IBD - 142

Question 1

Describe UC

Answer 1

Recurring episodes of inflammation limited to the mucosal layer of the COLON. UC typically involves the rectum, and extends in a continuous fashion

Question 2

Describe Crohn’s disease

Answer 2

Transmural inflammation with skip lesions. It can involve the entire GI tract. The transmural inflammation can lead to strictures. Development of sinous tracts penetrate bowel serosa and can cause microperforations leading to fistulas or abscesses

Question 3

Name some risk factors for IBD

Answer 3

Age - most common in 15-40s. More common in Jews. Uncommon in non-whites in underdeveloped areas

Question 4

A mutation on what gene is linked to Crohn’s susceptibility?

Answer 4

CARD15 on chromosome 16. Associated with disease in the distal ileum

Question 5

What gene is associated with UC?

Answer 5

HLA-DR2

Question 6

Is smoking protective against UC or CD?

Answer 6

UC

Question 7

Name some factors that increase and decrease the risk of IBD

Answer 7

Smoking - decreases UC but increases CD 2x. 
The pill - increases risk
Appendectomy - protective for UC
Measles & TB increase CD risk
E. coli increases UC risk

Question 8

In IBD is there an increased or decreased number of circulating B cells and autoantibodies?

Answer 8

Increased.

In CD there is a Th1 inflammatory profile generated

Question 9

How many stools are typically passed/day in mild, moderate and severe UC?

Answer 9

Mild: 10

Question 10

What are most of the complications with Crohn’s due to and name some

Answer 10

Malabsorption. E.g. bile salt malabsortion causes watery diarrhoea, vitamin B12, steatorrhoea, gall stones

Question 11

Name some differences between CD and UC

Answer 11

CD: rectal bleeding not common, diarrhoea, R abdo pain, ulcers, skip areas, cobblestone appearance, spared rectum, granulomas, fistulas

UC: rectal bleeding common, frequent small stools, tenesmus, L abdo pain, pinpoint ulcerations, rectal involvement, crypt abscesses, gland atrophy, loss of haustra

Question 12

How would you diagnose IBD?

Answer 12

History
Flexible sigmoidoscopy with biopsy
Barium studies (better for Crohn's)
Abdo and pelvic CT
Autoantibodies in serum, stool culture

Question 13

What happens in Hirschsprung’s disease?

Answer 13

All or part of the colon has no nerves and cannot function. In foetal development neural crest cells fail to migrate into the colon

Question 14

Describe the treatment for active UC

Answer 14

• ASA - mesalazine. If it doesn’t work by itself prednisolone can be added in
• Ciclosporin (immunosuppressant) or infliximab (monoclonal Ab)

Question 15

Describe treatment for maintaining remission of UC

Answer 15

Mesalazine daily. If it isn’t enough by itself azathioprine can be added in (immuno)

Question 16

What is the first line treatment for active Crohn’s?

Answer 16

Corticosteroids - prednisolone

2nd step: azathioprine or infliximab

Question 17

What treatment is used in remission Crohn’s?

Answer 17

1st line: azathioprine

2nd: methotrexate
3rd: monoclonal Ab, e.g. infliximab

Question 18

What must be measured when starting a patient on a thiopurine (e.g. azathioprine)?

Answer 18

TPMT as patients are at an increased risk of bone marrow suppression

Question 19

Which drug for Crohn’s disease can be prescribed once a week ONLY?

Answer 19

Methotrexate, due to hepatoxicity.

Folic acid must be given with it