IBD

Question 1

Inflammatory bowel disease is

Answer 1

an umbrella term for two main diseases causing inflammation of the GI tract: Ulcerative Colitis and Crohn’s disease. They both involve inflammation of the walls of the GI tract and are associated with periods of remission and exacerbation

Question 2

Crohn’s disease features (NESTS)

Answer 2

N - No blood or mucus

E - Entire GI tract

S - Skip lesions on endoscopy

T - Terminal ileum most affected and Transmural inflammation

S - Smoking is a risk factor

Crohn’s is also associated with weight loss, strictures and fistulas.

Question 3

Ulcerative Colitis (CLOSEUP)

Answer 3

C - Continuous inflammation

L - Limited to the colon and the rectum

O - Only the superficial mucosa is affected

S - Smoking is protective

E - Excrete blood and mucus

U- Use aminosalicylates

P - Primary Sclerosing Cholangitis (associated with)

Question 4

Presentation and clinical features of IBD (FAILSAFA)

Answer 4

F - Fever

A - Abdominal pain

I - Involuntary weight loss

L - Loss of appetite

S - Stools are bloody and mucoid

A - Abdominal tenderness

F - Fatigue

A - Anemia

Question 5

Diagnosis gold standard

Answer 5

Endoscopy (OGD and Colonoscopy) with biopsy is diagnostic

Question 6

Routine bloods for diagnosis

Answer 6

anaemia, infection, kidney and liver function

Question 7

Diagnosis of stool sample is called

Answer 7

Faecal calprotectin is related to the intestines when inflamed - useful screening test and >90% sensitive and specific to IBD in adults

Question 8

What should you check for inflammation levels and active disease

Answer 8

CRP

Question 9

What also is used in the diagnosis to look for secondary complications

Answer 9

Imaging with ultrasound, CT, and MRI can be used to look for fistulas, abscesses and strictures

Question 10

Crohns management NICE guidelines (May 2016)

Answer 10

First line: Steroids (prednisolone or IV hydrocortisone)

Question 11

If steroids don’t work in Crohn’s as first-line treatment, what else can you use?

Answer 11

Immunosuppressant medication:

Azathioprine

Mercaptopurine

Methotrexate

Infliximab

Question 12

What about maintaining remission in Crohn’s

Answer 12

No meds are ok OR

Azathioprine
Mecatopurine

Question 13

Is surgery a treatment option for Crohn’s

Answer 13

Only when the disease affects the distal ileum it is possible to surgically resect this area and prevent further flareups.

However, Crohn’s usually affects the Entire GI tract thus making surgery only an option to treat strictures and fistulas, secondary to Crohn’s

Question 14

Management of Ulcerative Colitis NICE Guidelines (June 2013)

Answer 14

Inducing remission: Mild to mod

First line: aminosalicylate
Second line: corticosteroids (prednisolone)

Severe disease:

First line: IV corticosteroids (hydrocortisone)
Second line: IV ciclosporin

Question 15

What about maintaining remission in Ulcerative colitis

Answer 15

Aminosalicylate (oral or rectal mesalazine)

Question 16

Surgery options for treating ulcerative colitis

Answer 16

Surgery is an option for UC as it only affects the colon and the rectum, thus removing these two areas in a panproctocolectomy will remove the disease

Question 17

What is the surgery called that removes the disease in UC patients

Answer 17

panproctocolectomy

Question 18

After a panproctocolectomy the patient is left with what

Answer 18

either an ileostomy or a J-pouch. This is where the ileum is folded back in itself and fashioned into a larger pouch that functions like a rectum.

J pouch is attached to the anus and collects stools prior to the person passing the motion

Question 19

Prevalence of IBD

Answer 19

1 in 123 people

Question 20

Aetiology of IBD

Answer 20

Exact cause unknown

Genetic components

Weekend immune system