Inflammatory Bowel Disease

Question 1

What 2 main diseases are included in IBD?

Answer 1

Crohn’s Disease

Ulcerative Colitis

Question 2

Aetiology of IBD:

Answer 2

Genetic predisposition (stronger in Crohn's) - NOD2 on Ch16
Impaired mucosal immunity 
Environmental triggers (smoking > crohns)

Question 3

True or False - the genetic predisposition is stronger in Crohn’s than in UC?

Answer 3

TRUE

NOD2 on Ch16

Question 4

What is the step-up treatment for IBD?

Answer 4

1. 5-ASA (oral/topical mesalazine)
2. Steroids (prednisolone)
3. Immunosuppression (azathioprine)
4. Anti-TNF therapy (IV inflixumab)
5. Surgery

Question 5

What investigations would you do for IBD?

Answer 5

Raised CRP, lower Hb + albumin
Stool microscopy/culture
Malabsorption deficiency (B12)
AXR in UC (toxic megacolon0

Question 6

What is Crohn’s Disease?

Answer 6

Transmural, segmental inflammation affecting any part of the GI tract (mouth > anus)
SKIP LESIONS

Question 7

What is the classical appearance of Crohn’s Disease?

Answer 7

Cobblestone appearance
Pseudopolyps
Non-caseating granuloma in 50%

Question 8

Age range of Crohn’s?

Answer 8

young children ==> 40 years (variable)

Question 9

Symptoms of Crohn’s

Answer 9

Abdominal cramps
Diarrhoea
Weight loss
Painful ulcers
Abscesses

Question 10

What are some common complications of Crohn’s?

Answer 10

Malabsorption
Short bowel syndrome
Vitamin deficiencies, anaemia
Fistulas

Question 11

What is the surgical options in Crohn’s?

Answer 11

Resection
Stricturoplasty
Fistula repair

Question 12

What is Ulcerative Colitis?

Answer 12

Mucosal/sub-mucosal inflammation involving rectum that extends proximally (no skip lesions)

Question 13

What is the classical appearance of UC?

Answer 13

Distorted crypt architecture (crypt abscesses)
Inflammatory cell infiltrate
Th1 and Th2 mediated

Question 14

What is the age range for UC?

Answer 14

20-40 yrs (variable)

Question 15

What are the symptoms of UC?

Answer 15

Diarrhoea + bleeding + mucus
Increased bowel frequency 
Urgency, tenesmus, incontinence
Night rising 
Lower abdominal pain (LIF)
Weight loss

Question 16

What is severe UC defined as?

Answer 16

> 6 bloody stools/day + 1 of:

• Fever
• Tachycardia
• Anaemia
• Elevated ESR

Question 17

What are common complications of UC?

Answer 17

Toxic megacolon
Primary Sclerosing cholangitis
Extra-intestinal manifestations
Colorectal cancer

Question 18

What is Toxic Megacolon?

Answer 18

Persistent inflammation causes loss of muscle tone leading to distention

Question 19

What are the surgical options for UC?

Answer 19

Proctocolectomy with end ileostomy / with ileorectal anastamosis / with pouch

Minimise amount of bowel resected, can result in short gut syndrome

Question 20

What does cobblestone mucosa indicate?

Answer 20

Indicates deep fissuring ulceration of mucosa

CROHN’S

Question 21

Buzzword - pyoderma gangrenosum/erythema nodosum

Answer 21

Crohn’s/UC

Question 22

Buzzword – Crypt abscess/cryptitis

Answer 22

Inflammatory bowel UC