Inflammatory Bowel Disorders

Question 1

what is inflammatory bowel disease?

Answer 1

chronic relapsing inflammatory conditions of the bowel:
> crohns
> ulcerative colitis
> (microscopic, collagenous, lymphocytic colitis

Question 2

how may ulcerative colitis present?

Answer 2

> bloody diarrhoea
abdominal pain
weight loss

Question 3

describe the inflammation in ulcerative colitis

Answer 3

there is continuous inflammation that begins a the rectum and only effects the colon. there is variable distribution and severity.

Question 4

describe the markers of a severe attack of ulcerative colitis

Answer 4

> >6 stools a day with blood
> fever >37.5 degrees
> tachycardia (>90)
> raised ESR
> anaemia
> albumin <30g/l
> leucocytosis, thrombocytosis

Question 5

describe the inflammation in crohn’s disease

Answer 5

there is patchy disease from mouth to anus of skip lesions. the clinical features depend in the regions that are involved.

Question 6

how might the mucosa look in an endoscopy in crohn’s?

Answer 6

there may be cobbled stone mucosa, areas of inflammation

Question 7

what are the clinical features of crohn’s disease?

Answer 7

> diarrhoea
> abdominal pain
> weight loss
> malaise, lethargy, anorexia, low grade fever
> malabsorption (anaemia, vit defic.)

Question 8

what may be raised in inflammatory bowel disease (in regards to inflammatory indices)

Answer 8

> ESR and CRP
platelet count
WCC

Question 9

would you expect haemoglobin and albumin to be high or low in IBD?

Answer 9

low

Question 10

what level of calprotectin is classed as elevated?

Answer 10

> 200

Question 11

what has more crypt abscesses, UC or CD?

Answer 11

ulcerative colitis

Question 12

how are goblet cells effected in UC?

Answer 12

they are depleted

Question 13

which disorder has granulomas, fistulae and peri-anal disease?

Answer 13

crohn’s disease

Question 14

what are the manifestations of IBD in the eyes?

Answer 14

> uveitis
episcleritis
conjunctivitis

Question 15

how may IBD manifest in the joints?

Answer 15

> sacroiliitis
monoarticular arthritis
ankylosing spondylitis

Question 16

what disorder can cause renal calculi?

Answer 16

crohn’s disease

Question 17

how may the liver and biliary tree be affected in IBD?

Answer 17

> fatty change
pericholangitis
sclerosing cholangitis
gallstones

Question 18

how may IBD manifest in the skin?

Answer 18

> pyoderma gangrenosum
erythema nodosum
vasulitis

Question 19

what is the differential diagnosis for IBD?

Answer 19

> chronic diarrhoea: malabsorption and malnutrition
ileo-ceacal TB
other types of colitis (ischaemic, infective, amoebic)

Question 20

what must colitis be distinguished from?

Answer 20

> infection
amoebic
ischaemia

Question 21

describe sclerosing cholangitis

Answer 21

> disease of the bile ducts
multiple stricture
slowly progressive
can lead to cirrhosis

Question 22

how does the extent of colitis effect the risk for colonic carcinoma?

Answer 22

> pancolitis 26*
left colitis 8*
proctitis minimal

Question 23

how does the duration of colitis effect the risk for developing a colonic carcinoma?

Answer 23

> <10yrs minimal risk
20 yrs 23*
30 yrs 32*

Question 24

in extensive colitis how frequently will a 8-20 yr old patient receive a surveillance colonoscopy?

Answer 24

every 3 years

Question 25

in extensive colitis how frequently will a 30-40 yr old patient receive a surveillance colonoscopy?

Answer 25

every 2 years

Question 26

in extensive colitis how frequently will a >40 yr old patient receive a surveillance colonoscopy?

Answer 26

every year

Question 27

how many biopsies are taken during a surveillance colonoscopy in extensive colitis?

Answer 27

every 10 cm, 32 biopsies on average.

Question 28

what is the general out patient medical management?

Answer 28

> 5ASA > steroids > immunosuppression

Question 29

what is the general hospital medical management?

Answer 29

> steroids > anticoagulation > rest > (cyclosporine, infliximab, surgery)

Question 30

what makes up aminosalicylates?

Answer 30

> mesalazine | > pro-drugs

Question 31

name three pro-drugs

Answer 31

> balsalazide > olzalazine > sulfasalazine

Question 32

when is rectal 5ASA used in UC?

Answer 32

for distal and more extensive disease

Question 33

what is the effect of 5ASA in UC?

Answer 33

> 1st line therapy for induction of remission > Dose of >3g per day shows no improvement on remission rate, greater and quicker clinical improvement and no increase in adverse events > 1st line therapy for maintenance of remission > Reduced number and severity of relapses > Reduced CRC risk

Question 34

when can 5ASA be used in crohn's?

Answer 34

> widely used but little evidence > for induction of remission (in mildly active ileocolonic disease) > in maintenance of Crohn's (only if remission induced by 5ASA or post-bowel resection)

Question 35

what are the significant side effects of thiopurines?

Answer 35

> leucopenia > hepatotoxicity > pancreatitis > long term lymphoma risk

Question 36

why does elemental feeding work better in children?

Answer 36

compliance is difficult as you can only eat disgusting thing for 6 weeks but parents will make their kids do it

Question 37

what shows a failure of medical therapy?

Answer 37

> recurrent course of steroids > relapse prior to or shortly after stooping therapy > failure to control symptoms > unacceptable complications of steroids (diabetes, severe osteoporosis, psychosis)

Question 38

what surgeries can be carried out in severe colitis?

Answer 38

> total colectomy > rectal preservation > ileostomy

Question 39

what is left after a total colectomy?

Answer 39

end ileostomy and rectal stump. pouch procedure)

Question 40

when is surgery indicated in crohns?

Answer 40

> Failure of medical management > Relief of obstructive symptoms (small bowel) > Management of fistulae - e.g. bowel to bladder > Management of intra-abdominal abscess > Management anal conditions > Failure to thrive