Week 8 - IBD

Question 1

Who does crohns predominantly affect?

Answer 1

-15-30 years then 60

Question 2

Who does UC predominantly affect?

Answer 2

-Young adults up to 30

Question 3

Name 3 less common IBD

Answer 3

• Diversion colitis
• Pouchitis
• Microscopic colitis

Question 4

What is diversion colitis?

Answer 4

-Section of bowel has been removed and ileostomy -> remaining bit of bowel with no flow can become inflamed

Question 5

What is microscopic colitis?

Answer 5

-Inflammation on a microscopic level

Question 6

Where does crohn’s disease affect?

Answer 6

• Anywhere in GI tract from mouth to anus

- Ileum involved in most cases

Question 7

Where does UC affect?

Answer 7

-Begins in rectum and can extend to involve entire colon

Question 8

Which IBD has skiplesions? What are they?

Answer 8

• Crohns

- The ulceration occurs in patches leaving islands of uninflammed mucosa forming skip lesions

Question 9

Which IBD is transmural? What is meant by this?

Answer 9

• Crohns

- Affects the whole thickness of the bowel wall

Question 10

Which IBD is described as continuous? Why?

Answer 10

• UC

- Ulceration is continuous along the tract

Question 11

Which IBD only has mucosal inflammation?

Answer 11

-UC

Question 12

What is backwash ileitis?

Answer 12

-Complication of UC where ulceration can breach the ileocecal valve and cause inflammation of terminal ileum

Question 13

Describe some of the systemic problems which can occur in conjunction with IBD in order of incidence

Answer 13

• MSK pain eg arthritis (50%)
• Skin eg erythema nodosum, psoariasis
• Liver/biliary tree eg primary sclerosing cholangitis
• Eye eg sceritis

Question 14

Which IBD is more associated with primary sclerosing cholangitis?

Answer 14

-UC

Question 15

What is the main cause of IBD?

Answer 15

-Idiopathic

Question 16

Name some factors which are thought to contribute to the development of IBD

Answer 16

• Genetic
• Immunological
• Gut organisms

Question 17

In which IBD is smoking thought to be protective?

Answer 17

-UC

Question 18

Describe a typical presentation of crohns disease

Answer 18

• Abdo pain (RLQ)
• Weight loss
• Loose stools (non-bloody)

Question 19

Which IBD can involve perianal inflammation and ulceration?

Answer 19

-Crohns

Question 20

Describe the pathological changes which occur in crohns

Answer 20

• Superficial and deep ulcers
• Hyperaemia
• Mucosal oedema
• Inflammation causing thickening of bowel and narrowing of lumen

Question 21

Why is crohn’s described as a cobblestone appearance?

Answer 21

-Skip lesions created by criss crossing of linear ulcers leaving islands of non-ulcerating or oedematous tissue gives a cobblestone appearance

Question 22

Which IBD do you get fistulae formation? Why?

Answer 22

• Crohn’s

- Due to transmural ulceration

Question 23

Which IBD has the presence of granulomas?

Answer 23

-Crohn’s

Question 24

Why is IBD assiciated with anaemia?

Answer 24

-Failure to absorb iron and vitamins

Question 25

Why would you not just do colonoscopy when you had suspicion of crohns?

Answer 25

-Colonoscopys cannot visualise small bowel

Question 26

How does UC typically present?

Answer 26

- Loose bloody stools with mucus - Weight loss - Lower abdo pain

Question 27

Describe the pathological changes which occur in UC?

Answer 27

- Chronic inflammation upto lamina propria - Crypt abscesses - Decreased goblet cells - Pseudopolyps - Loss of haustra

Question 28

Why is there mucus and blood in UC stool?

Answer 28

-Large areas of superficial mucosa affected causing sloughing of cells and mucus

Question 29

What is a crypt abscess? What is the consequence?

Answer 29

- Crypts of lieberkuhn fill with inflammatory cells | - Causes loss of renewal of epithelia

Question 30

Why does anaemia occur in UC?

Answer 30

-Loosing blood in stool

Question 31

Why do you do stool culture if UC is suspected?

Answer 31

-Want to rule out infection because it is bloody and mucus

Question 32

What is indeterminate colitis?

Answer 32

-IBD which cannot be classified into one of crohn's r UC

Question 33

State 3 distinguishing features between crohn's and IBD

Answer 33

- Crohns= anywhere UC=rectum/colon - Crohns = perianal disease UC=no - Crohns=fistula formation UC =no

Question 34

State 2 pathological differences between crohns and UC

Answer 34

- Crohns has skip lesions and granulomas | - UC is continuous and no granulomas but crypt abscesses

Question 35

Which IBD has liner ulcers?

Answer 35

-Crohn's

Question 36

Which IBD gets lead pipe colon?

Answer 36

-UC (loss of haustra)

Question 37

What is the stepwise pharmacological approach for treating IBD?

Answer 37

1) Anti-inflammatory 2) Corticosteroids 3) Immunomodulators

Question 38

What are the surgical options for crohn's?

Answer 38

-Not curable so want to remove as little bowel as possible to prevent short bowel syndrome

Question 39

What are the surgical options for UC? What are indications for surgery?

Answer 39

- Curable via colectomy | - Inflammation not settling, precancerous changes, toxic megacolon

Question 40

What imaging is often used in Crohn's?

Answer 40

-CT/MRI

Question 41

Why can crohn's have periods of exacerbations?

Answer 41

-It is a relapse and remitting disease where by the acute inflammation can be treated but the underlying chronic condition is still present

Question 42

What anti-inflammatories are used in UC?

Answer 42

-Amino-salicylates

Question 43

When can crohn's present like UC?

Answer 43

-When only the colon is affected

Question 44

What are the two common types of irritable bowel disease?

Answer 44

- Crohns | - Ulcerative colitis