Case 12 SAP

Question 1

Risk factors for Crohn’s disease

Answer 1

Positive family history, adverse life events, stress, depression, smoking, GI infections, excessive sanitation

Question 2

Protective factor for Crohn’s disease

Answer 2

Breastfeeding

Question 3

Morphological features of Crohn’s disease

Answer 3

Ulceration, skip lesions (normal areas within the ulcerations), cobblestoning, pseudopolyps, scarring, strictures, fistulas, granulomas, transmural, discontinuous

Question 4

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

Answer 4

Perianal fistulas

Question 5

Where is Crohn’s disease located?

Answer 5

Anywhere in the GI tract but most commonly in the terminal ileum, often spares rectum

Question 6

Complications of Crohn’s disease

Answer 6

Strictures, fistulas, perforation, malabsorption

Question 7

Crohn’s disease statistics for patient future

Answer 7

50% will undergo surgery in 10 years
Only 20% will have long-term remission in 20 years
Steroid use within three months predictive of surgery

Question 8

Clinical presentation of IBD

Answer 8

Diarrhoea, rectal bleeding with colon inflammation, abdominal pain, weight loss, fatigue, negative impact on quality of life

Question 9

What to ask about in IBD history

Answer 9

Chronicity, bleeding, pain location, incontinence, nocturnal diarrhoea, contacts with or recent gastroenteritis, smoking, family history, appendectomy status, NSAID use

Question 10

What does visible blood in the stool suggest about the location of the inflammation?

Answer 10

Lower down e.g. rectum or large intestine

Question 11

What to look for on IBD examination?

Answer 11

Anaemia, mouth ulcers, angular stomatitis, swollen lips, clubbing, bloating, visible pain, slim/cachectic build, erythema nodosum, uveitis, pyoderma gangrenosum, arthritis

Question 12

Definition of IBD

Answer 12

Aberrant inflammatory response to host microbial or environmental factors in a genetically predisposed individual. Can occur at any age. Can have many inflammatory diseases at once e.g. MS, coeliac, type 1 diabetes

Question 13

Genes in IBD

Answer 13

Very strong genetic component, can very rarely be monogenic but this presents very early (<2 or <6) and is very severe

Question 14

Risk factors for ulcerative colitis

Answer 14

Positive family history , adverse life events , stress, depression, GI infections, excessive sanitation

Question 15

Protective factors in ulcerative colitis

Answer 15

breastfeeding and smoking

Question 16

Morphological features of ulcerative colitis

Answer 16

Erosions, ulcerations, continuous so NO SKIP LESIONS, pseudopolyps crypt abscesses, confined to mucosa

Question 17

Where is ulcerative colitis located?

Answer 17

Always in the rectum but may extend upwards to a variable length

Question 18

Complications of ulcerative colitis

Answer 18

Double risk of colonic carcinoma, risk of severe acute colitis that can lead to toxic megacolon

Question 19

Statistics for ulcerative colitis patient future

Answer 19

90% will have relapses
Early relapse (within 2 years) associated with worse course
Male gender, young age, and elevated inflammatory markers on diagnosis predictive for surgery

Question 20

Epidemiology of IBD

Answer 20

Prevalence highest in Northern Europe and North America
Prevalence increasing - now 0.8%
Migrants take on prevalence of new country