IBD

Question 1

How might a kid with IBD present?
State which 2 symptoms are more prevalent in UC
State which 3 symptoms are more prevalent in Crohn’s
State which both present in both types of IBD

Answer 1

With diarrhoea - UC
Rectal bleeding - UC

Abdo Pain
Fever
Arthritis

Weight loss - Crohn’s
Growth failure - Crohn’s
Mass - Crohn’s

Question 2

Extraintestinal manifestations in:
Both [1]
Crohns [2]

Difference in macrophology between UC and Crohn’s [2]

Answer 2

Erythema nodosum can occur in both types
Crohns - apthous ulcers, dermatitis herpetiformis

UC - submucosal involvement, pancolitis (only in children) and pseudopolyps

Crohn’s features - transmural involvement but mouth to anus, has skip lesions

Question 3

What else would you want to know about a kids history if we suspect IBD? [5]

Answer 3

FH
Growth development
Sex development
Nutritional Status
Intestinal and other symptoms

Question 4

How do you approach a kid you suspect IBD? Investigations [5]

Answer 4

FBC, ESR, CRP, Albumin

Stool Calprotectin (mainly for UC)
Stool culture to exclude infection

MRI or Barium Meal

Endoscopy & Biopsy

Question 5

What would blood tests show in IBD? [3]

Answer 5

FBC - Anaemia & Thrombocytosis
ESR & CRP - raised
Albumin - Low

Question 6

When would we use a barium meal in place of an MRI?

Answer 6

Barium meal is good for younger kids who can’t sit through an MRI

Question 7

Which tests are definitive for IBD? [2]

Answer 7

MRI/Barium Meal

Endoscopy & biopsy

Question 8

How do we manage Crohn’s? [6]

Answer 8

• Polymeric diet is first line for crohn’s - 6-8w with 75% effectiveness
• Anti-inflammatories e.g. 5ASA mesalazine
• Flare ups: steroids, immunosuppressants eg azathioprine
• Biologics e.g. Infliximab
• Surgery
• Long term enteral feeding for growth failure

Question 9

When to consider surgery? [4]

Answer 9

Necessary for complications like obstruction, fistulae, abscess, severe localized disease unresponsive to medication

Question 10

How do we manage Ulcerative Colitis? [3]

When would we do surgery? [1]

Answer 10

• Anti-inflammatories e.g. 5ASA mesalazine
• Flare ups: steroids, immunosuppressants eg azathioprine
• Screen for adnocarcinoma
• Surgery for severe fulminating disease ie colectomy

Question 11

When do u use topical steroids in UC [1]

Answer 11

When disease is confined to the rectum and sigmoid colon