L24: Inflammatory Bowel Disease

Question 1

Which layers of the intestinal wall does UC affect?

Answer 1

mucosa + submucosa

Question 2

Which layers of the intestinal wall does Crohn’s disease affect?

Answer 2

transmural

Question 3

What are some of the aetiological theories of IBD?

Answer 3

• genetics
• infection (e.g. E. coli, salmonella)
• immunological

Question 4

Which age group does IBD normally affect?

Answer 4

young adults [15 - 35 years]

Question 5

Which part of the intestine does ulcerative colitis typically affect?

Answer 5

• rectum
• left side of colon
• sometimes pancolitis

Question 6

Which part of the intestine does Crohn’s disease typically affect?

Answer 6

• small intestine (only)

- ileocolonic (around ileocaecal valve)

Question 7

List some of the common symptoms of UC

Answer 7

• bloody diarrhea (w/ mucus)
• cramping abdominal pain
• increased frequency + urgency of defecation
• tenesmus (feeling of incomplete emptying)

Question 8

What is the True-Love and Witt score used for?

Answer 8

determines severity of of a patient’s UC

Question 9

What is the name of the severity assessment score that is used for UC?

Answer 9

True-Love and Witt Score

Question 10

What are the criteria that are a part of the True-Love and Witt score?

Answer 10

1. > 6 Blood Stool
2. Pulse > 90 BPM
3. Temperature > 37.8
4. HB < 10.5 g/dL
5. CRP: very raised

Question 11

List some of the common symptoms of Crohn’s Disease

Answer 11

• non-bloody diarrhea (usually)
• abdominal pain
• abdominal mass
• malabsorption + weight loss
• peri-anal fistulas a/w abscess formation

Question 12

Is weight loss more common in UC or in Crohn’s disease? Why?

Answer 12

Crohn’s Disease

- Crohn’s more commonly affects the small intestine while UC mainly affects the large intestine

Question 13

What fistulas are the most common in Crohn’s disease?

Answer 13

peri-anal fistulas

Question 14

What is the Harvey Bradshaw Index used for?

Answer 14

determines the severity of a patient’s Crohn’s disease

Question 15

What severity score is used for Crohn’s Disease?

Answer 15

Harvey-Bradshaw Index

Question 16

List the 5 main categories of the Harvey Bradshaw Index which is used to determine the severity of Crohn’s disease

Answer 16

1. General Well-Being
2. Abdominal Pain
3. # of Liquid Stools
4. Abdominal Mass
5. Complications

Question 17

List some of the extra-intestinal complications of Crohn’s Disease

Answer 17

• enteropathic arthritis
• uveitis
• erythema nodosum
• pyoderma gangrenosum
• mouth ulcers (aphthous ulcers)

Question 18

List some of the extra-intestinal complications of Ulcerative Colitis

Answer 18

• osteoarthritis
• ankylosing spondylitis
• primary sclerosing cholangitis (PSC)
• erythema nodosum
• pyoderma gangrenosum

Question 19

What is the Bristol stool chart used for?

Answer 19

• investigates what type of diarrhea a patient may have

- helps measure the time it takes for food to pass through your body and leave as waste

Question 20

When can an abdominal x-ray or plain film abdomen (PFA) show when investigating IBD?

Answer 20

• toxic megacolon

- colitis

Question 21

What can an erect CXR show when investigating IBD?

Answer 21

free air under the diaphragm (due to perforation)

Question 22

When is a barium follow-through imaging test used when investigating IBD?

Answer 22

for Crohn’s Disease in small intestine

Question 23

A “cobblestone” pattern upon endoscopy, is indicative of what illness?

Answer 23

Crohn’s Disease

Question 24

List some of the INTESTINAL complications of ulcerative colitis

Answer 24

• toxic megacolon
• stricture
• bowel perforation
• increased risk of colorectal carcinoma
• fibrosis
• shortening of colon

Question 25

List some of the INTESTINAL complications of Crohn's disease

Answer 25

- strictures (leading to obstruction) - obstruction - fistula formation (leading to abscess formation) - abscesses - adhesions

Question 26

List the types of fistulas that may occur as a complication of Crohn's disease

Answer 26

- peri-anal - entero-enteric (intestine-intestine) - entero-vesical (intestine-bladder) - mesenteric - retroperitoneal - entero-cutaneous

Question 27

What is the first-line medications given to treat UC?

Answer 27

5-aminosalicylic acid derivatives (5-ASAs) - Mesalazine - Sulphasalazine

Question 28

Give 2 examples of 5-ASAs which are used in the firstline treatment of UC

Answer 28

- Mesalazine* | - Sulphasalazine

Question 29

What 2 treatments/medications are given to treat an acute flare of IBD/UC?

Answer 29

1. Steroids (e.g. hydrocortisone, prednisolone) 2. Antibiotics (if perforation, fistula, peri-anal disease..) - - e.g. metronidazole

Question 30

Give an example of an antibiotic that may be given to treat an acute flare of IBD

Answer 30

Metronidazole

Question 31

List 3 important drugs that may be given to treat resistant/refractory IBD

Answer 31

Immunomodulators: 1. Azathioprine 2. 6-Mercaptopurine Biologic Therapy: 3. TNF(alpha) Inhibitors

Question 32

What can azathioprine and 6-mercaptopurine be used for?

Answer 32

resistant/refractory IBD

Question 33

In regards to the GIT, what can TNF(alpha) Inhibitors be used to treat?

Answer 33

resistant/refractory IBD

Question 34

Azathioprine and 6-mercaptopurine may be used to Crohn's disease. List the side effects of these 2 drugs

Answer 34

- pancreatitis - hepatotoxicity - bone marrow suppression - increased cancer risk - should not be used in pregnant people!

Question 35

List some of the indications for surgery in a patient that has IBD

Answer 35

- bowel perforation - toxic megacolon - fibrostenotic strictures - massive haemorrhage - abscesses - complex peri-anal or internal fistulas - risk of cancer - chronic ill health

Question 36

Compare the intestinal wall thickness in UC and Crohn's Disease

Answer 36

UC = normal thickness | Crohn's Disease = increased thickness