Inflammatory Bowel Disease

Question 1

what does transmural mean

Answer 1

across the entire wall of the vessel or structure

Question 2

which IBD features non-caseating granulomas on histology

Answer 2

crohn’s

Question 3

serosa in CD pathological appearance

Answer 3

dull, grey and granular

Question 4

mesentery of CD

Answer 4

thick, oedematous and fibrotic

Question 5

what wraps around the gut tube in CD

Answer 5

mesenteric fat

Question 6

intestine wall in crohn’s

Answer 6

thick with fluid and inflammatory cells

Question 7

inside wall appearance in CD

Answer 7

‘cobblestone’ with clear demarcation between diseased and normal segments

Question 8

two IBDs

Answer 8

crohn’s and ulcerative colitis

Question 9

presentation of UC

Answer 9

bloody diarrhoea
abdominal pain
weight loss
tenesmus
rectal bleeding
erythema nodosum

Question 10

classification of UC attacks

Answer 10

mild moderate and severe

Question 11

features of a severe UC attack

Answer 11

>6 bloody stools a day
raised CRP and ESR
fever
tachtycardic
anaemia

Question 12

blood investigations in UC

Answer 12

WCC
CRP and ESR
albumin
Hb
vitamins and minerals

Question 13

special test in IBD of faeces

Answer 13

faecal calprotectin (inflammatory marker)

Question 14

biopsy in UC

Answer 14

rectal biopsy from a sigmoidoscopy

Question 15

imaging in UC

Answer 15

abdominal XR, US, CT, MRI
Barium flurososcopy
colonoscopy

Question 16

5 points of treatment in UC

Answer 16

anti-inflammatories
immunosuppressants
biologics
surgery
nutrional support

Question 17

what type of drug is azathioprine

Answer 17

an immunosuppressatn

Question 18

what type of drug is prednisolone

Answer 18

a corticosteroid (anti-inflammatory)

Question 19

what type of drug is aminosalicylate

Answer 19

anti-inflammatory

Question 20

what is the first line treatment for first presentation of UC

Answer 20

topical aminosalicylate (may need enema)

Question 21

surgical option in UC

Answer 21

removal of colon (proctocolectomy) with an ileostomy and stoma bag or pouch procedure to maintain anal function

Question 22

complications of UC in colon

Answer 22

haemorrhage, perforation, fistula, toxic dilatation

colonic carcinoma

Question 23

what screening do UC patients recieve

Answer 23

colonic carcinoma

Question 24

what is UC

Answer 24

an autoimmune condition that causes inflammation in the colon only and moves continuously from the rectum

Question 25

peak incidence of UC

Answer 25

20-30 y/o and again at 70-80 y/o

Question 26

what causes the autoimmune response in UC

Answer 26

normal gut flora

Question 27

true/false granulomas are observed in UC

Answer 27

false

Question 28

difference in ulceration of UC and CD

Answer 28

UC will not spread past the submucosa | CD will spread down into the entire intestinal wall (transmural)

Question 29

which IBD in granulomatous

Answer 29

Crohn's

Question 30

pathology of crohn's

Answer 30

immune reaction to gut flora is dysregulated and results in cellular damage

Question 31

routes of treatment in crohn's

Answer 31

anti-flammatory, antibiotics, immunosuppressants, surgical and nutritional support

Question 32

process of treatment in IBD

Answer 32

5ASA (aminosalicylates) --> prednisolone or budesonide --> immunosuppressants --> biologics --> surgery

Question 33

presentation of Crohn's

Answer 33

``` diarrhoea abdominal pain weight loss malaise, lethargy etc anaemia vitamin deficiency arthritis erythema nodosum PSCholangitis ```

Question 34

faeces marker in IBD

Answer 34

faecal calprotetin

Question 35

where do you biopsy in Crohn's

Answer 35

terminal ileum and colon

Question 36

where does crohn's affect

Answer 36

anywhere from mouth to anus but mostly the small and large intestine

Question 37

what lifestyle factor is important to stop in Crohn's

Answer 37

smoking

Question 38

cancer risk of IBD

Answer 38

colon cancer

Question 39

complications of IBD

Answer 39

``` fistula intra-abdominal abscess perforation obstruction colon cancer haemorrhage ```