can fistulas occur, UC or Crohn’s?

Answer 10

Crohn’s

Question 11

Which condition typically presents with bloody diarrhoea + mucus, UC or Crohn’s?

Answer 11

UC

Question 12

Which condition do you get faecal urgency and tenesmus, UC or Crohn’s?

Answer 12

UC

Question 13

What size does the colon have to be before it can be called a toxic megacolon?

Answer 13

> 6cm

Question 14

Name the three skin signs in IBD

Answer 14

Clubbing
Erythema nodosum
Pyoderma gangrenosum (esp UC)

Question 15

Name the three eye signs in IBD

Answer 15

Iritis
Episcleritis
Conjunctivitis

Question 16

Name the three joint signs in IBD

Answer 16

Arthritis (non-deforming, assymetrical)
Sacroiliitis
Ank Spond

Question 17

Name the three HPB signs in IBD

Answer 17

Primary sclerosing cholangitis + cholangiocarcinoma (esp. UC)
Gallstones (esp crohns)
Fatty liver

Question 18

Which do you have a higher risk of colorectal cancer, UC or Crohn’s?

Answer 18

UC - 15%

Question 19

What are abdominal and anorectal abscesses more common in, UC or Crohn’s?

Answer 19

Crohn’s

Question 20

What is malabsorption more common in, UC or Crohn’s?

Answer 20

Crohn’s

Fat = steatorrhoea, gallstones
B12 = megaloblastic anaemia
Vit D = Osteomalacia
Protein = oedema

Question 21

What bloods would you run to investigate UC? (4)

Answer 21

FBC: drop in Hb, raised WCC
LFT: drop in albumin
CRP/ESR raised
Blood Cultures

Question 22

What stool sample tests would you run in UC and Crohns? (2)

Answer 22

M, C and S (Microscopy, culture and sensitivity): exclude campy, shigella, salmonella

CDT (C. diff toxin)

Question 23

What imaging would you order for UC? (2 main, 2 special)

Answer 23

ABX: megacolon, wall thickening
CXR: perf

CT
Barium/gastrograffin enema (lead piping=no haustra, thumbprinting=muscosal thickening, pseudopolyps=regenerating mucosal island

Question 24

What is the criteria used to assess the severity of UC?

Answer 24

Truelove and Witts

Mild, moderate, severe

Question 25

What does the Truelove and Witts criteria take into account? (6)

Answer 25

``` Motions PR bleed Temp HR Hb ESR ```

Question 26

What is the management of acute UC?

Answer 26

``` NBM IV hydration Hydrocortisone IV 100mg QDS + PR transfuse if required Thromboprophylaxis: LMWH ``` RCT's show no benefit of ABx

Question 27

What are the four acute complications of UC

Answer 27

Perf Haemorrhage Toxic megacolon VTE

Question 28

What therapy do you use if you see an improvement after an acute episode of UC or Crohns?

Answer 28

Oral prednisolone

Question 29

What therapy do you use if you see a regression after an acute episode of UC?

Answer 29

Surgical: ?Colectomy Medical: ciclosporin, infliximab

Question 30

In mild to moderate UC, what oral therapies are used?

Answer 30

Mesalazine Prednisolone 2nd line Infliximab 3rd line

Question 31

What percentage of UC sufferers require emergency surgery at some stage?

Answer 31

20%

Question 32

What bloods would you run to investigate crohns? (5)

Answer 32

``` FBC: drop in Hb, raised WCC LFT: drop in albumin CRP/ESR raised Blood Cultures Haematinics: Fe, B12, Folate ```

Question 33

What imaging would you request in Crohns (2 basic, 2 special)

Answer 33

AXR: obstruction, sacroiliitis CXR: perf MRI: pelvic disease + fistulas Small bowel follow through: skip lesions, rose-thorn ulcers, cobblestoning, string sign of Kantor (narrow terminal ileum - little bit of contrast allowed through, looks like string)

Question 34

What is cobblestoning?

Answer 34

Ulceration and mural oedema

Question 35

What 6 parameters indicate a severe attack?

Answer 35

raised temp, HR, ESR, CRP, WCC | drop in albumin

Question 36

Mx of severe attack of crohns?

Answer 36

``` NBM, IV hydration Hydrocortisone IV + PR if rectal disease Metronidazole Thromboprophylaxis: LMWH Dietician review ```

Question 37

What is the difference in acute management between UC and Crohns?

Answer 37

You don't use Abx in UC

Question 38

What are the two supportive treatments for crohns?

Answer 38

High fibre diet | vitamin supplements

Question 39

What is 1st line medical therapy for crohns affecting: 1) ileocaecal region 2) colonic region

Answer 39

1) budesonide | 2) sulfasalazine

Question 40

What is second line medical therapy for crohns

Answer 40

prednisolone 3rd-methotrexate 4th-infliximab