IBD

Question 1

What is IBD?

Answer 1

Chronic recurring inflammation of the GI tract

Question 2

Define Crohns Disease (CD)

Answer 2

• Inflammation of any part of the GI tract.
• Involves ileum, caecum and colon
• Effects regions in a discontinuous pattern - skip lesions

Question 3

What are the complications of CD?

Answer 3

maligancy, anal lesions

Question 4

Define Ulcerative colitis

Answer 4

• Confined to the colon
• Effects regions in a continuous patter
• Starts in the rectum and progresses upwards

Question 5

What are complications of UC?

Answer 5

Blood loss, electrolyte disturbances

Question 6

What are the differences of UC and CD?

Answer 6

UC - blood in stool, mucus, occasionally - pain, colonic obstruction and abdominal mass
CD - Fistulas, abdominal mass, responds to antibiotics but can recurs after surgery , small intestine obstruction

Question 7

What are the symptoms of IBD?

Answer 7

bloody diarrhoea
urgency to empty bowels
malnutrition
fever and weight loss

Question 8

What is an ESR test and its process?

Answer 8

Measures severity of CD and UC
- RBCs placed in a tube sediment at a set rate. If inflamed they clump together and sediment faster - indication of inflammation.

Question 9

What are the extra-intestinal manifestations (EIM) that are the result of IBD/treatment?

Answer 9

Dermatological
Rheumatological
Ocular
General - kidneys and liver

Question 10

Describe the 2 types of skin lesions

Answer 10

Erythema nodosum - tender red bumps
Pyoderma gangrenosum - deep chronic ulcers - UC

Question 11

Describe malignancy screening

Answer 11

Pt with extensive colitis of > 8-10yrs are under surveillance programmes and undergo regular colonoscopy with multiple biopsies.

Question 12

What are the IBD risk factors?

Answer 12

Luminal microbial antigens
Immune response
Environmental triggers - smoking, diet, stress, lifestyle etc

Question 13

What is the treatment pathway for IBD?

Answer 13

Induction of remission
Maintenance of remission
Improved quality of life
Prevent bowel complications/ EIM
Mucosal healing - decrease risk of cancer

Question 14

What is TMPT?

Answer 14

Thiopurine Methyl Transferase
- Enzyme responsible for metabolism of azathioprine
- Pt with no TMPT enzyme can become ill if treated with normal dose of thiopurine durgs - high risk of marrow suppression/death

Question 15

Aminosalicylate (5-ASA)

Answer 15

• 1st line induction of remission UC and decrease efficacy in CD
• Anti-inflammatory effects - works locally not systemically
  EXAMPLE: Sulfasalazine

Question 16

Corticosteroids

Answer 16

• Used along 5-ASA or when they have failed
• Induces rapid remission in CD and UC