Clinical Case Studies - IBD

Question 1

What is IBD?

Answer 1

• Inflammatory bowel disease
• Comprised of two major disorders: ulcerative colitis and Crohn disease
• Different pathologic and clinical characteristics, but with substantial overlap

Question 2

What is Ulcerative Colitis?

Answer 2

• Relapsing and remitting autoimmune condition
• Involves the rectum and may extend in a proximal and continuous fashion to involve other parts of the colon
• Rarely affects the terminal ileum (backwash ileitis)
• limited to the mucosal layer of the colon
• NO granulomas
• Smoking is protective (but not advised!)
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Question 3

What are the signs and symptoms of UC?

Answer 3

• (Bloody) Diarrhoea
• Colicky abdominal pain
• Fever, Fatigue, Weight loss
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Question 4

What extra-colonic manifestations are there of UC?

Answer 4

Musculoskeletal – Arthritis/arthropathy

Skin – Erythema nodosum and pyoderma gangrenosum

Hepatobiliary – Primary sclerosing cholangitis

Hematopoietic/coagulation – Venous and arterial thromboembolism

Question 5

What are the complications of UC?

Answer 5

• Severe bleeding
• Toxic megacolon
• Perforation
• Strictures,
• Dysplasia and colorectal cancer

Question 6

How do you investigate UC?

Answer 6

• History, examination
• Bloods - FBC, platelets, ESR, CRP, Albumin,
• Stool sample and culture - calprotectin, C. Diff
• Colonoscopy — erythematous, granular, pseudopolyps
• Biopsy - crypt abscesses, crypt branching and crypt atrophy
• Radiology - Abdominal CT, Double contrast barium enema - thickening of bowel wall, ulcers, loss of haustra, pseudopolyps

Question 7

What is Crohn’s Disease?

Answer 7

• Disordered response to intestinal bacteria
• Chronic and intermittent, but can be continuous and progressive.
• Transmural inflammation
• Involves any portion of gastrointestinal tract, from the oral cavity to the perianal area
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Question 8

What are the signs and symptoms of CD?

Answer 8

• Crampy abdominal pain,
• Chronic intermittent diarrhea (with or without gross bleeding)
• Fatigue
• Weight loss due to malabsorption, hypocalcemia, vitamin deficiency (eg, vitamin B12), and metabolic bone disease
• Features of transmural inflammation — fistulas, phlegmons, perianal abscesses,
• Aphthous ulcers in mouth
• Odynophagia or dysphagia - esophageal involvement

Question 9

What extra-colonic manifestations are there of CD?

Answer 9

• Arthritis or arthropathy – Primarily involving large joints
• Eye involvement – uveitis, iritis, and episcleritis
• Skin disorders – erythema nodosum and pyoderma gangrenosum
• Primary sclerosing cholangitis
• Secondary amyloidosis

Question 10

What complications are there of CD?

Answer 10

• Fistulas
• Perianal disease - abscesses
• Risk of surgery — Bowel obstruction, abscesses, perforation, or refractory disease
• Dysplasia, malignancy
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Question 11

How do you investigate CD?

Answer 11

• History, examination
• Bloods - FBC, platelets, ESR, CRP, Albumin,
• Stool sample and cultures - Calprotectin and C. Diff
• Ileocolonoscopy — focal ulcerations next to normal mucosa w/ nodular mucosal changes (cobblestone)
• OGD
• Biopsy - Non-caseating granulomas,
• Radiology - Abdominal CT, Video capsule endoscopy, small bowel enteroscopy