IBD

Question 1

What is IBD?

Answer 1

Inflammation of the gastric mucosa

Question 2

What area does ulcerative colitis involve?

Answer 2

The mucosa of the rectum and colon

Question 3

Which areas does Crohn’s disease effect?

Answer 3

Whole GIT from mouth to anus

Question 4

What surgical procedure provides total cure of ulcerative colitis?

Answer 4

Total colectomy

Question 5

Surgery for Crohn’s disease is curative. True or false?

Answer 5

False

Question 6

Strictures and fistulas are common in what type of IBD?

Answer 6

Crohn’s disease

Question 7

What are strictures and fistulas?

Answer 7

Strictures are narrowed segments of bowel which can lead to blockages, acute dilation and perforation

Fistulas are abnormal channels lined with granulation tissue

Question 8

What are some possible causes of IBD?

Answer 8

smoking, genetics, environmental factors, gut microbes, diet, medication

Question 9

What are some signs and symptoms of IBD?

Answer 9

Abdominal pain, bloating and distension, diarrhoea, tiredness, fatigue, fever, anemia, weight loss. Nausea and vomiting, urgency

Question 10

What are some extra-intestinal manifestations of IBD?

Answer 10

Swollen joints, eye problems, erythema nodosum (swollen fat under skin causing redness, bumps), Pyoderma gangrenosum (skin ulceration)

Question 11

What variables are assessed to calculate Crohn’s disease activity index?

Answer 11

1. Number of liquid or soft stools
2. Severity of abdominal pain
3. general wellbeing
4. presence of complications
5. fever
6. use of Loperamide
7. presence of anaemia
8. weight
9. Abdominal mass absent or present

Question 12

How is severe active Crohn’s disease defined?

Answer 12

very poor general health with one or more symptoms including: weight loss, fever, severe abdominal pain, increased frequency of soft stool

Question 13

What does treatment of IBD depend on?

Answer 13

Type, location and extent of disease, severity

Question 14

What are the primary aims of treatment?

Answer 14

Achieving and maintaining remission and improving quality of life

Question 15

What are the secondary aims of treatment?

Answer 15

avoiding surgery, reducing long term steroid use, reduce risk of colorectal cancer, and development of complications

Question 16

What is the general management of acute mild to moderate IBD?

Answer 16

Local application of corticosteroid or aminosalicylate

Question 17

How is diffuse inflammatory disease not responding to local therapy managed?

Answer 17

Oral treatment with aminosalicylate or corticosteroid

Question 18

How is severe inflammatory bowel disease managed?

Answer 18

Admission to hospital, IV corticosteroids and other immunsuppressive agents

Question 19

What are the monitoring parameters for IBD?

Answer 19

Faecal calprotein
Stool frequency
Presence of blood and/or mucous in the stool
Temperature
CRP
U&Es

Question 20

Name 3 aminosalicylates that are only licensed for use in UC

Answer 20

Mesalazine, Balsalazide, Olsalazide

Question 21

What causes side effects in sulphasalazine?

Answer 21

Sulphapyridine - carrier molecule - this is not present with new analogues of Aminosalicylates

Question 22

Explain the pharmacological treatments available for IBD

Answer 22

corticosteroids, Aminosalicylates, Immunomodulating agents such as Thiopurines, biologics and others including methotrexate, Ciclosporin and Tacrolimus

Question 23

Purpose and MoA of corticosteroids in IBD treatment

Answer 23

used to induce remission, work by reducing inflammation and modulating the immune system. Prednisolone binds to cellular glucocorticoid receptors, inhibiting inflammatory cells and suppressing expression of inflammatory mediators

Question 24

Purpose and MoA of Aminosalicylates

Answer 24

to induce and maintain remission. Mechanism not fully understood but reduces inflammation in GI tract through variety of anti-inflammatory processes. It also decreases prostaglandin production in colon and inhibits pro-inflammatory cytokines

Question 25

Purpose and MoA of Thiopurines

Answer 25

1st line immunomodulators for IBD, induce and maintain remission, mechanism not fully understood but acts as an immunomodulator and suppresses immune response and inflammation

Question 26

What actions are taken if there is acute relapse of UC or Crohn’s?

Answer 26

Bed rest
Low residue diet
Monitoring
Corticosteroids - hydrocortisone IV or methylprednisolone

Question 27

When are immunosuppressive agents used?

Answer 27

In patients where the disease is not responding to oral corticosteroids

Question 28

Immunosuppressants work immediately. True or false?

Answer 28

false, may take 1 or 2 months to be effective

Question 29

Name the immunosuppressants that are used for patients who do not respond to oral corticosteroids

Answer 29

Azathioprine, 6-mercaptopurine, Once weekly methotrexate, Ciclosporin - UC only

Question 30

Which monoclonal antibodies are used in IBD and why?

Answer 30

Infliximab, Adalimumab, Golimumab, Vedolizumab. Used as they have a high afftinity to alpha-TNF and so inhibit its activity

Question 31

Which IBD complications require immediate surgery?

Answer 31

bleeding, fistulas, perforation, abscess, intestinal blockage

Question 32

Give examples of elective surgery procedures for IBD

Answer 32

bowel resection, strictureplasty, colectomy, fistula treatment, abscess drainage