IBD

Question 1

What are the risk factors for ulcerative colitis?

Answer 1

Family history
HLA-B27
Caucasian
Non-smoker

Question 2

What are the clinical features of ulcerative colitis?

Answer 2

Diarrhoea
Blood and mucus in stool
Urgency and tenesmus
LLQ pain
Weight loss (but more commonly seen in Crohn’s)
Fatigue

Question 3

What are the risk factors for Crohn’s?

Answer 3

Family history
HLA-B27
Caucasian
Ashkenazi Jewish
Smoking

Question 4

What are the features of Crohn’s disease?

Answer 4

Diarrhoea
Abdominal pain
Bloody stools (more common in UC)
Weight loss
Lethargy
Delayed puberty in children

Question 5

What are the differentiating features of Crohn’s?

Answer 5

NESTS
N - no blood or mucus
E - entire GI tract affected
S - skip lesions on endoscopy
T - terminal ileum most affected and transmural inflammation
S - smoking is a risk factor

Question 6

What are the differentiating features of UC?

Answer 6

CLOSEUP
C - continuous inflammation
L - limited to colon and rectum
O - only superficial mucosa affected
S - smoking may be protective
E - excrete blood and mucus
U - use aminosalicylates
P - primary sclerosing cholangitis

Question 7

What are the extraintestinal manifestations of IBD?

Answer 7

Erythema nodosum
Pyoderma gangrenosum
Enteropathic arthritis
Episcleritis (Crohn’s > UC)
Uveitis (UC > Crohn’s)
Primary sclerosing cholangitis - UC
Autoimmune hepatitis - UC

Question 8

What initial investigations are performed for IBD?

Answer 8

Faecal calprotection - raised
FBC - leukocytosis in flare
LFTs
CRP/ESR
Anti-TTG - exclude coeliac disease

Question 9

What is the definitive investigation for diagnosis of IBD?

Answer 9

Colonoscopy with multiple intestinal biopsies

Question 10

What will be seen on histology in Crohn’s disease?

Answer 10

Transmural inflammation
Goblet cells
Granulomas

Question 11

What will be seen on histology in ulcerative colitis?

Answer 11

Shallow ulceration
Pseudopolyps
Crypt abscesses
Goblet cell depletion
Continuous inflammation

Question 12

How is remission induced in mild to moderate acute ulcerative colitis (proctitis)?

Answer 12

First line - topical aminosalicylate
Second line - add oral aminosalicylate
Third line - add topical or oral corticosteroid

Question 13

How is remission induced in proctosigmoiditis and left sided UC

Answer 13

First line - topical aminosalicylate
Second line - add high dose oral ASA or switch to high dose oral ASA and topical corticosteroid
Third line - stop topical therapy and commence high dose oral ASA and oral corticosteroid

Question 14

How is remission induced in extensive UC disease?

Answer 14

First line - topical ASA and high dose oral ASA
Second line - stop topical therapy and commence high dose oral ASA and oral corticosteroid

Question 15

What is the management of a UC flare?

Answer 15

Admit to hospital
First line - IV corticosteroid
Second line - add IV ciclosporin
Third line - colectomy

Question 16

How is remission maintained in UC?

Answer 16

First line - aminosalicylate (oral or rectal mesalazine)
Azathioprine
Mercaptopurine

Question 17

How is remission induced in Crohn’s disease?

Answer 17

First line - glucocorticoids
Second line - aminosalicylates

Add on medications:
Azathioprine
Mercaptopurine
Methotrexate
Infliximab
Adalimumab

Question 18

How is remission maintained in Crohn’s?

Answer 18

First line - azathioprine or mercaptopurine
Second line - methotrexate

Question 19

What are the complications of UC?

Answer 19

Toxic megacolon
Perforation
Colonic adenocarcinoma
Strictures and obstruction

Question 20

What are the complications of Crohn’s disease?

Answer 20

Peri-anal abscess
Anal fissure
Anal fistula
Strictures and obstruction
Perforation
Colorectal cancer
Anaemia and malnutrition

Question 21

What is the maintenance of UC in a patient with more than 2 flare ups in the past year?

Answer 21

Oral azathioprine or oral mercaptopurine