IBD

Question 1

Feature that distinguishs Crohns and UC?

Answer 1

UC starts in the rectum and does not spread the ileocaecal valve. It is continuous. Crohn’s is discontinuous throughout the GI tract

Question 2

Peak age of onset of UC

Answer 2

15-25 years, 55-65 years

Question 3

Presentations of UC

Answer 3

bloody diarrhoea, urgency, tenesmus, abdominal pain (LLQ), extra-intestinal symptoms

Question 4

Common presentations associated with UC disease process?

Answer 4

arthritis, erythema nodosum, episcelritis, osteoporosis

Question 5

Common presentations not associated with the UC disease process

Answer 5

arthritis, uveitis, clubbing, primary sclerosis cholangitis

Question 6

Inflammation in UC is found where?

Answer 6

not beyond the submucosa

Question 7

Crypt abscesses - crohns or UC?

Answer 7

UC

Question 8

Pseudopolyps - crohns or UC?

Answer 8

UC

Question 9

what causes the formation of crypt abscesses?

Answer 9

neutrophils infiltrating the submucosal wall

Question 10

pathology of the glandular epithelium in UC?

Answer 10

depletion of goblet cells and mucin production

Question 11

If a barium enema was performed on a UC patient (old practice) what would be seen?

Answer 11

lack of haustrations, possible pseudopolyps

Question 12

Tests and Investigations carried out in UC?

Answer 12

Bloods - FBC, U&Es, CRP, ESR, LFTs; Stool culture - to rule out microbial involvement; Colonoscopy - to assess disease extent; AXR and CXR - faecal shadowing, colon dilation, perforation

Question 13

Treatment of UC to maintain remission?

Answer 13

5-ASAs such as mesalazine, sulfasalazine

Question 14

Treatment of UC flair ups - mild to moderate disease

Answer 14

steroids i.e. prednisolone PO, may be used as suppositories if necessary

Question 15

Treatment of severe UC flair ups?

Answer 15

Nil by mouth, IV hydration, steroids rectally and IV;monitor bloods, temp, HR and BP and stool frequency and character; consider blood transfusion if low Hb,

Question 16

Where might surgical intervention occur in UC?

Answer 16

perforation, massive haemorrhage, toxic dilation, last resort due to failed medical therapy

Question 17

Immunemodulation may be used when?

Answer 17

there is no remission of disease or there is prolonged steroid use

Question 18

Examples of immune modulation therapy in UC?

Answer 18

azathioprine, methotrexate, infliximab

Question 19

It is important to monitor ___ while using immune modulation therapies

Answer 19

bloods - FBCs and LFTs particularly

Question 20

Crohn’s typically affects…?

Answer 20

the terminal ileum and colon but anywhere mouth to anus

Question 21

Inflammation occurs where in crohn’s?

Answer 21

all the way to the serosa

Question 22

Crohn’s patients are prone to…?

Answer 22

strictures, fistulas and adhesions

Question 23

Presentation of crohn’s may include?

Answer 23

weight loss, lethargy, diarrhoea (bloody or non-bloody), abdominal pain, perianal disease (skin tags and ulcers)

Question 24

Extra-intestinal features of crohn’s include?

Answer 24

arthritis, erythema nodosum, pyoderma gangrenosum, clubbing, apthous ulcers

Question 25

Pathology of crohns

Answer 25

goblet cells and granulomas

Question 26

complications associated with crohns?

Answer 26

small bowel obstruction, abscess formation, fistulae, colon cancer, fatty liver disease, primary sclerosing cholangitis

Question 27

Tests involved in Crohn’s investigations

Answer 27

Bloods - FBCs, ESR, CRP, U&Es, LFTs, INR, ferritin, VitB12, Folate; Stools - exclude infection; Colonscopy and biopsy; small bowel enema - detects ileal disease; MRI - detects pelvic disease and fistulae

Question 28

Treatment of mild Crohn’s?

Answer 28

steroids tapered over time

Question 29

Treatment in severe Crohn’s flair up?

Answer 29

steroids, metronidazole, daily bloods and stool, consider transfusion,

Question 30

Additional therapies that may or may not work in Crohn’s patients?

Answer 30

Azathioprine, sulfasalazine, TNFa inhibitors - infliximab, methotrexate for inducing remission, surgery