Inflammatory bowel disease

Question 1

What are the causes of inflammatory bowel disease?

Answer 1

Genetic

Normal flora of large intestine

Immune response

Question 2

What are the types of inflammatory bowel disease?

Answer 2

Crohn’s disease

Ulcerative colitis

Intermediate colitis

Question 3

What age group is more commonly affected by Crohn’s disease? And by ulcerative colitis?

Answer 3

Crohn’s - young adults, elderly

Ulcerative colitis - young adults

Question 4

What part of the GI tract can be affected by Crohn’s disease? And by ulcerative colitis?

Answer 4

Crohn’s - any part of GI tract

Ulcerative colitis - colon

Question 5

What part of the GI tract is most commonly affected by Crohn’s disease? And by ulcerative colitis?

Answer 5

Crohn’s - ileum

Ulcerative colitis - rectum then extends proximally

Question 6

How continuous are the parts of the GI tract affected by Crohn’s disease? And by ulcerative colitis?

Answer 6

Crohn’s disease - discontinuous, unaffected then affected than unaffected, called skip lesions

Ulcerative colitis - continuous

Question 7

How deeply does Crohn’s disease affect the wall of the GI tract? And ulcerative colitis?

Answer 7

Crohn’s disease - transmural, meaning entire depth of wall

Ulcerative colitis - mucosa

Question 8

What are the signs and symptoms of Crohn’s disease?

Answer 8

RLQ pain

Diarrhoea

Weight loss

Fever

Anaemia

Perianal inflammation

Question 9

What is the macroscopic appearance of the intestines with Crohn’s disase?

Answer 9

Inflamed - red, swollen

Deep ulceration

Cobblestone appearance

Thickening of wall

Strictures

Fistulae

Question 10

Why do the intestines have a cobblestone appearance with crohn’s disease?

Answer 10

Deep ulceration

adjacent to inflamed swollen tissue, or adjacent to fibrosing tissue, or adjacent to healthy tissue

Question 11

What is a fistula?

Answer 11

Abnormal connection between two epithelia-lined surfaces

Question 12

What do fistula occur between with Crohn’s disease?

Answer 12

Intestines
and
other part of intestine, bladder, skin etc.

Question 13

What is a stricture?

Answer 13

Narrowing of lumen

Question 14

What is the microscopic appearance of Crohn’s disease?

Answer 14

Granuloma

Question 15

What investigations are done for a patient with Crohn’s disease?

Answer 15

Full blood count

CT and MRI scans

Barium follow through or enema

Question 16

What might the full blood count of a patient with Crohn’s disease show?

Answer 16

Anaemia

Question 17

Why do patients with Crohn’s disease get anaemia?

Answer 17

Iron deficiency, due to bleeding, malabsorption

B12 deficiency, due to malabsorption

Anaemia of chronic disease

Question 18

What do CT and MRI scans of a patient with Crohn’s disease show?

Answer 18

Intestinal wall thickening

Strictures

Question 19

What might barium enema and follow throughs of a patient with Crohn’s disease show?

Answer 19

Strictures

Fistulae

Question 20

What are the signs and symptoms of ulcerative colitis?

Answer 20

Lower abdominal pain

Diarrhoea with blood and mucus

Weight loss

Anaemia

Question 21

What is the macroscopic appearance of the intestines with ulcerative colitis?

Answer 21

Ulcerations

Pseudopolyps

Lead pipe colon

Question 22

What is a pseudopolyp?

Answer 22

Projecting masses of oedematous tissue, granulation tissue or scar tissue
between areas of ulceration

Question 23

What is meant by a lead pipe colon?

Answer 23

No haustra

Question 24

What is the microscopic appearance of the intestines with ulcerative colitis?

Answer 24

Crypt distortion

Crypt abscesses

Question 25

What investigations are done for a patient with ulcerative colitis?

Answer 25

Full blood count Stool culture Colonoscopy Plain abdominal radiographs Barium enema for more mild cases CT/MRI scan for more severe cases

Question 26

What might a full blood count of a patient with ulcerative colitis show?

Answer 26

Anaemia

Question 27

Why causes anaemia in a patient with ulcerative colitis?

Answer 27

Iron deficiency, due to bleeding

Question 28

What are the extra-intestinal signs and symptoms of inflammatory bowel disease?

Answer 28

Arthritis Erythema nodosum Pyoderma gangrenosum Psoriasis Primary sclerosing cholangitis Eye problems

Question 29

What is intermediate colitis?

Answer 29

The in between Crohn's and ulcerative colitis

Question 30

What is erythema nodosum?

Answer 30

Red round lumps beneath the skin

Question 31

What is pyoderma gangrenosum?

Answer 31

Deep ulcers on the skin

Question 32

What is primary sclerosing cholangitis?

Answer 32

Inflammation and fibrosis of the bile ducts

Question 33

How is inflammatory bowel disease treated?

Answer 33

Medically Surgically if medical treatment is unsuccessful

Question 34

What are the medical treatments of inflammatory bowel disease?

Answer 34

Aminosalicyclates for flare-ups, remission Corticosteroids for flare ups Immunomodulators for more severe disease

Question 35

What are the surgical treatments of inflammatory bowel disease?

Answer 35

Crohn's - removing small amounts of most affected bowel e.g. strictures, fistula Ulcerative colitis - colectomy

Question 36

How successful is the surgical treatment for Crohn's disease? Why?

Answer 36

Not successful | because may affect another part of the GI tract

Question 37

How successful is the surgical treatment for ulcerative colitis?

Answer 37

Cures ulcerative colitis

Question 38

When is surgical treatment for ulcerative colitis done?

Answer 38

Medical treatment was unsuccessful | colon is still inflamed and ulcerated, becoming precancerous