IBD

Question 1

What is the cause of IBD?

Answer 1

Unknown
Genetics
Environmental factors

Question 2

What does ulcerative colitis present with?

Answer 2

Bloody diarrhoea
Abdo pain
Weight loss

Question 3

What are the markers of a severe attack of ulcerative colitis?

Answer 3

Stool frequency >6 times daily with blood
Fever
Tachycardia
Raised CRP
Anaemia
Albumin <30g
Leucocytosis, thrombocytosis

Question 4

How can the histology of Crohn’s be described?

Answer 4

Patchy disease
One but f inflammation, then a gap before another patch
Copplestone appearance

Question 5

What are the clinical features of Crohn’s disease?

Answer 5

Diarrhoea
Abdo pain
Weight loss
Malaise, lethargy, anorexia and vomiting, fever
Anaemia and vit deficiency

Question 6

What effect does inflammation have on blood counts?

Answer 6

High ESR and CRP, platelet, white cell

Low Hb and albumin

Question 7

What is tested in the stool to detect inflammation?

Answer 7

Calprotectin

Question 8

What level of calprotectin in the stool is normal?

Answer 8

<50

Question 9

What level of calprotectin in the stool is elevated?

Answer 9

> 200

Question 10

How can UC and Crohn’s be differentiated?

Answer 10

Crohn’s= gramulomas
UC= crypt cells depleted and more crypt abscesses
UC only colon, Crohn’s whole gut tube

Question 11

What is the differential for suspected IBD?

Answer 11

Chronic diarrhoea
Ileo-caecal TB
Infective, anaerobic and ischaemic colitis

Question 12

What liver disease is associated with IBD?

Answer 12

Schlerosing cholangitis

Question 13

What is schlerosing chilangitis?

Answer 13

Disease of bile ducts
Slowly progressive
Causes strictures

Question 14

What are the long term complications of IBD?

Answer 14

Can lead to colonic carcinoma

Question 15

How is the risk of colonic carcinoma in IBD managed?

Answer 15

Surveillance colonoscopy

Increase in frequency with increasing age

Question 16

What is the outpatient management of IBD?

Answer 16

5ASA
Steroids
Immunosuppression

Question 17

What steroids are given for IBD?

Answer 17

Prednisolone

Budenoside for ileal and ascending colon only

Question 18

What are the side effects of immunosuppressants given for IBD?

Answer 18

Leucopenia
Hepatotoxicity
Pancreatitis
Long term lymphoma risk

Question 19

How is prednisone given for IBD?

Answer 19

Oral

Tapering reduction over 4 weeks

Question 20

When are 5ASAs given for Crohn’s?

Answer 20

Widely but only continued if remission induced by medication

Question 21

What therapy is used to treat IBD in hospital?

Answer 21

Steroids
Anticoagulation
Cyclosporin
Biologics
Surgery

Question 22

What are signs of failure of medical therapy?

Answer 22

Recurrent courses of steroids
Recurrent relapses
Failure to control symptoms

Question 23

What are the unacceptable side effects of steroids in IBD treatment?

Answer 23

Diabetes
Severe osteroporosis
Psychosis

Question 24

What are the acute surgical options for severe colitis?

Answer 24

Total colectomy
Rectal preservation
Ileostomy

Question 25

What is a pouch procedure?

Answer 25

Small bowel attached to anus

Have to use bowel frequently post op

Question 26

Where is the majority of surgery performed in Crohn’s?

Answer 26

Ileocaecal area

Question 27

What are indications for surgery in Crohn’s?

Answer 27

Failure of medical management
Relief of obstructive symptoms
Management of fistulae and intra abdo abscesses
Management of anal conditions
Failure to thrive