IBD

Question 1

Define crohn’s

Answer 1

Disorder chararcterised by transmural inflammation of the GI tract. Anywhere from mouth-anus but mainly the terminal ileal & perianal areas.

Question 2

Define UC

Answer 2

Type of inflammatory bowel disease characteristically involving the rectum & extending proximally to affect a variable length of colon.

Question 3

What is the prevalence of crown’s & UC

Answer 3

Uncommon

Question 4

What are the patient demographics for UC & Crohn’s?

Answer 4

Crohn’s: 15-40yrs, M=F, more common in white people & Ashkenazi Jews
UC: Western & northern, 20-40yrs then another peak at 60yrs, M>F

Question 5

Causes of Crohn’s?

Answer 5

Unknown

Question 6

Causes of UC?

Answer 6

Unknown, genetic factors, autoimmune condition initiated by inflammatory response to colonic bacteria, immune dysfunction, diet?

Question 7

Risk factors for Crohn’s?

Answer 7

Smoking
White ancestry
FHx of IBD
15-40yrs OR 60-80 yrs
Drugs: OCP, NSAIDs
Diet high in refined sugar

Question 8

Risk factors for UC?

Answer 8

Infection
HLA-B27
FHx of IBD
NSAIDs

Question 9

Clinical presentation & signs of crohn’s

Answer 9

Weight loss, fatigue, prolonged bloody diarrhoea, Abdo pain, perianal lesions, bowel obstruction, oral lesions/ulcers
Colonoscopy: Transmural inflammation of GI tract, mouth-anus, skip
Lesions, fistulae, intestinal obstruction
Extra-intestinal: Erythema Nodosum, Pyoderma Gangrenosum

Question 10

Clinical presentation & signs of UC

Answer 10

Rectal bleeding, blood in stools, diarrhoea, abdo pain/tenderness, arthritis & spondylitis, malnutrition, weight loss
Colonoscopy: Loss of vascular markings, diffuse erythema, fistulas, normal
Terminal ileum, mucosal granularity, rectal involvement, continuous
Continuous involvement

Question 11

Differentials for IBD

Answer 11

UC/Crohn’s, IBS
Ectopic pregnancy, PID, Endometriosis
Pseudomembranous, infective colitis
Ischaemic, radiation colitis
Diverticular disease, appendicitis
Intestinal TB
Y enterocolitica, amoebiasis
Colorectal Ca

Question 12

Investigations for Crohn’s

Answer 12

Bloods (FBC, CRP &ESR, serum folate, serum vit B12), plain abdominal films, CMP, stool testing,  CT/MRI abdo, endo/colonoscopy
          iron studies (serum iron & ferritin, TIBC, transferrin saturation)

Question 13

Investigations for UC

Answer 13

Stool studies, Bloods (FBC, CRP, ESR, comprehensive metabolic panel (LFTs)), abdo x-ray, colonoscopy, biopsies, flexible sigmoidoscopy

Question 14

Management of Crohn’s

Answer 14

ACUTE: Mildly active- Obs, 5-ASA/budesonide therapy, manage extra
intestinal manifestations
Mod. Active- Above plus oral corticosteroids, antibiotics, surgery
Severely active- Hospitalization, IV corticosteroids, Immunomodulatory therapy, biological therapy
REMISSION: Maintenance therapy, smoking cessation, antidiarrhoeals, Flu jab

Question 15

Management of UC

Answer 15

ACUTE: fulminant disease (>10b/o) IV hydrocortisone/ methylprednisolone Na succinate, IV fluids, Ciclosporin/infliximab, colectomy
Mild-mod: Topical mesalazine, topical corticosteroids/oral mesalazine, Oral corticosteroids +/- oral tacrolimus
REMISSION: oral & topical mesalazine, oral beclomethasone
REFRACTORY: Thiopurines, Ciclosporin, Colectomy, Infliximab/ Methotrexate

Question 16

Prognosis of Crohn’s

Answer 16

Dec in life expectancy, mortality inc with duration of disease, higher comorbidity score, lower socioeconomic status, colon Ca leading cause of death.

Question 17

Prognosis of UC

Answer 17

Mortality generally the same as population. Mortality inc in elderly with UC or those with complications

Question 18

Complications of Crohn’s

Answer 18

Obstruction, anaemia, sinuses, pregnancy complications (immunoS therapy), malignancy, kidney stones, malabsorption complications, short-bowel syndrome, metabolic bone disease

Question 19

Complications of UC

Answer 19

Inflammatory pseudopolyps, perforation,
Both: Toxic megacolon, infection (intra-abdo sepsis), massive lower GI bleed, colonic adenocarcinoma, benign stricture, primary sclerosing cholangitis