IBD

Question 1

what are the two major forms of IBD ?

Answer 1

crohn’s disease
Ulcerative colitis

Question 2

what are the areas of affection for each disease ?

Answer 2

CD - anywhere in the GI tract , but has a tendency to affect the terminal ileum and ascending colon
UC - only the large bowel is affected

Question 3

what gene increases the susceptibility of IBD ?

Answer 3

HLA-B27

Question 4

what are the pathological features associated with CD ?

Answer 4

transmural
skip lesions
cobblestone appearance

Question 5

backwash ileitis is specific to which type of IBD ?

Answer 5

Ulcerative colitis

Question 6

what is an early feature seen on endoscopy of Crohn’s disease ?

Answer 6

aphthoid ulcerationn

Question 7

what is a late feature seen in CD ?

Answer 7

llarger, deeper ulcers appear in patchy distribution

Question 8

what are the pathological features associated with UC ?

Answer 8

inflammatory polyps
superficial affection
pseudo polyps and friability

Question 9

what are thee microscopic changes seen in CD vs UC ?

Answer 9

CD - since its transmural - lymphoid hyperplasia and granulomas are present ( langhan cells )

UC- superficial inflammation , crypt abscess and goblet cell depletion

Question 10

what are the extra gastrointestinal manifestations of IBD ?

Answer 10

joint affection ( type 1 and 2 polyarthropathy)
eyes (uveitis )
pyoderma gangrenosum and erythema nodosum
primary sclerosing cholangitis

Question 11

what does fulimant colitis refer to ?

Answer 11

intense form of UC

Question 12

what are the clinical features of CD ?

Answer 12

diarrhea, abdominal pain and weight loss
diarrhea usually contains blood
constitutiional symptoms

Question 13

if the small bowel is affected in CD what is the C/P of that ?

Answer 13

steatorrhea

Question 14

what often precedes small intestine symptoms in CD ?

Answer 14

anal and perianal diseases as well as enteric fistula

Question 15

what type of anemia is seen in CD ?

Answer 15

normocytic normochromic anemia

Question 16

what is seen on blood test of CD ?

Answer 16

normocytic normochromic anemia
iron and folate deficiency
raised ESR and CRP
hypoalbuminemia

Question 17

what are the serological tests performed in CD ?

Answer 17

Anti-ASCA is usually positive
P-ANCA is negative

Question 18

when should colonoscopy be performed ?

Answer 18

if colonic involvement is suspected except in acute severe disease

Question 19

what appears on colonoscopy before cobblestone appearance in CD ?

Answer 19

aphthoid ulcers

Question 20

what investigation is required for patients suspected to have CD ?

Answer 20

small bowel imagine whether CT oral contrast or MRI enteroclysis

Question 21

what imaging modalities can be used to asses the thickness of the bowel wall and abscesses ?

Answer 21

High resolution US
Spiral CT scanning

Question 22

what can be used as a non invasive marker of disease activity in IBD ?

Answer 22

faecal calprotectin

Question 23

what marker can be used to predict response and failure to treatment ?

Answer 23

faecal calprotectin

Question 24

what is the management for CD patients with mild symptoms ?

Answer 24

cigarette smoking should be stopped
diarrhea - use loperamide, codeine phosphate, co-phenotrope
correct anemia according to cause

Question 25

what could be the cause of diarrhea in long standing non active CD ?

Answer 25

may be due to bile acid malabsorption and should be treated with cholestyramine

Question 26

steatorrhea is an indication off ?

Answer 26

involvement of the small bowel

Question 27

what is used for the induction of remission ?

Answer 27

glucocorticoids - prednisone
azathioprine/ mercaptopurine is also added at the beginning

Question 28

what is used for maintenance ?

Answer 28

aminosalicylates or mycophenolate mofetil

Question 29

what is a common side effect of azathioprine ?

Answer 29

at high doses it may cause leukopenia

Question 30

what is the management in CD patients who are corticosteroid or immunosuppressive therapy resistant?

Answer 30

methotrexate or Iv cyclosporine

Question 31

what are the biological therapies and when are they indicated ?

Answer 31

anti-TNF - infliximab
used when conventional therapy fails
in the presence of fistulas

Question 32

what are the complications of UC ?

Answer 32

acute severe UC
toxic megacolon
dysplasia ( indicated for colectomy )

Question 33

when is an attack of UC considered severe ?

Answer 33

more than 6 bloody stools per day
fever
tachycardia
ESR > 30
Anemia < 10 g/dl
Albumin < 30g/L

Question 34

what is the serology in UC ?

Answer 34

pANCA positive
pASCA negative

Question 35

in moderate to severe attacks of UC what are the key investigations ?

Answer 35

plain abdominal x ray with an abdominal ultrasound

Question 36

where is 5 ASA absorbed ?

Answer 36

in the small intestine

Question 37

what is the management of UC with proctitis ?

Answer 37

oral aminosalicylate plus a local rectal steroid prep

Question 38

what is the mngmtn for UC patients with total colitis ?

Answer 38

admitted to the hospital
initially given hydrocortisone with 6 hourly aminosalicylate
full investigation and enteral nutrition

Question 39

what is the association between IBD and cancer ?

Answer 39

patients with UC for more than 10 years are at a higher risk for developing colorectal cancer

Question 40

what is the presentation of patients with microscopic inflammatory colitis ?

Answer 40

chronic or fluctuating watery diarrhea
normal colonoscopy
findings on biopsy