Case 15

Question 1

Main Drug treatment of UC

Answer 1

5-aminosalicylic acid (mesalazine) , corticosteroids, immunosuppressive drugs (azathioprine), anti-TNF drugs, dietary therapy, antibiotics)

Question 2

Main drug treatment of Crohn’s

Answer 2

Corticosteroids, Immunosuppressive drugs- azathioprine, anti-Tnf, dietary therapy, antibiotics

Question 3

Drug therapy for active disease in UC

Answer 3

Mesalazine, corticosteroid, Anti-TNF

Question 4

Maintenance of remission- UC

Answer 4

Mesalazine, azathioprine/6-mercaptopurine, anti-TNF, vedolizumab, tofacitinib

Question 5

Crohn’s active disease drug therapy

Answer 5

Budesonide, dietary therapy (kids) , antibiotics (perianal disease), prednisolone (systemically active corticosteroid), anti-TNF

Question 6

Maintenance of remission- Crohn’s

Answer 6

Azathioprine, methotrexate, Anti- TNF, vedolizumab, ustekinumab

Question 7

What type of drug is vedolizumab?

Answer 7

Gut-specific Lymphocyte traffic inhibitor. Stops the lymphocyte from trafficking inside. Blocks integrin

Question 8

Anti-TNF antibodies

Answer 8

Infliximab, certolizumab pegol, adalimumab

Question 9

General characteristics of UC

Answer 9

Diffuse mucosal inflammation limited to colon, affects rectum, may involve all or part of rest of colon

Question 10

General aspects of Crohn’s

Answer 10

Patchy transmural inflammation, may affect any part of the GI tract

Question 11

Symptoms of UC

Answer 11

Rectal Bleeding, diarrhoea, urgency, abdo pain

Question 12

Extraintestinal manifestations of IBD

Answer 12

Aphthous stomatitis, episcleritis and uveitis, arthritis, vascular complications, e.nodosum, p.gangrenosum

Question 13

Clinical patterns of Crohn’s

Answer 13

Inflammation, fistulization, obstruction, microperforation

Question 14

Early presentations of Crohn’s

Answer 14

LQ pain, tenderness, diarrhea, fever, anorexia, weight loss

Question 15

Endoscopic spectrum of severity in UC

Answer 15

Normal colon- mucosa is shy, pale pink and retains a delicate, reticulate vascular pattern

Mild- mucosa becomes duller and redder, often with a granular or fine sandpaper- like texture and vascular patter is obscured

Moderate - gross pitting of the mucosa is seen - lining may crumble away and bleed at the lightest tough - friability

Severe- macroulceration with mucopurulent exudate and spontaeous haemorrhage

Question 16

Most dangerous acute complication of UC

Answer 16

TOXIC MEGACOLON.
- Occurs when the ulcerating, inflammatory process dissects deeply through the wall of the colon

Radiologic sign- accumulation of gas over a long segment of colon

Maximal dilatation

representing a combination of pseudopolyps and submucosal edema.

Question 17

Early warning sign of impending malignant transformation in UC

Answer 17

Cellular atypia or dysplasia

However, dysplasia has to be found independent of severe inflammation

Question 18

Most common cutaneous manifestation in Crohn’s

Answer 18

Erythema nordosum

Question 19

Most common cutaneous manifestation in Ulcerative colitis

Answer 19

Pyoderrna gangrenosum

Question 20

Extra-intestinal complications unrelated to disease activity - central arthropathy

Answer 20

Ankylosing spondylitis (associated with HLAB27)
Sacro-iliitis

Question 21

Liver disease complicated of UC

Answer 21

• Primary sclerosing cholangitis
• Steatosis (fatty liver)
• Chronic hepatitis
• Cirrhosis

Question 22

Two clinical patterns of Crohn’s disease

Answer 22

Stricturing (obstructive) or penetrating (fistulizing)

Question 23

Signs and symptoms of Inflammatory Crohn’s

Answer 23

• Pain
• Tenderness
• Diarrhea
• Low-grade fever
• Weight loss (anorexia)

Question 24

Signs and Symptoms of Obstructive Crohn’s

Answer 24

• Post-prandial cramps
• Distention
• Borborygmi
• Vomiting
• Weight loss (food avoidance)

Question 25

Different types of fistulization

Answer 25

Enteroenteric- may be asymptomatic

Enterovesical - recurrent UTIs, pneumaturia