IBD

Question 1

Crohn’s

Answer 1

Inflammation of the full thickness of the bowel wall

Can affect any part of GI tract from mouth to anus

Question 2

Ulcerative colitis

Answer 2

Inflammation of lining of large intestine

With ulceration

Question 3

Most common (4)

Answer 3

Crohns
Ulcerative colitis
IBDU
Intermediate colitis

Question 4

Aetiology

Answer 4

Cause unknown - likely multifactorial

Question 5

Aetiology:

Theories

Answer 5

Immune system - exposed to ‘agent’

Hygiene hypothesis - too clean

Question 6

Aetiology:

Potential causative factors

Answer 6

Ethnicity
Diet
Genetics
Drugs
Smoking

Question 7

Diagnosis (5)

Answer 7

Lab - full blood count, Us + Es, CRP, liver function tests
Stool sample - faecal calprotectin 
Biopsy
Colonoscopy/endoscopy
Barium enema

Question 8

Nutritional implications

Answer 8

Water + salt loss + poor absorption

• dehydration
• anaemia
• weight loss
• nutritional depletion

Regular malnutrition screening

Question 9

Nutritional implications:

Common deficiencies

Answer 9

Energy
Protein
Vit B12
Vit D + K + C
Electrolytes
Folate
Iron

Question 10

Nutritional implications:

Food intolerance

Answer 10

No convincing evidence
Often see self imposed restrictions
Active colitis may have secondary lactose intolerance

Question 11

Management aims

Answer 11

Maintain remission
Alleviate/treat clinical symptoms
Mucosal healing
Improving quality of life

Question 12

Requirements:

Energy

Answer 12

Same as healthy population

Question 13

Requirements:

Protein

Answer 13

Active - 1.2-1.5g/kg/d

Remission - 1g/kg/d

Question 14

Requirements:

Iron supplement

Answer 14

When iron deficiency anaemia present
To normalise haemoglobin levels + iron stores
Oral 1st line in active
IV for active IBS + previous intolerance to oral

Question 15

Requirements:

Vitamin B12 supplement

Answer 15

When >20cm distal ileum resected

Question 16

Requirements:

Monitor

Answer 16

Serum Ca + Vit D -> may req supplement to prevent low bone mineral density

Regular micronutrient deficiency checks

Question 17

Generic dietary advice

Answer 17

No IBD diet to promote remission

Address if specific deficiencies

Question 18

Surgery

Answer 18

2000pt/yr
Lifetime surgery risk
Will reduce absorptive area

Question 19

Drug management:

Drug-nutrient interactions

Answer 19

To correct nutritional status

Adversely affect nutritional status

Question 20

Drug management:

Other general effects

Answer 20

Changes vision
Gait
Hypertension
Dry mouth
Altered taste/smell

Question 21

Additional symptoms

Answer 21

Visual disturbance
Joint pain
Skin rash