IBD

Question 0

Characteristics of Crohns?

Answer 0

Can effect any part of GIT (gum->bum)

Skip lesions, transmural lesions

If SI involved, 75% will have terminal ileum involvement.

Question 1

Characteristics of UC?

Answer 1

Usually involves rextum and extends proximally to involve all of colon.

40% disease limited to rectum and rectosigmoid

Limited to superficial submucosa

Question 2

RF for crohns?

Answer 2

Smoking
OCP
APPENDICECTOMY
FHx

Question 3

What age group and which is more common?

Answer 3

UC more common than crohns

Both affect around 30yro with 2nd peak at 70

Question 4

What are UC symptoms?

Answer 4

Cramps ABDO pain - central or hypo gastric
Diarrhoea with blood/mucus either mixed
Tenesmus (feeling of incomplete defecation)
PR - blood and tender

Question 5

What is the commonest cause of toxic mega colon and what is the risk?

Answer 5

UC and perforation

Question 6

Symptoms of crohns?

Answer 6

Same as UC plus

1) terminal ileitis -> chronic recurrent RIF pain, palpable mass, N + V
2) intermittent bowel obstruction -> bowel wall oedema and spasm -> fibrosis -> stricture -> chronic bowel obstruction
3) fistula -> micro perforation -> UTI, pneumaturia, faecaluria
4) nutrient deficiencies - wt loss common, anemia (B12 folate or iron deficient)

Question 7

Extra-intestinal manifestations?

Answer 7

RHEUMATOLOGICAL
OCULAR
DERMATOLOGICAL
HUPEROXALURIA

Question 8

Ix?

Answer 8

LAB
CBE EUC LFT CRP
Stool MCS including for C. difficile toxin
Nutritional deficiencies (Fe, B12/folate, Vit D)
Antibodies - ASCA and pANCA

RAD
UC - sigmoidoscopy with biopsy
Crohns - colonoscopy
Crohns fistula - colonoscopy, barium enema then CT/MRI enterography (more for upper GI)

Question 9

What proportion of IBD pts get anal disease and what types?

Answer 9

30% get

• rectal fistulas
• anal fissures
• abscesses
• anal stenosis

Question 10

How do you induce remission?

Answer 10

Glucocorticoids PO/IV for both UC and Crohns
Just UC - sulfasalazine and 5-ASA agents?
Just crohns - ABx

Question 11

Management of UC?

Answer 11

Induce remission with 5-ASA (better for distal release) and corticosteroid (severe and first attacks), infliximab.

Maintain remission with 5-ASA or immunosuppressant

Surgery in fulminant causes

Question 12

What is IBS?

Answer 12

A gastrointestinal syndrome characterized by chronic abdominal pain and altered bowel habits in the absence of any organic cause.

Question 13

Role of sulfasalazine and 5-ASA?

Answer 13

Sulfasalazine reduces inflammatory markers as does glucocorticoids but also acts as a mild immunosuppressant

Question 14

When would you do surgery in UC?

Answer 14

Fulminant
Toxic megacolon
Severe haemorrhage
Refractory to 5 days of medical therapy

Question 15

Management of Crohns?

Answer 15

Remission - corticosteroids

Maintenance and induction- immunosuppressive agents e.g. Azathioprine

For perianal remission - metronidazole, ciprofloxacin

Surgery for complications or refractory

Question 16

Complications of disease?

Answer 16

Increased risk of VTE
Colorectal cancer
Vitamin B12 deficiency -> peripheral neuropathy
UC -> massive haemorrhage, toxic megacolon, strictures
Crohns -> perforation 1-2%, malabsorption, intra-abdominal/pelvic abcess