Inflammatory Bowel Disease

Question 1

2 main diseases

Answer 1

Crohn’s disease + UC

Question 2

Genetic predisposition of IBD is defect in?

Answer 2

NOD2 on chromosome 16

Question 3

Crohn’s is mediated by?

Answer 3

Th1 cells

Question 4

UC is mediated by

Answer 4

Th1 + Th2 + NK cells

Question 5

Affect of smoking on IBD

Answer 5

Aggravates crohn’s

Protects UC

Question 6

What nutrition factors lead to IBD?

Answer 6

Lack of breastfeeding, cow’s milk hypersensitivity, lack of fruit and fibre

Question 7

Nutritional deficiencies caused by IBD

Answer 7

Weight loss, anaemia, iron, vit B12, folic acid, vit D

Question 8

Parts of GIT affected by crohn’s

Answer 8

Mouth to anus

Question 9

Parts of GIT affected by UC

Answer 9

Colon and rectum

Question 10

Skip lesions, thickened bowel and stricture, granulomas

Answer 10

Crohn’s

Question 11

Fistulas more common in?

Answer 11

Crohn’s

Question 12

Crypt abscesses

Answer 12

UC

Question 13

Type of inflammation

Answer 13

C - transmural

UC - superficial

Question 14

Which has higher risk of cancer?

Answer 14

UC

Question 15

Psuedopolyps

Answer 15

Crohn’s

Question 16

Psuedopolyps

Answer 16

UC

Question 17

Cobblestone mucosa

Answer 17

Crohn’s

Question 18

Cobblestone mucosa

Answer 18

Crohn’s

Question 19

Rose-thorn ulcers

Answer 19

Crohn’s

Question 20

Non-caseating granuloma

Answer 20

Crohn’s

Question 21

Patient characteristics of Crohn’s

Answer 21

young, male, gall stone history

Question 22

Presentation of crohn’s

Answer 22

Bloody diarrhoea, cramps, weight loss, ulcers, abscesses, RIF mass

Question 23

Investigation of crohn’s

Answer 23

Bloods, endoscopy, colonoscopy, histology, small bowel - barium, MRI, WBC scan

Question 24

Complications of Crohn’s

Answer 24

Gallstones, short bowel syndrome, colorectal cancer, strictures, fistula, anal disease, vit def, anaemia

Question 25

Treatment

Answer 25

1. Corticoidsteroids 2. Immunosuppressants 3. Anti-TNF 4. Bowel resurrection

Question 26

What can bowel resurrection lead to

Answer 26

Short bowel syndrome

Question 27

Patient characteristics of UC

Answer 27

young/elderly, males

Question 28

Presentation of UC

Answer 28

Blood + mucus diarrhoea, tenesmus, increased bowel freq, urgency, night rising, LIF pain

Question 29

Extra-GI manifestations of UC

Answer 29

Uveitis, arthritis, ankle spondylitis, erythema nodusum

Question 30

UC is severe if

Answer 30

>6 bloody stools/24 hr + fever, tachycardia, anaemia, elevated ESR

Question 31

UC complications

Answer 31

Oxalate renal stones Toxic megacolon Primary sclerosing cholangitis High risk of colorectal cancer

Question 32

Investigations of UC

Answer 32

Bloods, plain AXR, endoscopy, histology, barium enema

Question 33

AXR UC findings

Answer 33

Stools absent in inflamed colon, “thumb-printing” and toxic megacolon (transverse >5.5 cm and caecum > 9cm)

Question 34

Barium enema UC findings

Answer 34

Loss of haustrations superficial ulceration, pseudopolyps, 'drainpipe colon'

Question 35

Histology UC findings

Answer 35

Crypt abscesses, absence of goblet cells, affects only mucosal and submucosal layer, loss of haustra, fibrinopurulent exudate, pseudopolyps

Question 36

Increased goblet cells

Answer 36

Crohn's

Question 37

Treatment of UC

Answer 37

1. 5-ASAs 2. Corticoidstroids 3. Immunosuppressants 4. Anti-TNF 5. Permanent ileostomy/ Restorative proctocoloectomy + pouch

Question 38

Antibodies for UC and PSC

Answer 38

p-ANCA

Question 39

Blood results for IBD

Answer 39

Elevated CRP | Decreased Hb + albumin