3.7 Inflammatory Bowel Disease

Question 1

Name the mnemonic from remembering Crohn’s characteristics?

Answer 1

crows NESTS

Question 2

Name the mnemonic from remembering Ulcerative Colitis characteristics?

Answer 2

u-c-CLOSEUP

Question 3

What does the “crows NEST” mnemonic say?

Answer 3

crows NEST for Crohns:

N - No blood or mucous

E - Entire GI tract

S - Skip lesions on endoscopy

T - Terminal ileum and Transmural

S - Smoking risk (dont set the nest on fire!)

Question 4

What does the u-c-CLOSEUP mnemonic say?

Answer 4

u-c- CLOSEUP:

C - Continuous inflammation

L - Limited to colon and rectum

O - Only superficial mucosa affected

S - Smoking is protective

E - Excrete blood and mucous

U - Use aminosalicylates

P - Primary sclerosing cholangitis

Question 5

6 extraintestinal manifestations of IBD?

Answer 5

• finger clubbing
• erythema nodosum
• pyoderma gangrenosum
• episcleritis and iritis
• inflammatory arthritis
• primary sclerosing cholangitis (UC)

Question 6

What is a good screening test for IBD?

Answer 6

Faecal calprotectin

(released by intestine when inflamed, more than 90% sensitive and specific for IBD in adults)

Question 7

Gold standard diagnostic test for IBD?

Answer 7

• ENDOSCOPY (OGD and colonoscopy) with biopsy is gold standard

Screening: faecal calprotectin

Looking for complications: US, CT, MRI for complications eg fistulas, abscesses and strictures

Question 8

How do you induce remission of Crohn’s?

Answer 8

• steroids (oral pred or IV hydrocort)
• enteral elemental nutrition

or:

• azathioprine, mercaptopurine, methotrexate, inflixmab, adalimumab

Question 9

How do you maintain remision in Crohn’s?

Answer 9

1st line:

• azathioprine
• mercaptopurine

2nd line:

• methotrexate
• infliximab
• adalimumab

Surgery for strictes and fistula, or remove distal ileum if that is particularly affected.

Question 10

How do you induce remision in UC?

Answer 10

MILD to MOD:

1st line - aminosalicylate eg mesalazine oral or rectal

2nd line: - corticosteroids eg pred

SEVERE:

1st line: IV corticosteroids

2nd: IV ciclosporin

Question 11

How do you maintain remision in UC?

Answer 11

• aminosalicylate eg mesalazine oral or rectal
• azathioprine
• mercaptopurine

SURGERY:

UC is only colon and rectum, panproctocolectomy removes disease. Leave with ileostomy or J-pouch. J-pouch is ileo-anal anastomosis where ileum is fashioned into larger pouch to be a rectum and connected to anus.