Case 2 - IBD

Question 1

Symptoms to ask about in IBD

Answer 1

• Stool consistency
• Stool frequency
• Blood/mucus in stool
• N+V
• Joint pain?
• Recent travel - infection rule out
• Waking up overnight?
• Incontinence?

Question 2

Clinical findings to be aware of for IBD

Answer 2

• Perianal disease
• Pale conjuctiva of anaemia
• Signs of dehydration
• Fever
• Angular stomatitis
• Tender abdomen
• Oral ulcers
• Clubbing
• Erythema nodosum
• Muscle wasting

Question 3

How can we assess nutritional status?

Answer 3

• MUST - malnutrition universal screening tool
• Takes into account BMI, weight loss, acute disease that can affect swallow
• Determines if need nutritional care plan, dietician involvement ot food/fluid charts etc

Question 4

Investigations for IBD

Answer 4

• Bloods - FBC, U&E, CRP
• Stool culture
• Faecal calprotectin
• Abdominal X-ray
• Endoscopy
• CT abdo?

Question 5

Crohns vs UC

Answer 5

Question 6

Differentials for bloody diarrhoea

Answer 6

• IBD
• Gastroenteritis - Shigella, Campylobacter, Escherichia coli
• Colorectal cacer
• Colonic polyps
• Ischaemic colitis
• Diverticulitis

Question 7

Crohns disease - induction management

Answer 7

• Glucocorticoids
• 5-ASA drugs eg Mesalazine if steroids non effective
• Azathioprine/Mercaptopurine used as add on to steroids sometimes but not alone
• Infliximab
• Metronidazole for isolated peri-anal disease

Question 8

Crohns maintaining remission therapy

Answer 8

• Smoking cessation
• Azathioprine/Mercaptopurine
• TPMT needs to be checked before starting (MTX second line)
• Surgery eventually

Question 9

UC remission induction - procitits

Answer 9

Topical aminosalicylate

Question 10

UC remission induction proctosigmoiditis and left UC

Answer 10

• Topical aminosalicylate
• If remission not within 4 weeks add oral AS or switch to oral AS and topical steroid
• If still not oral AS + oral steroid

Question 11

UC remission induction if extensive disease

Answer 11

• Topical aminosalicylate and oral aminosalicylate
• If remission not within 4 weeks do oral steroid and oral AS (instead)

Question 12

Severe colitis management

Answer 12

• In hospital
• IV steroids first line
• IV ciclosporin if contraindictaed steroids
• If after 72 hrs no improvement add ciclosporin to IV steroids and consider surgery

Question 13

Maintaining remission UC - proctitis andd proctosigmoiditis

Answer 13

• Topical aminosalicyclate alone
• OR oral AS plus topical AS
• OR oral AS alone

Question 14

For left sided or UC extensive disease maintaining remission

Answer 14

• Low dose AS oral

Question 15

Treatment following severe relapse or 2 or more relapses in one year

Answer 15

Oral azathioprine or mercaptopurine