Gastroenterology 15 - Inflammatory Bowel Disease

Question 1

recall 8 key distinct features of Chron’s disease

Answer 1

no blood or mucus
entire GI tract
skip lesions 
terminal ileum most affected
transmural inflammation 
smoking risk factor 
strictures 
fistulas

Question 2

recall 6 distinct features of Ulcerative colitis

Answer 2

continuous inflammation 
limited to colon and rectum
only superficial mucosa
smoking is protective
excrete blood and mucus
PSC assoc

Question 3

typical presenting features of IBD

Answer 3

failure to thrive at any age
diarrhoea + many BO / day
fatigue 
weight loss
\+/- passing blood 

remits + remits

Question 4

5 bloods + 3 other tests if suspect IBD

Answer 4

FBC, CRP, TFTs, UEs, LFTs
faecal calprotectin
endoscopy both ends
imaging for complications

Question 5

summarise management of Chron’s (med, surg)

Answer 5

oral pred or IV hydrocort to induce remission

add Isupp if not enough (specialist input needed)

maintenance therapy - azathioprine or mercaptopurine

can stop meds if feel well ad use on symptomatic basis

surgery: can resect if limited to distal ileum, also ops for fistulas or stictures

Question 6

summarise treatment of ulcerative colitis (med, surg)

Answer 6

mesalazine (aminosalicylate)
+/- steroid

severe: IV steroid or ciclosporin

maintenance is mesalazine or as with Chron’s

surgery: panproctocolectomy with ileostomy bag or J pouch to anus