Gastro - IBD

Question 1

What are the general presenting features of IBD?

Answer 1

Diarrhoea
Abdominal pain
Rectal bleeding
Fatigue
Weight loss

Question 2

How do you differentiate between Crohn’s and UC?

Answer 2

NESTS

N- No blood or mucus
E- Entire GI tract
S- Skip lesions
T- Terminal ileum most affect and transmural inflammation
S- Smoking is a risk factor

Also associated with strictures and fistulas

Question 3

How is UC differentiated from Crohn’s?

Answer 3

You see (UC) CLOSEUP

C- Continuous inflammation
L- Limited to colon and rectum
O- Only superficial mucosa
S- Smoking may be protective, less common in smokers
E- Excrete blood and mucus
U- Use aminosalicylates
P- Primary sclerosing cholangitis

Question 4

What conditions are associated with IBD?

Answer 4

Erythema nodosum
Pyoderma gangrenosum
Enteropathic arthritis
Primary sclerosing cholangitis
Red eye conditions (episcleritis, scleritis, anterior uveitis)

Question 5

What investigations are done for IBD?

Answer 5

Bloods
- FBC
- CRP
- U&Es
- LFTs
- TFTs
- Anti-TTG antibodies

Stool microscopy and culture

Faecal calprotectin
90% sensitive and specific for IBD, initial test before endoscopy

Colonoscopy
With multiple intestinal biopsies

CT and MRI
Fistulas, abscesses and strictures

Question 6

What are the principles of managing IBD?

Answer 6

Inducing remission
Maintaining remission

Question 7

How is UC managed?

Answer 7

Mild to moderate
First line
Oral or rectal mesalazine

Second line
Oral or rectal prednisolone

Severe
IV ciclosporin
Infliximab
Surgery

Maintaining remission
Aminosalicylate (oral or rectal mesalazine) first line
Azathioprine
Mercaptopurine

Question 8

How is UC managed surgically?

Answer 8

Panproctocolectomy

Patient has permanent ileostomy or ileo-anal anastomosis (J-pouch)

Question 9

What is a J-pouch?

Answer 9

Ileum folded back on itself and makes a larger pouch

Attached to anus and functions like a rectum, collecting stools before bowel opening

Question 10

How is Crohn’s managed?

Answer 10

Inducing remission
First line
Steroids (oral prednisolone or IV hydrocortisone )
Enteral nutrition

Second line
Addition of :
- Azathioprine
- Mercaptupurine
- Methotrexate
- Infiliximab
- Adalimumab

Maintaining remission
First line
Azathioprine
Mercaptopurine

Second line
Methotrexate

Question 11

What is enteral nutrition?

Answer 11

Liquid diet given orally or by NG
- Treats nutritional deficiencies
- Improves gut microbiome
- Removes inflammatory foods

Question 12

What are the surgical managements for Crohn’s?

Answer 12

Resecting distal ileum
Treating strictures
Treating fistulas