IBD

Question 1

Inflammatory bowel disease mainly comprises of two idiopathic chronic inflammatory diseases - what are they?

Answer 1

crohn’s disease and ulcerative colitis (UC)

Question 2

what 3 things predispose IDB

Answer 2

Genes, impaired mucosal immunity, environmental triggers

Question 3

what gene impacts IBD and which disease is more affected

Answer 3

crohn’s more affected, NOD2 on chromosome 16

Question 4

smoking worsens which disease

Answer 4

crohn’s

Question 5

Both diseases are TH1 mediated, but which one also has TH2

Answer 5

UC

Question 6

what is UC

Answer 6

mucosal and submucosal inflammation of the rectum, extending proximally with no skip legions

Question 7

what age group is normally affected by UC

Answer 7

20’s-30’s

Question 8

what are the symptoms of UC

Answer 8

diarrhoea + blood,

increased bowel frequency and urgency, incontinence, night rising, LIF pain

Question 9

what are the symptoms of severe UC

Answer 9

6> bloody stool per day plus one of: tachycardia, anaemia, elevated ESR, fever

Question 10

what are the microscopic investigations of UC

Answer 10

endoscopy and biopsy: neutrophils NO granulomas, crypt abscesses, superficial in mucosa and submucosa

Question 11

what would you see on an AXR for UC

Answer 11

thumbprinting

Question 12

what is crohn’s disease

Answer 12

chronic inflammation and ulceration of GI tract, most common in terminal ileum and colon, skip legions, is transmural

Question 13

what are symptoms of crohn’s disease

Answer 13

abdominal pain, small bowel obstruction, diarrhoea + blood, weight loss, ulcers, abscesses

Question 14

what are the investigations of crohn’s

Answer 14

colonoscopy mucosal biopsy: granulomas (50%), knife-like fissues, bloods, stools, QFIT

Question 15

what are the complications of crohn’s

Answer 15

malabsorption, short bowel syndrome, fistulas

Question 16

what are the complications of UC

Answer 16

toxic megacolon, colorectal cancer, fistulas

Question 17

what is toxic megacolon

Answer 17

loss of muscle tone due to chronic inflammation - can be fatal

Question 18

what blood could be done for UC

Answer 18

CRP and albumin

Question 19

what can extra-intestinal symptoms of IBD can develop

Answer 19

joints, eyes, skin and primary sclerosing cholangitis (inflammation of biliary tree)

Question 20

what are the therapy options for UC in order

Answer 20

5-ASA, steroids, immunosuppressants and anti TNFa

Question 21

what are the therapy options chrons in order

Answer 21

steroids, immunosuppressants and anti TNFa

Question 22

what is 5-ASA and give an example

Answer 22

anti-inflammatory, mesalazine

Question 23

what 2 ways can 5ASA be taken

Answer 23

orally or topically

Question 24

what type is pH dependent release

Answer 24

orally

Question 25

what 2 ways can topical be administered and the advantages of both

Answer 25

``` enema = goes more proximal towards sigmoid. suppositories = better mucosal adherence but don't travel as far ```

Question 26

give an example of a steroid and how it is taken

Answer 26

prednisolone - orally/ topically, very short course

Question 27

give examples of immunosuppressants

Answer 27

azathioprine or methotrexate

Question 28

give examples of anti TNFa and what it does

Answer 28

infliximab, adalimumab. apoptosis of activates T lymphocytes.

Question 29

when should anti TNFa not be used

Answer 29

TB

Question 30

what are the emergency procedures for IBD

Answer 30

subtotal colectomy in UC (leaves rectum) and resection in crohn's

Question 31

what are indications for elective surgery in UC

Answer 31

medically unresponsive, malignancy, child growth retardation

Question 32

what are the 3 types of elective UC proctocolectomy

Answer 32

end ileostomy, pouch, ileorectal anastomosis

Question 33

what is end ileostomy proctocolectomy

Answer 33

small intestine feeds into soma bag

Question 34

what is a pouch proctocolectomy

Answer 34

loop intestine to create reservoir, 'normally' functionin rectum - can become impotent especially in women

Question 35

what set of criteria can assess severity of IBD

Answer 35

Trueman and witt's

Question 36

what surgery is more curative

Answer 36

UC, stomas often remove symptoms and improve QoL

Question 37

what is the purpose of crohn's disease surgery

Answer 37

temporary symptom relief, often need further surgeries where bowel is removed