Inflammatory Bowel disease

Question 1

Which part of the colon does Ulcerative collitis affect

Answer 1

Rectum (proctits 50%)

or extend and invlve part of the colon (left-sided colitis 30%)

or the entire colon (pancolitis 20%)

Never spreads proximal to the illoceacal valve.

Question 2

Causes of UC

Answer 2

Idiopathic

genetic

Question 3

Which gene is associated with UC

Answer 3

HLADR103

Question 4

Risk factors of UC

Answer 4

most present aged 15-30

More in non/ex smokers

Appendectomy protects

Question 5

Risk factors for Crohn’s

Answer 5

More common in smokers

Question 6

Presentation of UC

Answer 6

Episodic or chronic diarrohoea (+- blood or mucus)

Crampy abdominal discomfort

urgency/tenesmus - rectal UC

systemic symptoms in attacks: fever, malaise, anorexia, weight loss

higher stool frequency compared to Crohns

Question 7

A 35 year old male presents with weight loss, diarrohoea, and abdominal pain. On examination he has apthous ulcers in the mouth and a palpable mass in the right illiac fossa.

Answer 7

Crohn’s disease

Question 8

Extraintestinal signs of IBD in the mouth

Answer 8

Apthous ulcers in the mouth

Question 9

Extraintestinal signs of IBDin the eyes

Answer 9

conjuctivitis

Iritis

Episcliritis

Question 10

Extraintestinal signs of IBD in the liver

Answer 10

Abscess, fatty change, hepatitis, sclerosing cholangitis

Question 11

vascular Extraintestinal signs of IBD

Answer 11

Mesenteric, portal or deep vein thrombosis

Question 12

Extraintestinal signs of IBD in the skin

Answer 12

Erythema nodosum, pyoderma gangrenosum

Question 13

Extraintestinal signs of IBD in the boins/joints

Answer 13

Metabolic bone disease, sacroiliitis

Question 14

Mild UC characteristics

Answer 14

<4 motions/day

small rectal bleeding

HR <70

Question 15

Moderate UC characteristics

Answer 15

4-6 motions/day

medium rectal bleeding

HR 70-90

Question 16

Severe UC characteristics

Answer 16

> 6 motions/day

severe rectal bleeding

HR >90

Question 17

Symptoms of crohn’s disease

Answer 17

Diarrhoea/urgency “I get up at 4am and go 5-6 times in the next 45 mins”

Abdominal pain, weight loss, fever, malaise, anorexia.

“I can be fine one minute and deathly the other”

Question 18

Signs of Crohn’s

Answer 18

Apthous ulcers

Abdominal tenderness/mass

Fistulae

perianal abscess

skin tags

Anal strictures

Question 19

Investigations for inflammatory bowel disease

Answer 19

FBC - Anaemia

ESR

CRP

Faecal Calprotectin

Stool sample

Blood cultures

Sigmoidoscopy

Endoscopy/ Colonoscopy for biopsy

Radiology

Question 20

When is ESR elevated

Answer 20

In exacebrations or because of abscess in IBD

Question 21

What can we benefit from CRP

Answer 21

Helpful in monitoring Crohn’s disease activity

Question 22

Why would you want a stool sample in IBD?

Answer 22

Help to exclude superimposed infections in exacebrations

Question 23

What is sigmoidoscopy

Answer 23

Looks at rectum and sigmoid colon.

Question 24

What can sigmoidoscopy show in UC

Answer 24

Loss of vascular pattern

granularity

Friability

Ulceration

Question 25

What can sigmoidoscopy show in Crohn's

Answer 25

Patchy inflammation with discrete, deep ulcers, perianal disease or rectal sparing occurs Cobble stone appearance

Question 26

What Radiological investigations can help in IBD investigations

Answer 26

Barium enema - can show ulcers or strictures CT - colongram MRI - staging AXR - dilation of colon, mucosal oedema, perforation USS - thickened small bowel, stricture in Crohn's disease.

Question 27

Surgical treatment of UC

Answer 27

60% of UC will require surgery Panproctocolectomy with ileostomy or proctocolectomy with ileal–anal pouch anastomosis cures the patient

Question 28

Surgical treatment of Crohn's

Answer 28

Operations are often necessary to deal with fistulae, abscesses and perianal disease, or to relieve small or large bowel obstruction Surgery is not curative compated to UC, and recurrence is a rule

Question 29

IBD prognosis

Answer 29

Now life expectancy is similar to general population and patients can live normal life

Question 30

Medical treatment for mild to moderate subacute proctitis or proctosigmoiditis

Answer 30

Topical aminosalicylates (Enema or suppository) Or Oral + Topical aminosalicylates Or Oral alone but must explain that topical or combination is more effective

Question 31

Medical treatment for mild to moderate subacute left-sided and extensive ulcerative colitis

Answer 31

Offer high dose oral Aminosalicylates Can Add topical Aminosalicylates or oral beclometasone dipropionate (corticosteroid i think) Oral predinosolone if aminosalicylates is contraindicated

Question 32

Inducing remission in acute ulcerative colitis

Answer 32

IV corticosteroid to induce remision Or IV cyclosporine or surgery if IV corticosteroid is containdicated

Question 33

Inducing remission in Crohn's disease

Answer 33

Consider predinosonle or IV hydrocortisone in people with first presentation Consider budesonide(corticosteroid) if glucocorticoids are contraindicated If both of above fail/contraindicated consider antisalicylates - explain that it is less effective but has fewer SE adjunct treatment: azathioprine or mercaptopurine Influximab and adalimumab

Question 34

When to consider IV cyclosporine in severe acute Ulcerative colitis

Answer 34

if IV corticosteroid is containdicated If no impromvement within 72 hours of starting IV corticosteroids If symptoms persist after IV corticosteroid therapy

Question 35

When to consider IV cyclosporine in severe acute Ulcerative colitis

Answer 35

if IV corticosteroid is containdicated If no impromvement within 72 hours of starting IV corticosteroids If symptoms persist after IV corticosteroid therapy

Question 36

In a severe or exacebrations Crohn's disease presentation which of the following medications you should not offer

Answer 36

Budoneside Antisalicylates

Question 37

Do not offer these drugs as monotherapy for Crohn's disease

Answer 37

Axathiopurine mercaptopurine, methetroxate

Question 38

Maintaining remision in Crohn's

Answer 38

azathioprine or mercaptopurine Methotrexate if above is contraindicated

Question 39

Maintaining remision in mild to moderate subacute proctitis or proctosigmoiditis

Answer 39

same as acute Rx

Question 40

Maintaining remision in mild to moderate subacute left-sided and extensive ulcerative colitis

Answer 40

Same as acute but lower dose