Inflammatory bowel disease (Crohn's and UC)

Question 1

What are the two main types of inflammatory bowel disease?

Answer 1

Crohn’s disease and ulcerative colitis.

Question 2

What are common symptoms of IBD?

Answer 2

Abdominal pain, diarrhoea, fatigue, weight loss, and bloody stools.

Question 3

Which parts of the GI tract can Crohn’s disease affect?

Answer 3

Any part, from mouth to anus (commonly terminal ileum), with skip lesions.

Question 4

What layers of the GI wall does Crohn’s disease affect?

Answer 4

All layers (transmural inflammation).

Question 5

List 3 complications of Crohn’s disease.

Answer 5

Strictures, fistulas, malnutrition.

Question 6

First-line drug to induce remission in Crohn’s disease?

Answer 6

Corticosteroids (e.g. prednisolone, IV hydrocortisone).

Question 7

What is budesonide used for?

Answer 7

Mild ileal/right-sided Crohn’s where systemic steroids are contraindicated.

Question 8

Which immunosuppressants are used in Crohn’s for frequent flares/steroid-dependence?

Answer 8

Azathioprine, mercaptopurine, methotrexate (if TPMT deficient).

Question 9

What is the drug approach post-surgery in Crohn’s with ileocolonic resection?

Answer 9

Azathioprine + metronidazole (for up to 3 months).

Question 10

What is a fistula?

Answer 10

An abnormal connection between bowel and other structures (e.g. perianal skin, bladder).

Question 11

How is a perianal fistula in Crohn’s disease managed?

Answer 11

Drainage, antibiotics (metronidazole ± ciprofloxacin), azathioprine, infliximab.

Question 12

How long should biologics/immunosuppressants be continued for fistulas?

Answer 12

At least 1 year.

Question 13

Which layer of the bowel wall is affected in UC?

Answer 13

Mucosa only.

Question 14

How does inflammation spread in UC?

Answer 14

Continuously from the rectum.

Question 15

What is pancolitis?

Answer 15

Involvement of the entire colon.

Question 16

Three key symptoms of UC?

Answer 16

Bloody diarrhoea, urgency, abdominal pain.

Question 17

Four complications of UC?

Answer 17

Colorectal cancer, osteoporosis, venous thromboembolism, toxic megacolon.

Question 18

What drug is 1st-line for proctitis?

Answer 18

Topical aminosalicylates (e.g. mesalazine suppository).

Question 19

When is oral aminosalicylate added in UC?

Answer 19

If topical alone doesn’t achieve remission in 4 weeks.

Question 20

What is 1st-line for extensive colitis?

Answer 20

High-dose oral + topical aminosalicylate.

Question 21

What are 2 biologic options for moderate-severe UC?

Answer 21

TNF inhibitors (e.g. infliximab), JAK inhibitors.

Question 22

What is the emergency treatment for acute severe UC?

Answer 22

IV corticosteroids (hydrocortisone or methylprednisolone).

Question 23

If no improvement after 72 hours on IV steroids in UC, what next?

Answer 23

Add IV ciclosporin or infliximab, or consider surgery.

Question 24

Main drug class for UC remission maintenance?

Answer 24

Aminosalicylates (oral or rectal).

Question 25

What drugs are used in UC for frequent relapses or steroid dependence?

Answer 25

Azathioprine or mercaptopurine.

Question 26

What is the mechanism of action of azathioprine?

Answer 26

It is a purine analogue that inhibits DNA synthesis, suppressing immune cell proliferation.

Question 27

What are the key side effects of azathioprine?

Answer 27

Bone marrow suppression, hepatotoxicity, pancreatitis, increased infection risk, and increased risk of non-melanoma skin cancer.

Question 28

What monitoring is required for patients on azathioprine?

Answer 28

Regular full blood count (FBC), liver function tests (LFTs), and thiopurine methyltransferase (TPMT) activity before starting therapy.

Question 29

How does mercaptopurine work?

Answer 29

It is a purine antagonist that inhibits DNA and RNA synthesis, leading to immunosuppression.

Question 30

What drug class is mercaptopurine?

Answer 30

Known as a antimetabolite or thiopurine - like azathioprine. Mercaptopurine interferes with the growth of cancer cells, which are eventually destroyed.

Question 31

What are the main side effects of mercaptopurine?

Answer 31

Myelosuppression, hepatotoxicity, pancreatitis, and increased susceptibility to infections.

Question 32

What monitoring is essential for patients on mercaptopurine?

Answer 32

Regular FBC, LFTs, and TPMT activity assessment prior to initiation.

Question 33

What are the main side effects of ciclosporin?

Answer 33

Nephrotoxicity, hypertension, neurotoxicity, hyperlipidemia, and increased infection risk.

Question 34

What monitoring is essential during ciclosporin therapy?

Answer 34

Renal function tests, blood pressure monitoring, and ciclosporin blood levels.

Question 35

How do JAK inhibitors work?

Answer 35

They block Janus kinase enzymes, interfering with the JAK-STAT signaling pathway, thereby reducing inflammation.