Inflammatory Bowel Disease

Question 1

What conditions make up the bulk of IBD?

Answer 1

Crohn’s disease

Ulcerative colitis

Question 2

How is IBD classified?

Answer 2

Montreal classification

Question 3

When does incidence peak in UC?

Answer 3

20-40 years

Over 60

Question 4

How does UC present?

Answer 4

Bloody diarrhoea
Abdominal pain
Weight loss

Question 5

How does UC affect the body?

Answer 5

Continuous inflammation in the colon, with variable distribution and severity

Question 6

What are the clinical features of severe ulcerative colitis attack?

Answer 6

>6 stools/day + blood
Fever
Tachycardia
Raised CRP
Anaemia
Low alb

Question 7

How does Crohns disease affect the body?

Answer 7

Patchy skip lesions from mouth to anus

Question 8

What are the clinical features of Crohns disease?

Answer 8

Diarrhoea
Abdominal pain
Weight loss
Malabsorption ->
Malaise, anorexia, lethargy

Question 9

When is calprotectin raised in the stool?

Answer 9

> 200

When colon is inflamed

Question 10

Inflammatory indices for IBD

Answer 10

High ESR, CRP
High platelets
High WCC
Low Hb
Low Alb
High Calprotectin

Question 11

How does the histology of UC differ from CD?

Answer 11

CD - granulomas

UC - Goblet cell depletion, more crypt abscesses

Question 12

What features present in Crohn’s disease but not Ulcerative colitis?

Answer 12

Fistulae

Peri-anal disease

Question 13

Renal calculi are an additional manifestation of what?

Answer 13

Crohn’s disease

Question 14

Extra-intestinal manifestations of IBD are seen where?

Answer 14

Renal (CD)
Eyes
Joints
Liver/biliary
Skin

Question 15

Differential diagnosis for IBD

Answer 15

Chronic diarrhoea
Ileo-caecal TB
Infective/amoebic/ischaemic colitis

Question 16

Which liver disease is associated with IBD?

Answer 16

Sclerosing Cholangitis

Question 17

What is Sclerosing Cholangitis?

Answer 17

IBD associated bile duct disease
Multiple strictures
Slowly progressive to cirrhosis

Question 18

To what degree does colitis increase risks of colonic carcinoma?

Answer 18

Pancolitis 26x normal
Left colitis 8x normal
20yrs 20x normal
30yrs 30x normal

Question 19

What are the surveillance colonoscopy guidelines for extensive colitis?

Answer 19

8-20yrs - 3 yearly
30-40yrs - 2 yearly
+40yrs - yearly

Question 20

What drugs are indicated for management of IBD?

Answer 20

Aminosalicylates (5ASA)
Steroids
Thiopurines
Methotrexate
Immunosuppressants
Biologics

Question 21

What is the role of aminosalicylates in UC?

Answer 21

Induce and maintain remission

Question 22

Which steroids are indicated in IBD?

Answer 22

Prednisolone

Budenoside

Question 23

What is the role of thiopurines in IBD?

Answer 23

Induction and Maintenance of remission

Question 24

What are the significant side effects of thiopurines?

Answer 24

Leucopenia
Hepatotoxicity
Pancreatitis
Intolerance

Question 25

Adv/disadv of elemental feeding

Answer 25

As effective as steroids More effective in kids Compliance is difficult

Question 26

Which antibiotic is indicated for IBD, and how?

Answer 26

Metronidazole Crohns, peri-anal SI bacterial overgrowth

Question 27

What are the unacceptable complications of steroid use?

Answer 27

Diabetes Osteoporosis Psychosis

Question 28

When is drug therapy considered to have failed?

Answer 28

Recurrent courses of steroids Relapse prior to/short after stopping therapy Failure to control symptoms

Question 29

Surgical indications for Crohn's

Answer 29

Failure of medical management Relief of obstructive symptoms Manage fistulae, abscesses, anal conditions Failure to thrive

Question 30

How many patients need further surgery in IBD?

Answer 30

50%

Question 31

What is the sequence of therapies for IBD?

Answer 31

``` 5-ASA Steroids Immunomodulators Biologics Surgery ```