IBD

Question 1

Aetiology of IBD?

Answer 1

Ulcerative Colitis and Crohn’s disease

• both involve inflammation of walls of the GI tract and are associated with periods of remission and exacerbation

Question 2

Clinical presentation of CROHNS

Answer 2

Crohn’s (NESTS)

N - No blood or mucus (less common)

E - Entire GI tract

S - ‘skip lesions’ on endoscopy (patchy inflammation)

T - Terminal ileum most affected and Transmural (full thickenss) inflammation

S - Smoking is a risk factor (dont set the nest on fire)

associated with weight loss, strictures, and fistulas

Question 3

Clinical presentation of UC

Answer 3

CLOSE UP

C - Continuous inflammation

L - Limited to colon and rectum

O - Only superficial mucosa affected

S - Smoking is protective

E - Excrete blood and mucus

U - Use aminosalicylates (e.g. sulfasalazine)

P - Primary Sclerosing Cholangitis

Diarrhoea, abdominal pain, passing blood, weight loss, abdominal distension all common

Question 4

Investigation + diagnosis of IBD?

Answer 4

• routine bloods for anaemia, infection, thyroid, kidney and liver function
• CRP indicates inflammation and active disease
• Faecal calprotectin (released by the intestines when inflamed) is a useful screening test (>90% sensitive and specific to IBD in adults)
• Endoscopy (OGD and colonoscopy) with biopsy is diagnostic
• Imaging with ultrasound, CT and MRI can be used to look for complications such as fistulas, abscesses and strictures

Question 5

Pseudopolyps seen on endoscopy are seen more commonly in?

Answer 5

Ulcerative colitis

Question 6

Weight loss is seen more in?

Answer 6

Crohns

Question 7

Increased goblet cells is seen in which type?

Answer 7

Crohns

Question 8

Depletion of goblet cells is seen in which type?

Answer 8

UC

Question 9

Rose thorn ulcers are seen in which type of IBD?

Answer 9

Crohns disease

Question 10

most common dermatologic manifestation of inflammatory bowel disease (IBD)?

Answer 10

Erythema nodosum

occurring in up to 3 percent of patients with ulcerative colitis and up to 8 percent of patients with Crohn disease

Question 11

Features pointing to Crohn’s rather than UC?

Answer 11

Mouth ulcers
Erythema nodosum
History of smoking - risk factor

Question 12

Smoking and crohns + UC?

Answer 12

Smoking is a risk factor for crohns

Smoking is protective for UC

Question 13

Induce remission of Crohns (treatment)

Answer 13

P.O. Prednisolone or IV hydrocortisone

Question 14

Maintain remission of Crohns (treatment)?

Answer 14

Azathioprine or Mercaptopurine