IBD

Question 1

What are the common presenting features of UC & Crohns?

Answer 1

In teenagers rare in younger children. Peak is around early 20’s.

Chronic diahorrea aka >6 weeks which may be bloody. May be associated with weight loss and abdominal pain.

Systemic symptoms include: malaise, anorexia and fever.

Relapsing and remitting diseases.

GI symptoms are more common in UC.
Weight loss and malaise more common in Crohn’s.

Question 2

List the main differences between UC and Crohns?

Answer 2

Crohns:
Can occur anywhere.
Crampy abdo pain, diarrhoea & weight loss
Skipped lesions
Ulceration of the mucosa is transmural (extends through the whole to the serosa) therefore fistulas are a complication
Smoking bad
Commonly affects terminal ileum and proximal colon.

UC:
Starts in the rectum and moves proximal.
Diarrhoea with blood and mucus & colicky pain
Ulceration does not extend past inner lining.
Rectal bleeding is much more common.
Smoking is protective

Question 3

What are the extra GI manifestations of IBD?

Answer 3

Skin: erythema nodosum, pyoderma gangrenosum

Eyes: Conjunctivitis and uveitis

Mouth: Ulcers (more crohns)

Biliary: Sclerosing cholangitis and cholangiocarcinoma (rare in crohn’s more common in UC)

Joints: Arthirtis and Osteomalacia (Vit D deficiency in adults)

Question 4

What is the main stay of treatment of IBD?

Answer 4

Crohns initially treated with diet (whole protein modular diet)

UC is initially treated with aminosalicylates in mild disease (balsalazide and mesalazine).

Systemic steroids are used in flare ups.

Immunomodulators may be used: azathioprine, mercaptopurine and methotrexate.

Followed by Anti TNF drugs such as Infliximab.