5: IBD clinical signs and symptoms

Question 1

Normally, the gut acts as a ___ organ for the ___ immune system.

Answer 1

surveillance

mucosal

Question 2

What are the two types of inflammatory bowel disease?

Answer 2

Crohn’s disease

Ulcerative colitis

Question 3

What symptoms tend to be seen in Crohn’s disease?

Answer 3

Abdominal pain

Perianal disease

Watery diarrhoea

Question 4

What symptoms tend to be seen in ulcerative colitis?

Answer 4

Bloody diarrhoea

Question 5

What three factors are involved in the pathogenesis of IBD?

Answer 5

Genetics

Mucosal immune system

Environmental triggers

Question 6

Which gene predisposes you to develop IBD?

Answer 6

NOD2

Question 7

What does the NOD2 gene code for?

Answer 7

Proteins involved in bacterial recognition

Question 8

Smoking (aggravates / protects against) Crohn’s disease.

Answer 8

aggravates

Question 9

Smoking (aggravates / protects against) ulcerative colitis.

Answer 9

protects against

Question 10

Which class of drug aggravates colitis?

Answer 10

NSAIDs (ibuprofen, naproxen, diclofenac)

Question 11

Which part of the GI tract does ulcerative colitis start in?

Where does it go after that?

Answer 11

Rectum

Proximally

Question 12

If an acute flareup of UC doesn’t clear up with drugs (e.g steroids), what is performed?

Answer 12

Colectomy

Question 13

What are the main symptoms of ulcerative colitis?

Answer 13

Diarrhoea with blood

Increased bowel frequency

Question 14

Lower abdominal pain in the left iliac fossa is characteristic of which disease?

Answer 14

Ulcerative colitis

Question 15

What aspect of the past medical history is important in UC?

Answer 15

Antibiotics / NSAID use

Skin, eye, joint problems

Question 16

What is the criteria for diagnosing severe UC?

Answer 16

>6 bloody stools within 24 hours

+ 1 or more of:

Fever

Tachycardia

Anaemia

Question 17

What may be seen on the AXR of someone with UC?

Answer 17

Absence of stools

Mucosal oedema - thumb print sign

Toxic megacolon

Question 18

What would be seen upon endoscopy of someone with UC?

Answer 18

Continous inflammation

Granular mucosa

Pseudopolyps

Absence of goblet cells

Crypt abscesses

Question 19

Does UC affect the whole thickness of the gut?

Answer 19

No - mucosa only

Question 20

What does ulcerative colitis increase your risk of?

Answer 20

Colorectal cancer

Question 21

What are some extra-intestinal symptoms of UC?

Answer 21

Skin - rashes

Joint problems

Eye problems

Mouth ulcers

Oxalate renal stones

Question 22

What gallbladder condition is associated with ulcerative colitis?

Answer 22

Primary sclerosing cholangitis

inflammation due to stricture in cystic duct

Question 23

Which areas of the GI tract are affected by Crohn’s disease?

Answer 23

Mouth to anus

Question 24

What kind of lesions are seen in Crohn’s disease?

How does this differ from UC?

Answer 24

Skip lesions

UC is continous, Crohn’s skips bits of the GI tract

Question 25

What kind of inflammation is seen in Crohn’s disease?

Answer 25

Transmural

penetrates the whole gut wall

Question 26

What is perianal disease associated with?

Answer 26

Crohn’s disease

Question 27

Give an example of a perianal disease associated with Crohn’s.

Answer 27

Rectal abscesses

Question 28

What is a complication of rectal abscesses seen in Crohn’s disease?

Answer 28

Fistula formation

Question 29

Why may someone with Crohn’s disease become incontinent?

Answer 29

Damage to anal sphincters caused by abscesses

Question 30

What pathology, causing bowel obstruction, is seen in Crohn’s disease?

Answer 30

Strictures

Question 31

What kind of mucosa is seen in Crohn’s disease patients?

Answer 31

“Cobblestoning”

Question 32

What causes cobblestone mucosa in Crohn’s disease?

Answer 32

Omentum wraps round bowel and tries to seal off the injury