IBD

Question 1

signs of Crohns

Answer 1

N-no mucus or blood (less common)
E- entire GI tract
S- skip lesions on endoscopy
T-terminal ileum most affected and transmural full thickness
S-smoking is a risk factor

(strictures, weight loss, and fistulas)

Question 2

Signs of UC?

Answer 2

C-continuous inflammation
L-imited to colon and rectum
O- only superficial mucosa
s-smoking is protective
e- excrete blood and mucus
u- use aminosalicylates
p- primary sclerosing cholangitis

Question 3

presentation of IBD?

Answer 3

diarrhoea, abdominal pain, passing blood weight loss

Question 4

what test is specific to IBD?

Answer 4

faecal calprotectin

Question 5

how to diagnose IBD?

Answer 5

endoscopy with biopsy

Question 6

inducing remission for Crohns?

Answer 6

steroids oral prednisolone or IV hydrocortisone
if they dont work alone add maami- methotrexate azathioprine andalimumab mercaptopurine and infliximab

Question 7

maintaining remission for crohns?

Answer 7

mecaptopurine and azathioprine,

alternative methotrexate infliximab and andalimumab

Question 8

when to undergo surgery in crohns?

Answer 8

if only distal ileum affected or strictures, fistulas

Question 9

inducing remission in UC?

Answer 9

first line- aminosalicylate (mesalazine)
second- corticosteroids (prednisolone)

if severe: IV corticosteroids
then IV ciclosporin

Question 10

maintaining remission for UC?

Answer 10

aminosalicylate
azathioprine
mercaptopurine

Question 11

what surgery can someone with IBD get?

Answer 11

panproctoclectomy- j pouch or permanent ileostomy

Question 12

peak incidence of UC?

Answer 12

15-25 and 55-65

Question 13

features of UC?

Answer 13

bloody diarrhoea, urgency, tenesmus, abdominal pain in lower left quadrant and extra intestinal features

Question 14

when should you opt for flexible sigmoidoscopy?

Answer 14

if severe colitis and risk of perforation

Question 15

typical findings of UC?

Answer 15

red raw mucosa that bleeds easily
pseudopolyps
inflammatory cell infiltrate in lamina propria
neutrophils migrate through walls of glands to form crypt abscesses
depletion of goblet cells and mucin from gland epithelium,
infrequent granulomas

Question 16

What will barium enema show for UC?

Answer 16

loss of haustrations, superficial ulceration (pseudopolyps), if longstanding colon becomes narrow and short- drainpipe colon

Question 17

extraintestinal features of IBD

Answer 17

arthritis (PAUCIARTICULAR AND ASSYMETRICAL)- both
erythema nodosum
episcleritis (crohns)
osteoporosis

unrelated to disease activity:
clubbing
uveitis (UC)
primary sclerosing cholangitis
pyoderma gangrenosum
arthritis polyarticular and symmetrical

Question 18

what can cause UC flares?

Answer 18

NSAIDs antibiotics, stress and stopping smoking

Question 19

Flares of UC classification?

Answer 19

Mild- less than 4 with/out blood. no systemic disturbance. normal ESR and CRP

Moderate- 4-6 with minimal systemic disturbance

Severe- more than 6 containing blood- systemic disturbance: fever, tachycardia, abdominal tenderness, distension or reduced bowel sounds anaemia, hypoalbuminaemia

Question 20

what is treatment for severe colitis?

Answer 20

iv steroids first line. if contraindicated then iv ciclosporin

Question 21

after severe relapse or more than 2 exacerbations in past year then you should give?

Answer 21

oral azathioprine and oral mercaptopurine

Question 22

when does crohns present?

Answer 22

late adolescence or early adulthood

Question 23

presentation of Crohns?

Answer 23

weight loss, lethargy, diarrhoea, abdominal pain, perianal disease (skin tags or ulcers

Question 24

investigations of crohns

Answer 24

raised inflammatory markers, increased faecal calprotectin, anaemia, low vit b12 and d

Question 25

what is investigation of choice for crohns?

Answer 25

colonoscopy

Question 26

histology of crohns?

Answer 26

inflammation in all layers, goblet cells and granulomas

Question 27

what would a small bowel enema show for crohns?

Answer 27

strictures: kantor’s string sign
proximal bowel dilation
rose thorn ulcers, fistulae
Cobblestone
Rose thorn ulcers
Obstruction of bowel
Hyperplasia of mesenteric lymph nodes
Narrowing of intestinal lumen
Skip lesion

Question 28

when is infliximab used?

Answer 28

refractory disease and fistulating Crohns

Question 29

what is given for perianal fistulae which are symptomatic?

Answer 29

metronidazole

Question 30

what is used for complex fistulae?

Answer 30

draining seton

Question 31

what are effective in maintaining closure of fistulae?

Answer 31

infliximab

Question 32

complications of crohns

Answer 32

small bowel cancer, colorectal cancer, osteoporosis