IBD

Question 1

Definition

Answer 1

A group of idiopathic disorders that can cause inflammation either localised to the large intestine (UC) or everywhere in the GI tract (CD)

CD- can affect any part of the GI tract

UC- affects only colon and almost always extends into the rectum

Question 2

Aetiology/pathophysiology

Answer 2

The aetiology of IBD is unclear but there is an interaction between:
– genetic susceptibility- HLA-B27 gene (ankylosing spondylitis)
– genetic susceptibility is higher with CD than it is with UC
(up to 1 in 5 pt have a first degree relative- CD—- 1 in 6- UC)

– environmental factors:
—- smoking (decreases risk of UC and increases CD x2)
—- NSAID’s ingestion
—- psyhological factors like chronic stress

Associated with an abnormal mucosal immune response to luminal antigens (this can be from a leaky epithelium)
– bacterial ligands interact with the innate and acquired mucosal immune system.
– recent research has highlighted deficiencies in the clearance of invading bacteria by aspects of the innate immune system such as neutrophils, which may allow inappropriate activation of the acquired immune system

Question 3

Epidemiology

Answer 3

CD- uncommon, 20-30 increased incidence
Genetic susceptibility higher (1 in 5)
Smoking increases the risk x2

UC- uncommon, 15-25 increased incidence
Genetic susceptibility lower (1 in 6)
Smoking decreases risk

Question 4

CD

Answer 4

Idiopathic inflammatory bowel disease that is associated with multifocal areas of inflammation known as skip lesions. and can occur anywhere in the GI tract

40% ileocolonic

30-40% small bowel

20% colon

10% perianal

Question 5

UC

Answer 5

Idiopathic inflammatory bowel disease that is localised to the large intestine. Consistent inflammation that almost always extends into the rectum

Question 6

CD CP

Answer 6

Symptoms can depend on where has been affected:

main symptoms:
– diarrhoea
– abdominal pain
– weight loss

Ileoclonic:
– crampy RIF pain (may mimic appendicitis)
- diarrhoea occurs in 80% of colonic IBD usually with blood

Small bowel disease:
- abdominal pain, usually with weight loss

Perianal:
– anal fissures, tags and abscess formation

• fever
• malaise

Question 7

UC CP

Answer 7

Recurrent episodes of blood diarrhoea, often with urgency to go
- sometimes accompanied by lower abdominal discomfort

Tenasmus (feeling that you need to evacuate, even when you dont)

Incomplete evacuation

• lethargy, malaise and anorexia

Severe UC:
– 6 diarrhoeas or more
– low serum albumin
– raised inflammatory markers
– fever
– tachycardia
– anaemia

Mild UC:
– 4 or less diarrhoeas
– normal serum albumin
– slightly high inflammatory markers

Question 8

Extra GI manifestations

Answer 8

They are all rare and only occur in 10% of cases:
– arthralgia
– fatty liver
– gallstones