IBD

Question 1

What are the 2 main conditions of IBD

Answer 1

Crohn’s and Ulcerative Colitis

Question 2

What are some predisposing factors for IBD

Answer 2

Genetics
GI infections
Immunosuppression
Diet
Smoking (Crohn’s)

Question 3

What is ulcerative colitis

Answer 3

Continuous inflammation affecting either the entire or part (left side) of the colon with the rectum being involved in many patients

Question 4

What are the 3 main types of UC

Answer 4

Proctitis (rectum only)
Distal (rectum and end of colon)
Extensive (entire colon)

Question 5

What are the main differences between UC and Crohn’s

Answer 5

UC is continuous, Crohn’s is sections
UC only affect mucosal layer, Crohn’s penetrates deeper
Crohn’s has the presence of fistures
Crohn’s can affect the mouth and eye

Question 6

Describe the pathogenesis of IBD

Answer 6

After acute inflammation, immunoregulation fails resulting in chronic inflammatory processes, further damaging the tissue

Question 7

What are the primary symptoms of IBD

Answer 7

Constipation
Diarrhoea
Rectal bleeding
Abdominal pain

Question 8

What are the secondary symptoms of IBD

Answer 8

Weight loss
Malnutrition
Psychological effects

Question 9

What are some symptoms specific to Crohn’s

Answer 9

Mouth ulcers
Eye disturbances
Erythema nodosum
Liver and kidney impairment
Arthralgia
Fistulae
Short bowel syndrome

Question 10

What are the 3 main aims of treating IBD

Answer 10

Induce remission
Maintain remission
Fewest side effects

Question 11

Symptomatic treatment of IBD

Answer 11

Paracetamol for pain (not NSAID)
Bulk-forming laxatives
Loperamide for Crohn’s only
Nutritional supplements

Question 12

Crohn’s 1st-line inducing remission

Answer 12

Oral glucocorticoid
IV hydrocortisone for severe cases

Question 13

Crohn’s inducing remission 2nd line

Answer 13

Oral 5-ASA or budesonide

Question 14

Crohn’s add on therapies

Answer 14

Immunomodulators
Biologics

Question 15

UC 1st line inducing remission

Answer 15

Topical 5-ASA
Add on oral 5-ASA/steroid
Add on topical steroid

Question 16

UC 2nd line inducing remission

Answer 16

Oral 5-ASA

Question 17

Treatment of severe active UC

Answer 17

IV hydrocortisone
IV ciclosporin or surgery

Question 18

UC inducing remission in extensive disease

Answer 18

Topical 5-ASA + high dose oral 5-ASA
Oral prednisolone

Question 19

UC 1st line maintaining remission

Answer 19

Topical 5-ASA
Add oral 5-ASA

Question 20

UC 2nd line maintaining remission

Answer 20

Oral 5-ASA alone

Question 21

What are 4 treatment approaches in order for IBD

Answer 21

Aminosalicylates (5-ASA)
Glucocorticosteroids (prednisolone)
Immunomodulators
Biologics
(Surgery)

Question 22

Examples of aminosalicylates

Answer 22

Mesalazine
Olsalazine
Balsalazine

Question 23

Steroid examples

Answer 23

Prednisolone
Hydrocortisone (IV for severe)

Question 24

What is steroid refractory

Answer 24

When the patient is unresponsive to steroids so requires immunomodulators

Question 25

What is steroid dependency

Answer 25

When steroids have been used to induce remission but symptoms come back when attempting to withdraw

Question 26

How does ciclosporin work

Answer 26

Inhibits cyclophilin in lymphocytes, inhibiting calcineurin, inhibits production of IL-2

Question 27

What drug can be used to help steroid dependent patienrs

Answer 27

Azathioprine3

Question 28

3 examples of immunomodulators

Answer 28

Ciclosporin
Azathioprine
Methotrexate

Question 29

3 examples of biologic therapies

Answer 29

Adalimumab
Infliximab
Vedolizumab

Question 30

What index is used to measure severity of UC

Answer 30

Truelove and Witts’ severity index