14) Inflammatory Bowel Disease

Question 1

What are the 2 common types of IBD?

Answer 1

Crohn’s and ulcerative colitis

Question 2

What age groups does Crohn’s disease mainly affect?

Answer 2

15-30 and 60+

Question 3

What age group does ulcerative colitis mainly affect?

Answer 3

Young adults

Question 4

Describe how Crohn’s affects the GI tract:

Answer 4

Affects anywhere in GI tract
Ileum involved in most cases
Transmural - full thickness of wall and may have skip lesions

Question 5

Describe how UC affects the GI tract:

Answer 5

Begins in rectum
Can extend to involve entire colon
Continuous pattern but just mucosal inflammation

Question 6

What extra-intestinal problems can IBD cause?

Answer 6

MSK pain (50%) - Arthritis
Skin (30%) - Erythema nodosum (red lumps on leg), pyoderma gangrenosum, psoriasis
Liver/biliary tree - Primary Sclerosing Cholangitis (PSC)
Eye problems

Question 7

What are the probable causes of IBD?

Answer 7

Genetic
Gut organisms
Immune response

Question 8

How does Crohn’s present?

Answer 8

Loose stools (non-bloody)
Weight loss - malabsorption
Right lower quadrant pain
Anaemic - not absorbing iron or B12
Fever
Tiredness

Question 9

What pathological changes does Crohn’s cause in the GIT?

Answer 9

Mucosal oedema
Deep ulcers
Transmural inflamm - thickening of bowel wall and narrowing of lumen

Question 10

What pathological change occur in advanced Crohn’s?

Answer 10

Cobblestone appearance

Fistulae - bladder, vagina, skin

Question 11

What can be seen on microscopy in Crohn’s?

Answer 11

Granuloma formation

Question 12

What investigations may be done if Crohn’s is suspected?

Answer 12

Bloods - anaemia
CT/MRI - bowel wall thickening, obstruction
Barium enema
Colonoscopy

Question 13

How does UC present?

Answer 13

Blood and mucus in stools
Diarrhoea
Weight loss
Mid lower abdominal pain or cramps

Question 14

What pathological changes does UC cause in the GIT?

Answer 14

Chronic inflammatory infiltrate of lamina propria
Loss of goblet cells - less protective mucus
Pseudopolyps
Loss of haustra

Question 15

What investigations may be done if UC is suspected?

Answer 15

Bloods - anaemia, serum markers
Stool cultures
Abdominal XR
Colonoscopy

Question 16

What is the disease called if it can’t be distinguished between Crohn’s and UC?

Answer 16

Indeterminate colitis

Question 17

What sign may be seen on radiology in Crohn’s?

Answer 17

String sign of Kantour

Question 18

What may be seen on radiology in UC?

Answer 18

Lead pipe colon - featureless bowel

Continuous ulceration

Question 19

What is the first stage of medical treatment for IBD?

Answer 19

Aminosalicylates e.g. sulfasalazine 
For flares (symptoms active) and remission

Question 20

What is the second stage of medical treatment for IBD?

Answer 20

Corticosteroids e.g. prednisolone

For flares only

Question 21

What is the third stage of medical treatment for IBD?

Answer 21

Immunomodulators e.g azathioprine

For fistulas or maintaining remission if other drugs haven’t worked

Question 22

What surgical procedures may be used to treat Crohn’s?

Answer 22

Not curative but may be used for strictures or fistulas

Remove as little bowel as possible

Question 23

What surgical procedures may be used to treat UC?

Answer 23

Colectomy is a cure