IBD

Question 1

Describe types of IBD

Answer 1

• Crohn’s
• Ulcerative colitis
• indeterminate colitis: has characteristics of both
• Microscopic
• Collagenous
• Lymphocytic

Question 2

Explain montreal classification

Answer 2

• Determines the way you treat

Crohn’s

• Behavior
• Age of diagnosis
• Area

UC

• Severity
• Extent

Question 3

Determine the etiology of IBD

Answer 3

• Aetiology unknown
• Genetic: Ethnicity, GWAS
• Environmental triggers: bacteria, diet, vaccination, social factors

Question 4

Describe Crohn’s disease in terms of epidemology

Answer 4

• 8.5 per 100,000
• M=F
• Peak incidence: 20-40 and F>60
• Also affects children (more likely than UC)

Question 5

Describe Crohn’s disease in terms of pathology

Answer 5

• Patchy disease can occur anywhere from mouth to anus with skip lesions
• Inflammation -> stricture, then fistula

Question 6

Describe Crohn’s disease in terms of presentation

Answer 6

• Varies depending on site of inflammation
• Diarrhea
• Weight loss
• Nausea and vomiting
• Malaise, lethargy, anorexia, low grade fever
• Vitamin malabsorption
• Anaemia
• Abdominal pain

Question 7

Describe UC in terms of epidemology

Answer 7

• 20-40 years
• 1.3F:1M
• 11.3 in 100,000

Question 8

Describe UC in terms of pathology

Answer 8

• Continuous inflammation of the colon starting at the rectum and working its way back
• Variable distribution
• Variable severity
• 3% require surgical removal after first attack
• 8% require surgical removal after the second attack
• Mortality
• 3% first attack
• 2.3% have a severe attack which causes the colon to become twisted and swollen before bursting and causing peritonitis

Question 9

Describe UC in terms of presentation

Answer 9

Typical

• Bloody diarrhea
• Abdominal pain
• Weight loss

Severe

• Stool frequency: >6 bloody stools a day
• Fevre
• Tachycardia
• Raised ESR (CRP)
• Anaemia: Hb<10
• Albumin <30 g/l
• Thrombocytosis

Question 10

Describe the inflammatory indices

Answer 10

Blood

• Raised ESR and CRP
• Raised WCC
• Raised platelet count
• Blood loss (lowered Hb)
• Protein loss (lowered albumin)

Stool

• Calprotectin
• <50 is normal
• 50-200 is equivical
• > 200 is raised

Question 11

Describe the pathological differences between UC and CD

Answer 11

• CD: Granulomas and perianal disease (transmural)

- UC: Depleted goblet cells, only affects the mucosal bilayer

Question 12

Describe the extraintestinal manifestations of IBD

Answer 12

• Eyes: uritis, episcleritis, conjunctivitis
• Joints: monoarticular arthritis, ankylosing spondylitis, sacroiliitis
• skin: pyoderma gangrenosum, erythema nodosum, vasculitis
• Liver and billary tree: gallstones, fatty change, pericholangitis, sclerosing cholangitis

Question 13

Describe the differential diagnosis of IBD

Answer 13

• Ileocaecal TB
• Chronic diarrhoea
• Malabsorption
• Malnutrition
• Infective, ischemic or amebic colitis