Inflammatory Bowel Disease

Question 1

what is IBD?

Answer 1

chronic inflammatory disease of bowel

Question 2

class of IBD?

Answer 2

Crohn’s and UC

Question 3

epidemiology of IBD?

Answer 3

identification in young= severe disease

Question 4

genetic aetiology of IBD?

Answer 4

chromosome 16q12 or NOD2

Question 5

immunological aetiology of IBD?

Answer 5

impaired mucosal immunity

Question 6

environmental factors that inc risk of IBD?

Answer 6

smoking & NSAIDs

Question 7

site of UC?

Answer 7

colon/rectum

Question 8

site of crohn’s?

Answer 8

anywhere in GI tract

Question 9

so what is Crohn’s?

Answer 9

chronic transmural inflammation and ulcerating condition of GI tract that can affect anywhere from mouth anus

Question 10

what is the handy pneumonic for Crohn’s?

Answer 10

N- no blood in faeces
E- entire GI tract
S- skip lesions on endoscopy 
T- terminal ileum most affected and transmural (full thickness) inflammation 
S- smoking is a risk factor

Question 11

what else is commonly found with Crohn’s?

Answer 11

fistulas, strictures and wt loss

Question 12

what mutated gene may cause Crohn’s?

Answer 12

chromosome 16

Question 13

true/false…

young males in northern europe have higher chance of having Crohn’s?

Answer 13

true

Question 14

symptoms of Crohn’s affecting small intestine?

Answer 14

abdominal cramps, diarrhoea

Question 15

symptoms of Crohn’s affecting colon?

Answer 15

cramps, diarrhoea w blood

Question 16

symptoms of Crohn’s affecting mouth?

Answer 16

ulcers, swollen lips, angular chelitis

Question 17

symptoms of Crohn’s affecting anus?

Answer 17

anal pain, abscess

Question 18

signs of Crohn’s?

Answer 18

RIF mass, peri-anal signs e.g. fistula

Question 19

clinical course of crohn’s?

Answer 19

chronic OR exacerbations & remission- unpredictable response to therapy

Question 20

ix for Crohn’s

Answer 20

endoscopy w mucosal biopsy, Ba imaging, bloods (CRP, albumin, FBCs, B12)

Question 21

what are common findings on endoscopy for Crohn’s?

Answer 21

cobblestone appearance, pseudo polyps, fissures, non-caseating granuloma, transmural inflammation, skip areas

Question 22

tx for Crohn’s?

Answer 22

lifestyle- no smoking
drugs- steroids, immunosuppressants, anti-TNF therapy
surgery- resection, stricturoplasty, fistula repair (non-curative !!)

Question 23

what drug is given to maintain remission for Crohn’s?

Answer 23

azathioprine

Question 24

what emergency surgery is done for Crohn’s?

Answer 24

colectomy

Question 25

complications of Crohn's?

Answer 25

fistula*, SBS, anal disease, bowel obstruction, perforation, malabsorption, amyloidosis

Question 26

what is UC?

Answer 26

chronic inflammatory disorder confined to colon and rectum which involves inflammation of mucosal and submucosal layers (superficial)

Question 27

what is the acronym for UC?

Answer 27

``` C- continuous inflammation L- limited to colon and rectum O- only affects superficial mucosa S- smoking is protective E- excretes blood & mucous U- use aminosalicyclates as tx P- primary sclerosis cholangitis ```

Question 28

is the epidemiology of UC same as that of Crohn's?

Answer 28

yes- young males mostly affected

Question 29

symptoms of UC?

Answer 29

diarrhoea w blood/exudate, lower abdominal cramps, inc bowel frequency, tenesmus, incontinence

Question 30

what are the 5Ps of UC?

Answer 30

``` pyrexia pseudopolyps lead-piping appearance poo proctitis ```

Question 31

systemic signs of UC?

Answer 31

uveitis mouth- stomatitis, ulcers skin- erythema nodosum

Question 32

ix for UC?

Answer 32

endoscopy with mucosal biopsy, bloods (albumin, CRP etc), AXR to rule out toxic megacolon

Question 33

what criteria is used to assess severity of UC?

Answer 33

truelove & Witt's criteria

Question 34

what does Truelove & Witt's criteria state?

Answer 34

>6 blood stools + | fever/ tachy/anaemia/ elevated ESR (erythrocyte sedimentation ratio)

Question 35

what histological findings on biopsy may be found in a pt with UC?

Answer 35

many inflammatory cells, crypt distortion (irregularly shaped), mucosal ulceration with fibrinopurulent exudate, NO GRANULOMA

Question 36

Rx for UC?

Answer 36

inducing remission: 1st line= 5-ASAs, 2nd line= steroids, immunosuppressants & anti-TNF therapy severe: IV corticosteroids, 2nd line= IV cyclosporin (immunosuppressant)

Question 37

what Rx is given to maintain remission in UC?

Answer 37

aminosalicyclates

Question 38

what is the non-emergency surgical tx for UC?

Answer 38

protocolectomy - pouch given | CURATIVE

Question 39

what is the emergency surgical tx for UC?

Answer 39

sub-total colectomy

Question 40

complications for UC?

Answer 40

toxic megacolon, intractable disease, colorectal carcinoma, anal fissures

Question 41

recap: Crohn's... 1. occurs only in colon & rectum 2. has skip lesions on endoscopy 3. transmural inflammation as opposed to superficial 4. non-granulomatous inflammation 5. fistulas present 6. extra GI complications/ symptoms 7. cancer risk low

Answer 41

1. NO- anywhere in GI tract 2. YES 3. YES 4. NO- has granulomatous inflammation 5. YES 6. NO- extra GI common in UC 7. YES

Question 42

cure for fistula?

Answer 42

seton or surgery | SNAP: sepsis, nutrition, anatomy, plan