Inflammatory Bowel Disease

Question 1

chrons disease symptoms

Answer 1

abdominal pain

diarrhoea

fever

weight loss

Question 2

IBD aetiology

Answer 2

possible environmental trigger

genetically susceptible people

Question 3

Environmental triggers to IBD

Answer 3

role of bacteria

diet

vaccination history

social factors

ethnicity

Question 4

ulcerative colitis presents with

Answer 4

bloody diarrhoea

abdominal pain

weight loss

Question 5

what is ulcerative colitis?

Answer 5

continuous inflammation with variable distribution and severity

Question 6

clinical features of ulcerative colitis

Answer 6

more than 6 stools a day

fever

tachycardia

CRP raised

Anaemia

leucocytosis

thrombocytosis

Question 7

chron’s disease is a patchy disease that presents with

Answer 7

skip lesions

Question 8

chron’s disease clinical features

Answer 8

diarrhoea

abdominal pain

weight loss

malaise, lethargy, anorexia, N+V, low-grade fever

malabsorption (anaemia, vitamin deficiency)

Question 9

CRP

Answer 9

C-reactive protein

test for inflammation

Question 10

IBD tests that show inflammatory indices

Answer 10

High WCC

High ESR + CRP

High platelet count

Low Hb

Low albumin

Question 11

ESR

Answer 11

erythrocyte sedimentation rate

test for inflammation - its a marker

Question 12

Histology of ulcerative colitis

Answer 12

goblet cells are depleted

Question 13

histology of chron’s disease

Answer 13

granulomas

Question 14

Chron’s disease includes conditions such as

Answer 14

fistulae

peri- anal symptoms

Question 15

IBD: Extra-intestinal manifestations

Eyes

Answer 15

uvetitis

conjunctivits

Question 16

IBD: Extra-intestinal manifestations

joints

Answer 16

sacroilititis

arthritis

Question 17

IBD: Extra-intestinal manifestations

liver and biliary tree

Answer 17

fatty change

gallstones

pericholangitis

Question 18

cholestasis

Answer 18

a decrease in bile flow due to impaired secretion by hepatocytes or to obstruction of bile flow through intra-or extrahepatic bile ducts

Question 19

Sclerosing cholangitis is an Associated liver disease of IBD. what is it?

Answer 19

disease of the bile ducts

multiple strictures

slowly and progressively can lead to cirrhosis

Question 20

medical management of IBD

out patient

Answer 20

5ASA

steriods

immunosuppression

Question 21

medical management of IBD

hospital

Answer 21

steriods

anticoagulation

rest

(occasionally surgery)

Question 22

Aminosalicylates (5ASA)

Answer 22

group of anti-inflammatory drugs used to treat chrons and ulcerative colitis

Question 23

5ASA in UC results in

Answer 23

reduced numer and severity of relapses

higher mucosal levels = greater benefit

Question 24

5ASA treatment in UC leads to a reduced risk of

Answer 24

CRC

colorectal carcinoma

Question 25

CRC

Answer 25

colorectal carcinoma

Question 26

steroids used include

Answer 26

prednisolone budenoside

Question 27

immunosuppressants (3)

Answer 27

ciclosporin (salvage therapy for refractory UC) mycophenolate tacrolimus

Question 28

exclusive elemental feeding can be as effective as

Answer 28

steroids

Question 29

Failure of medical therapy can lead to...

Answer 29

recurrent courses of steroids relapse after therapy stops failure to control symptoms

Question 30

Poor response to medicine leads to

Answer 30

fistulas fibrotic strictures peri-anal disease severe fulminating disease

Question 31

surgery for severe colitis

Answer 31

total colectomy rectal preservation ileostomy

Question 32

ileostomy

Answer 32

is a stoma (surgical opening) constructed by bringing the end or loop of small intestine (the ileum) out onto the surface of the skin, or the surgical procedure which creates this opening

Question 33

colectomy

Answer 33

removing all or part of the colon

Question 34

after a total colectomy the patient will end up with an

Answer 34

end ileostomy and a rectal stump

Question 35

chronic UC can be treated surgically either by..... or.....

Answer 35

pouch procedure (no ileostomy) protocolectomy (ileostomy)

Question 36

pouch procedure

Answer 36

the ileum is attached to the anus after the rectum has been removed

Question 37

surgical options for chron's disease

Answer 37

small intestine ileocaecal area colon and rectum

Question 38

anus symptoms in chrons can be

Answer 38

fissures abscesses fistulas skin tags

Question 39

chrons surgical indications

Answer 39

failure of medicine to receive obstructive symptoms (small bowel) fistula intra-abdominal abscess anal conditions failure to thrive

Question 40

order of treatment for IBD

Answer 40

5ASA prednisone or budesonide immunomodulators biologic agents surgery

Question 41

biologic agents used to treat IBD include:

Answer 41

anti-TNFalpha antibodies alpha4b7 intern blockers IL12/IL23 blockers