IBD

Question 1

A narrowing of the start of the transverse colon seen by barium enema is indicative of what type of IBD?

Answer 1

Crohn’s disease: in chrohn’s disease there is involvement of the whole thickness of the bowel wall, therefore stricturing can occur. Ulcerative colitis only affects the mucosa and so a narrowing of the lumen would be rare

Question 2

What is the most common extra-intestinal manifestation of IBD?

Answer 2

Arthritis - affecting the spine, sacroiliac joint and peritheral joints

Question 3

What are the most common skin disorders with IBD?

Answer 3

1. Erythema nodosum - inflammatory condition -> inflamed fat cells under skin -> tender red lumps (shins)
2. Pyoderma gangrenosum - skin condition -> painful ulcers (usually legs)
3. And related psoriases

Question 4

In addition to arthritis and skin problems, what other extra-intestinal manifestation of IBD is seen in up to 5% of patients?

Answer 4

Eye-related issues e.g.

1. Episcleritis - inflammatory disease affecting the episclera
2. Scleritis - inflammatory disease of the sclera

Question 5

Continuous mucosal involvement is a gross pathological change observed on colonoscopies of which type of IBD?

Answer 5

Ulcerative colitis - not all the mucosa is ulcerated but the ulcerated portions are linked together into a continuous pattern of mucosal ulceration

Question 6

Skip lesions are a gross pathological change observed on colonoscopies of which type of IBD?

Answer 6

Crohn’s disease - where obvious gaps of normal mucosa are seen in between the disease involved areas

Question 7

Fistula are a gross pathological change observed on colonoscopies of which type of IBD?

Answer 7

Crohn’s disease - due to the involvement of the full thickness of the bowel wall

Question 8

Cobblestone appearance is a gross pathological change observed on colonoscopies of which type of IBD?

Answer 8

Crohn’s disease - in severe Crohn’s where islands of mucosa are separated with longitudinal and horizontal ulceration

Question 9

What parts of the GI tract are commonly involved in ulcerative colitis?

Answer 9

The majority of patients with UC have disease in the rectum, often continuous with disease in the colon which can extend back to the caecum.
In some cases ‘backwash ileitis’ can occur with the terminal ileum being inflamed

Question 10

What parts of the GI tract are commonly involved in Crohn’s disease

Answer 10

Perianal disease
Often spares the rectum
Terminal ileum

Question 11

Which parts of the gastrointestinal wall are affected in ulcerative colitis?

Answer 11

Chronic inflammation of the mucosa

Question 12

Which parts of the gastrointestinal tract are principally affected in ulcerative colitis?

Answer 12

Rectum and sigmoid colon

Question 13

Which parts of the gastrointestinal wall are affected in Crohn’s disease?

Answer 13

Chronic inflammation which extends through the whole bowel wall

Question 14

Which parts of the gastrointestinal tract are principally affected in Crohn’s disease?

Answer 14

Can occur anywhere in the gastrointestinal tract but most commonly affects the terminal ileum and the more proximal colon

Question 15

What characterises the first, often most serious event, of ulcerative colitis?

Answer 15

Urgent diarrhoea with mucus and often bloody stools

Question 16

After the first event of ulcerative colitis, what type of path does the disease take?

Answer 16

A relentless remitting relapsing course which has a major effect on the patient’s quality of life

Question 17

How is ulcerative colitis managed?

Answer 17

Management concentrates on reducing the inflammation, usually with steroids.
Long-term patients are maintained on amino-salicylates, such as Sulphasalazine

Question 18

Which is more prevalent of the two IBDs: ulcerative colitis and Crohn’s disease?

Answer 18

UC

Question 19

Why does the presentation of Crohn’s disease vary?

Answer 19

Depends on what part of the bowel is affected:

Question 20

How does Crohn’s disease present if the ileum is affected?

Answer 20

Pain, often associated with diarrhoea. Commonly malabsorption -> weightloss and if terminal ileum is affected there may be anaemia due to poor absorption of B12. Effects of inflammation may be severe and may present with intestinal obstruction requiring urgent medical intervention

Question 21

How does Crohn’s disease present if the colon is affected?

Answer 21

Similar to UC - bloody diarrhoea, passage of mucus and symptoms such as malaise, anorexia and weight loss.
Many patients have involvement of both the ileum and colon and so present with symptoms of both

Question 22

How is Crohn’s disease managed?

Answer 22

Similar to ulcerative colitis:
Management concentrates on reducing the inflammation, usually with steroids.
Long-term patients are maintained on amino-salicylates, such as Sulphasalazine
BUT…surgical intervention may be required to resect particularly affected lengths of bowel