Crohn's and Ulcerative Colitis

Question 1

Inflammatory bowel disease is inflamed intestines resulting in…

Answer 1

malabsorption

Question 2

Which group is inflammatory bowel disease most common in?

Answer 2

Jews

Question 3

What gene is associated with IBD?

Answer 3

HLA B27

Question 4

What age group is IBD most common?

Answer 4

Bimodal
15-20 and over 55s

Question 5

What causes Crohn’s disease?

Answer 5

NOD-2 mutation and environment.

Bacteria cause immune mediated response (T cells)

Overproduction of TNF-a contributing to tissue damage and disruption to intestinal barrier. Elevated levels of IL-1 and IL-6 contribute to tissue destruction and damage by activating immune cells.

Question 6

In Crohn’s disease, where is affected?

Answer 6

Whole GIT especially the distal ileum and proximal colon. Patches of inflammation.

Question 7

Who is at risk of Crohn’s disease?

Answer 7

Family History, Jewish, smokers

Question 8

With Crohn’s disease, the inflammation is ______, affecting which layers?

Answer 8

transmural, all 4 layers: mucosa, submucosa, muscularis propria, serosa

Question 9

What are common symptoms of Crohn’s disease?

Answer 9

Pain in RLQ
Malabsorption
Deficiency in B12/folate/iron
Gall stones and kidney stones
Weight loss
Watery diarrhoea
Aphthous mouth ulcers

(May also have, but more common in UC)
Uveitis/ episcleritis
Pyoderma gangrenosum / erythema nodosum
Spondylarthritis - “spineache”

Question 10

How can Crohn’s disease cause gallstones?

Answer 10

Bile salts are not reabsorbed well due to inflammation. Instead they react with bilirubin in the colon changing it to a form that can be reabsorbed. More absorption of bilirubin results in more incorporated in the bile forming black gallstones

Question 11

What is uveitis?

Answer 11

Inflammation of uvea. middle layer of eye

Question 12

What is episcleritis?

Answer 12

inflammation of the connective tissue between the conjunctiva(sufrace membrane) and sclera (white)

Question 13

What is pyoderma gangrenosum

Answer 13

Rare skin condition that causes painful skin ulcers (not related to gangrene, is not contagious)

Question 14

What is erythema nodosum?

Answer 14

tender red bumps, often found symmetrically on the shins

Question 15

What is spondyloarthritis?

Answer 15

Group of diseases characterised by inflammation in the spine and joints

Question 16

What investigations are carried out for Crohn’s disease?

Answer 16

pANCA -ve (perinuclear Anti-Neutrophil Cytoplasmic Antibodies)

Increased faecal calprotectin (result of neutrophil migration into GI due to inflammation)

Biopsy: transmural inflammation with non caseating granulomas

Endoscopy/X-ray: skip lesions, cobble stoning, “string sign” structures

Question 17

What are “string sign” structures?

Answer 17

Narrowing of the terminal ileum due to symmetric, transmural granulomatous inflammation and fibrotic thickening of the wall.

Question 18

How do you treat flares of Crohn’s disease?

Answer 18

Sulfasalazine given via rectal suppository therefore better in UC

Prednisolone

Question 19

What is treatment for remission of Crohn’s disease?

Answer 19

Azathioprine
Methotrexate

Question 20

What are the biologics treatment for Crohn’s?

Answer 20

Anti TNF-a: Infliximab
IL 12 and 23 inhibitor: Ustekenumab

Question 21

True or false: Surgery is not curative for Crohn’s disease

Answer 21

True
As entire bowel can be affected

Question 22

What are complications of Crohn’s disease?

Answer 22

Fistula (abnormal connection)
Strictures
Abscesses (painful collection of pus)
Small bowel obstruction

Question 23

Ulcerative colitis is an a_______ colitis

Answer 23

autoimmune

Question 24

What gene is associated with UC?

Answer 24

HLA B27

Question 25

In UC, is the pANCA likely to be positive or negative?

Answer 25

Positive (is a test for autoimmune vasculitis, more likely to be negative in Crohn’s)

Question 26

Which area is affected by UC?

Answer 26

Colon only
Starting at rectum to sigmoid to proximal colon

Question 27

What are risk factor for UC?

Answer 27

Family history, Jewish.

However, smoking is somehow protective for UC!

Question 28

In UC, the inflammation is c____ to…

Answer 28

confined to the mucosa

Question 29

What are common symptoms of UC?

Answer 29

Pain in LLQ
Tenesmus (rectal defecation pain)
Bloody mucous/watery diarrhoea
Uveitis / episcleritis
Pyoderma gangrenosum / erythema nodosum
Spondylarthropathy
PSC (primary sclerosing cholangitis)

Question 30

What is PSC?

Answer 30

Primary sclerosing cholangitis

Uncommon chronic liver disease where bile ducts get smaller due to inflammation and fibrosis, commonly linked to UC.

Question 31

What are diagnostic tests for UC?

Answer 31

pANCA: positive

Increased faecal calprotectin

Biopsy: mucosal inflammation with crypt hyperplasia

Colonoscopy: continuous “lead pipe sign”

Question 32

Why is there crypt hyperplasia?

Answer 32

Not fully understood, considered compensatory response to mucosal injury and inflammation to replace lost epithelial cells.

Question 33

What is the “lead-pipe” sign in UC?

Answer 33

Uniform loss of haustral markings (pouch like structures” in the colon. Smooth appearance resembling a lead pipe!

Question 34

What is used to score the severity of UC flares?

Answer 34

Truelove + Witts severity index

Question 35

What is treatment for flares of UC?

Answer 35

If severe, first give Prednisolone
Sulfasalazine

Question 36

What is treatment for remission of UC?

Answer 36

Azathioprine
Methotrexate
Ciclosporin (calcineurin inhibitor)

Question 37

What are biologic treatments for UC?

Answer 37

Anti TNF-a: Infliximab

Surgery (total or partial colectomy)

Question 38

True or false: Surgery is not curative for UC?

Answer 38

False
It is curative

Question 39

What are complications of UC?

Answer 39

Toxic megacolon