Inflammatory Bowel Disease

Question 1

What are the typical clinical presentations of Crohn’s?

Answer 1

Abdominal pain and peri-anal disease

Question 2

What are the typical clinical presentations of UC?

Answer 2

Diarrhoea and bleeding

Question 3

What genes are associated with IBD and what do these encode?

Answer 3

NOD2/CARD15 on chromosome 16 (IBD-1 cluster). They encode a protein involved in bacterial recognition

Question 4

Which immune cell mediates Crohn’s?

Answer 4

Th1 cells

Question 5

Which immune cells mediate UC?

Answer 5

Mixed Th1/Th2 cells

Question 6

What are one of the main theories on the pathophysiology of IBD?

Answer 6

On culture, people with Crohn’s are less able to control the numbers of bacteria so have overpopulation, while UC have much lower numbers, as they may be attacking their own numbers

Question 7

What is the peak age incidence for UC?

Answer 7

20-30s

Question 8

Which criteria is used to determine the severity of UC?

Answer 8

Truelove and witt criteria Severe colitis: 6 bloody stools/24 hour + 1 or more of: • Fever (>37.8°C) • Tachycardia (>90/min) • Anaemia (Haemoglobin 30mm/hr)

Question 9

What investigations would you do for UC?

Answer 9

• Bloods:
  
  • CRP
  • Albumin
• Plain AXR (thumb printing, absence of stool distribution due to inflammation, toxic megacolon)
• Endoscopy (loss of vessel pattern, transition zone, granular mucosa, contact bleeding)
• Histology

Question 10

What extra-intestinal manifestations of IBD are there?

Answer 10

• Skin
  
  • Erythema nodosum (shins)
  • Pyoderma gangrenous
• Joints
  
  • Spondylitis
  • Joint pain
• Eyes
  
  • Eye pain
  • Uveitis/scleritis
• Deranged LFTs
• Oxalate renal stones
• Primary sclerosing cholangitis (UC)

Question 11

When is the peak onset for Crohn’s?

Answer 11

15-40y then 60-80y

Question 12

What are the symptoms of Crohn’s according to site?

Answer 12

• Small intestine
  
  • Abdominal cramps
  • Diarrhoea
  • weight loss
• Colon
  
  • Abdominal cramps (lower abdomen)
  • Diarrhoea with blood
  • Wt loss
• Mouth
  
  • Painful ulcers
  • swollen lips
  • angular chielitis
• Anus
  
  • peri-anal pain especially when sitting down, abscess

Question 13

What could you find on examination for crohns?

Answer 13

Evidence of wt loss, RIF mass, peri-anal signs

Question 14

What investigations would you do for Crohn’s?

Answer 14

• Bloods
  
  • CRP, albumin, platelets – inflam markers
  • B12 (t.ileum), ferritin
• Colonoscopy
  
  • Cobblestoning – loss of normal crypt architecture and thickening due to inflammation
  • Omentum wraps around these areas of inflame as bodies natural defence
  • Pseudopolyps develop also

Question 15

At what site are the majority of Crohn’s found?

Answer 15

Terminal ileum

Question 16

Chronic and active inflammation + granuloma indicates…?

Answer 16

Crohn’s

Question 17

Deep knife-like fissuring ulcers are associated with…

Answer 17

Crohn’s

Question 18

Which IBD is smoking a risk factor for, and for which is it protective?

Answer 18

Risk for Crohn’s - protective for UC

Question 19

Of UC and Crohn’s - which is more common in children?

Answer 19

Crohn’s

Question 20

Is UC more common in males or females?

Answer 20

Males

Question 21

Of Crohns and UC, which has a greater association with colorectal cancer?

Answer 21

UC

Question 22

Of Crohns and UC, which has a greater association with toxic megacolon?

Answer 22

US

Question 23

Of Crohns and UC, which has a greater association with fistulas?

Answer 23

Crohn’s

Question 24

Of Crohns and UC, which has a greater association with strictures?

Answer 24

Crohn’s

Question 25

Of Crohns and UC, which has a greater association with Primary sclerosis cholangitis?

Answer 25

UC

Question 26

What are the main differences between Crohn's and UC?

Answer 26

.

Question 27

What are the main differences between Crohn's and UC histologically?

Answer 27

Question 28

What are the main aims of IBD therapy?

Answer 28

- Control inflammation + heal mucosa - Restore normal bowel habit - Improve quality of life - Balance the effects of disease with side effects of treatment - Avoid long-term complications

Question 29

What is the pharmacological therapy for UC?

Answer 29

1) Smoking cessation 2) 5ASA - anti-inflam (**mesalazine**) 3) Steroids (oral prednisolone/budenoside or IV hydrocortisone if acute) 4) Immunosuppressants (infliximab/ciclosporin) 5) Anti-TNF therapy

Question 30

What is the pharmacological therapy for Crohn's?

Answer 30

1) Smoking cessation (5ASA - anti-inflame (mesalazine) - though may be limited to ileocaecal disease) 2) Steroids (budenoside) 3) Immunosuppressants (infliximab/anzathioprine) 4) Anti-TNF therapy

Question 31

What is the surgical cure for UC?

Answer 31

Colectomy

Question 32

How does UC colon appear macroscopically?

Answer 32

Featureless

Question 33

What is a panproctocolectomy?

Answer 33

All large bowel is removed

Question 34

What are the two options for panproctocolectomy?

Answer 34

End ileostomy (stoma) or pouch formation (S/J pouch)