IBD

Question 1

Name 8 git symptoms of IBD

Answer 1

Chron:
• diarrhea
• crampy abdominal pain especially rif
• b12 deficiency (terminal ileum)
• anaemia of chronic disease

Ulcerative colitis:
. Bloody diarrhea

Both:
• rectal bleeding
• urgency
• fatigue, weight loss, loss appetite, fever

Question 2

Name 10 extra git symptoms of IBD

Answer 2

• Cutaneous: erythema nodosum! (pretibial), pyoderma gangrenosum!
• ocular: uveitis!, scleritis, episcleritis
• mouth: aphthous stomatitis!
• pulmonary: chronic bronchitis, bronchiectasis
• HPB: primary sclerosing cholangitis
• pancreatic: pancreatitis!
• Genito urinary: nephrolithiasis
• musculoskeletal: inflammatory arthropathies (large joint arthritis, axial arthropathies)
• haem: anemia! Increased thromboembolic events
• perianal: abscess, fissure

Question 3

Name 4 anatomical location differences between Cd and uc

Answer 3

• Whole gi tract vs colon and rectum
• terminal ileum most commonly involved vs rectum
• affects right colon more vs left.
• segmental, discontinuous distribution through the gi tract vs diffuse continuous

Question 4

Name 8 endoscopic and pathologic findings differences between Cd and uc

Answer 4

• aphthoid ulcers, deep confluent linear ulcers vs superficial
• pseudopolyps uncommon vs common
• skip lesions vs continuous distribution
• cobblestoning present vs absent
• deep fissures and fistulae present vs absent (except in fulminant
• mucosal atrophy minimal vs marked
• full thickness of wall vs mucosal only
• fat wrapping present vs absent

Question 5

Difference between the immune mediated responses in IBD?

Answer 5

Chron th 1
Ulcerative colitis Th 2

Question 6

Difference between the radiology features in IBD?

Answer 6

Chron “ string “ sign
Ulcerative colitis “lead pipe” colon

Question 7

Role of smoking in IBD?

Answer 7

Chron = risk factor
Ulcerative colitis - protective

Question 8

Which IBD has higher risk of colon cancer?

Answer 8

Ulcerative colitis

Question 9

CT finding in Chron’s ?

Answer 9

Comb sign due to vasa recta hypervascularity!
Fat stranding
Bowel thickening, abscesses

Question 10

Clinical scoring of ulcerative colitis? (6)

Answer 10

Bowel movements per day
• < 4 mild
• 4-6 moderate
• ≥ 6 plus at least one of the features of systemic upset severe

Blood in stools
• small amounts mild
• mild-severe moderate
• visible blood severe

Pyrexia ( >37,8) = severe

Pulse >90 = severe

Anemia = severe

ESR >30 = severe

Question 11

Name 7 complications IBD

Answer 11

Chron’s
• Benign strictures (may cause bowel obstruction)
• fistulae and abscess: enterocutaneous, enteroenteral, enterovesical, perianal fistulae

Ulcerative colitis
• malignant strictures
• perforation and toxic megacolon! High mortality
• malignancy, look for after 8-10 years diagnosis!

Both
• obstructive hydronephrosis due to pelvic fibrosis
• extra intestinal manifestations eg uveitis, erythema nodosum etc

Question 12

First line treatment IBD? (4)

Answer 12

Medical with step up approach if mild and step down approach if severe ( order nb ):
• amino salicylates
• steroids
• immune modulating drugs
• targeted therapy with biologicals eg anti - tnm infliximab

Question 13

Name 4 indications for surgery in ulcerative colitis

Answer 13

• Severe disease with possible perforation, or not responding to treatment
. Risk of cancer not excluded
. High grade dysplasia
• extra-intestinal manifestations

Question 14

Which surgery is performed for ulcerative colitis if indicated?

Answer 14

Total proctocolectomy with iLeo anal pouch anastomosis

Question 15

Name 5 indications surgery for Chron’s

Answer 15

Not curable by surgery so last resort, should be limited to pathology and conservative
• failure medical treatment
• bowel obstruction due to stricture
• fistulae
• perforation
• bleeding

Question 16

Which type of surgery is performed in Chron’s strictures if indicated?

Answer 16

Dilatation of stricture or stricturoplasty
Limited resection of multiple or long strictures, or fistulae with anastomosis.