IBD

Question 1

What affects only the colon, UC or CD

Answer 1

UC

Question 2

What develops in patches, UC or Crohn’s disease

Answer 2

Crohns

Question 3

For patients who have features of both, what are they classed as x

Answer 3

IBD-U

Question 4

What is microscopic colitis

Answer 4

Inflammation that can only be seen under microscope

Question 5

What are the two forms of microscopic colitis

Answer 5

Collagenous: thickening of subepithelial collegen band

Lymphocytic colitis

Question 6

How does microscopic colitis present

Answer 6

Chronic, non bloody, watery diarrhoea with no macroscopic abnormalities

Question 7

What is associated with microscopic colitis

Answer 7

Autoimmune disease, rheumatoid, thyroid, coeliac

Question 8

What are risk factors for IBD

Answer 8

Smoking 
Stoping smoking in UC 
Young Asian men coming west
Genetics: snp (nod2) 
Heritiary

Question 9

Describe the microbial communities in IBD

Answer 9

Dysbiosis

Increase in actionbacteria, proteobscteria and decrease in bacteroides species

Question 10

Describe clinical profile of someone with UC

Answer 10

Peak 20-40
Makes = females
Bloody diarrhoea, abdominal pain, Weight loss and fatigue

Question 11

In UC where does
Procitis 
Procitisigmoidtisi 
Left side colitis 
Extensive 
Pancolitis 
Effect

Answer 11

Procolitis effects rectum only 
Rectum to sigmoid 
Left sided up to splenic flexure
Extensive up to hepatic flexure
Pancolitis whole colon

Question 12

For proctitis what has to be check to make sure it is IBD

Answer 12

STI, Chlymydia and ghonorea

Question 13

In someone suffering from UC procolitis what symptoms may they experience

Answer 13

Frequency and urgency to go
Small volume mucous and blood
Constipation
Responds to topical therapy

Question 14

How is UC severity, what score is used

Answer 14

True love and witts

Question 15

What are the categories in true love and witts criteria

Answer 15

Mi,d
Moderate
Sever
Fulminant

Question 16

If I have 10 stools a day +bleeding , toxicity is this sever or fulminant

Answer 16

Fuliminant

Question 17

In UC what investigations are conducted

Answer 17

Bloods - CRP increase, albumin decrease
Stool culture to rule out infection
Faecal calprotectin
Colonoscopy

Question 18

What is considered a normal level of faecal calprotectin in the stool

Answer 18

0-50 normal
59-200 equivocal
>200 elevates

Question 19

What is faecal calprotectin a measure of

Answer 19

Any inflammation in the gut, not just UC or Cd

Question 20

What is the name of the poo chart

Answer 20

Bristol

Question 21

In acute sever colitis, how is it treated in first 24 hours

Answer 21

4 stools for C diff
Blood tests
Stool chart
Avoid specific drugs, NSAIDs, opiates,anti-diarrhoea’s 
IV conticosterioids, methyl pred twice daly 
IV hydration 
Lmwh 
Axr for toxic diliation

Question 22

What are complications of crohns

Answer 22

Inflammation
Stricture
Fistula

Question 23

In symptoms with Crohn’s disease what do symptoms depend on

Answer 23

Where in GI is it occurring

Question 24

What are the investigations for cd

Answer 24

Same as UC
+ small bowel mri
Only occasionally do you do CT to rule out abscess

Question 25

Histologically what is the diff betweeen CD and UC

Answer 25

Cd causes granulomatous, transmural | UC limited to muscosa, globet cells lost, crypt abscesses

Question 26

What are the complications of CD

Answer 26

Inflammation Stricture Fistula Abscess

Question 27

What symptoms does perianal CD cause

Answer 27

Pain in anus Inability to sit Plus

Question 28

What is the investigations used for someone with perianal Crohn’s disease

Answer 28

MRI of pelvis | Examination under anasthetic

Question 29

What treatment is given to someone with perianal Crohn’s disease

Answer 29

Surgery to drain abbesses and seton stitch | Medical antibiotics and biological therapy

Question 30

What are the extra intestinal manifestations of IBD

Answer 30

``` Mouth ulcers Skin rashes Musculoskeletal Eyes Primary sclerosing cholangitis ```

Question 31

What factors determine risk to carinoma from IBD

Answer 31

Extent | Duration.

Question 32

When is someone first colitis survaliienced

Answer 32

10 years

Question 33

What is 1 st line treatment for both during and induction of remission

Answer 33

5-ASA ONLY in UC mile - moderat No more than 3 g per day orally or suppository in rectal disease

Question 34

What is second line of tresatment

Answer 34

Prednisolone (40mg per day) tapering it down with calcium and vit D to reduce side effect of bone density Budesonide which though less effective, less side effects INDUCE REMISION IN BOH UC AND CROHNS

Question 35

What is the 3rd line of treatment

Answer 35

Immunomodulation in both UC and crohns Azathioptine/ 6 MP: requires monitoring of blood due to hepatoxicity, pancreatitis, lymphoma risk and skin cancer, 28% intolerant Methotrexate : crohns only, is teratogenic

Question 36

What is the 4th line of treatment

Answer 36

Monoclonal antibodies | See slide

Question 37

What has been found to be equally effective as steroids

Answer 37

Elemental feeding | Though hard to comply, for children

Question 38

In someone acutely I’ll, what is the surgery called

Answer 38

Subtotal colectomy, leaving only recital remaining

Question 39

After someone who has had subtotal colectmy what are their two options regarding the rectum

Answer 39

Pouch | Removal

Question 40

Can someone with CD get a pouch

Answer 40

No only UC