CD & UC

Question 1

Ulcerative colitis is an inflammatory disease of ?

Answer 1

Mucosa and submucosa started in rectum and goes proximally

Question 2

Crohn’s disease is ?

Answer 2

Transmural inflammatory disease attacking any part of alimentary tract
And it is bimodal distribution ( young - older )

Question 3

Etiology of inflammatory bowel disease ?

Answer 3

Unknown cause immune disturbance
- Environmental.
Alcohol and oral contraceptive use.
Tobacco use.
Diet and exposure to microorganisms
- Genetic
Approximately 10% to 30% of IBD patients will have at least one other family member also affected
by IBD
- Immune
A chronic immune dysregulation.

Question 4

Risk factors of CD & UC

Answer 4

Question 5

Gross appearance of UC

Answer 5

Gross appearance.
• Continuous involvement of the rectum and colon
• Pseudopolyps,
• Small superficial erosions , patchy ulceration
• Foreshortened
• Colonic stricture 5%-12%. Cancer?
• Backwash ileitis

Question 6

Histological appearance of UC.

Answer 6

• Inflammation of the mucosa and submucosa ( typical microscopic finding)
• Crypt abscesses (most characteristic lesion)
• Perinuclear antineutrophil cytoplasmic antibodies 86%

Question 7

Gross appearance of CD

Answer 7

• Thickened colonic wall
• Cobblestone appearance.
• Creeping fat of the mesentery and strictures.
• Mucosa may demonstrate long, deep linear ulcers.

Question 8

Histological appearance of CD

Answer 8

• Transmural inflammation
• Noncaseating granuloma (pathognomonic histologic feature)
• Submucosal edema
• Fibrosis

Question 9

Clinical presentation of UC

Answer 9

• Diarrhea • Passage of mucus • Bleeding per rectum • Urgency • Abdominal pain

Question 10

Clincal presentation of CD

Answer 10

• Abdominal pain • Diarrhes • Weight loss • Passage of mucous • Tender abdominal mass • Peri-anal disease • Opthous ulcer

Question 11

EXTRAINTESTINAL MANIFESTATIONS CD and UC

Answer 11

• Arthritis 20%
• erythema nodosum 10%-15%
• pyoderma gangrenosum
• ankylosing spondylitis 3%-5%
• primary sclerosing cholangitis (PSC) and cirrhosis
• Fatty liver.
• ocular lesions

• in UC all of these manifestations healed except Ankylosing spondylitis and PSC

Question 12

Risk of carcinoma

Answer 12

Common with UC than CD
Most important risk factor
• Prolonged duration of the disease
The cumulative risk for cancer : 25% at 25 years, 35% at 30 years, 45% at 35 years, and 65% at 40
years.
• Pan colonic disease • Continuously active disease • Degree of dysplasia
• Periodic colonoscopy surveillance ??

Question 13

The most important risk factor for carcinoma in UC

Answer 13

Most important risk factor
• Prolonged duration of the disease
كل ما تشخص بعمر اصغر كل ما كان الرسك للكانسر أعلى

Question 14

Diagnosis of UC and CD

Answer 14

• Clinical presentation
• Investigation
• CBC, electrolyte, inflammatory marking and stool analysis.
• CT abdomen and air contrast enema.
• Endoscopic examination

Question 15

Differential diagnosis of UC and CD

Answer 15

First rule out malignancy
• Intestinal TB
• Segmental colitis associated with diverticulosis
• CMV colitis superimposed in IBD
• Clostridium difficle
• Campylobacter colitis
• Ischaemic colitis
• Medication effects
• Solitary rectal ulcer syndrome
• Behçet disease
• Amebic colitis

Question 16

Complication of UC

Answer 16

• Massive bleeding
• Toxic megacolon
• Fluminant colitis
• Maliganancy
• Intestinal obstruction

Question 17

Complications of CD

Answer 17

• Perforation and intr-abdominal abscess • Intestinal obstruction • Toxic megacolon • Massive bleeding

Question 18

Treatment UC & CD

Answer 18

• Requires a multidisciplinary approach to the management. • Medical therapy focuses on decreasing inflammation and alleviating symptoms. • Medical treatment is the first line of treatment. • Medication groups can be classified to :
aminosalicylates, corticosteroids, immunomodulators, and biologic

Question 19

INDICATIONS OF SURGERY UC

Answer 19

Intractability
• Dysplasia
• cancer
• Massive colonic
bleeding
• Toxic megacolon