IBD

Question 1

What is it?

Answer 1

Spectrum of disease characterised by chronic relapsing inflammatory conditions of the bowel.
Chrohn’s and U.C.

Question 2

what classification is used?

Answer 2

Montreal:

• age
• location
• extent
• severity
• disease behaviour e.g. penetration, fistulas

Question 3

what is the source of IBD?

Answer 3

Thought to be triggered by an environmental trigger in the genetically susceptible

Question 4

Surgery?

Answer 4

• Rectum preservation : large instestine removed. Small intestine is attached to rectum
• Total cholectomy: rectum also removed. Pouch- where small intestine and anal canal are connected.
• Proctocolectomy: colon, rectum and anal canal are all removed. Need for an Ileostomy
• Ileostomy: Surgical incision on abdomen to remove part of small intestine. Bag placed around the hole and collects waste products.

Question 5

Relevant investigations

Answer 5

Blood tests:

• pANCA
• high CRP
• low albumin
• low hb
• high abc

Imaging:

• CT
• MRI
• Barium swallow
• Colonoscopy

Faecal test:
-calprotein : indicator of intestinal inflammation- used to distinguish from IBS

Screening:
In UC- HLA gene
In Crhn’s- NOD2 gene

Question 6

Medical treatments

Answer 6

Basic:

• 5ASAs- antiinflammatories
• steroids
• immunosuppressants
• biologics
• surgery

In the case of an acute flare up which leads to hospital admission

• short term steroids
• anticoagulation
• rest
• immunosuppressant cyclosporin as a rescue therapy
• surgey
• biologics

Question 7

what happens when medical therapy fails?

Answer 7

• Relapse as soon as you stop or interrupt treatment
• Contraindications of steroids e.g. psychosis
• Developments of fistulas, strictures as a result of poor response

Question 8

How does it manifest outside of Intestine

Answer 8

• Can lead to inflammation in biliary tree, eyes, skin, joints, liver
• Obvious manifestations are: erythema nodosum, gallstones, fatty changes in liver

Question 9

Which immunosuppressants are used

Answer 9

Azathioprine: prevents use of steroids but may lead to lymphoma

Methotrexate, ciclosporin, Thiopurines

Question 10

What are biologics

Answer 10

New drugs such as anti-TNF alpha antibodies (monoclonal antibodies) e.g. infliximab

given by IV of SC injection

Question 11

when do you use antibiotics?

Answer 11

Metronidazole

• Perianal disorders in crohns
• Bacterial overgrowth may lead to use of metronidazole