IBD

Question 1

2 branches of IBD

Answer 1

Crohn’s

Ulcerative Colitis

Question 2

Crohn’s Disease definition

Answer 2

Chronic inflammatory and ulcerating condition of GI tract that can affect anywhere from mouth to anus

Question 3

Crohn’s disease who?

Answer 3

Young patients

Question 4

Crohn’s disease presentation

Answer 4

Abdominal pain
Small bowel obstruction
Diarrhoea
Bleeding PR
Anaemia
Weight loss

Question 5

Crohn’s Disease

Answer 5

Segmental (patchy) 
Ileal and/or colonic chronic active mucosal inflammation including crypts and crypt abscesses
Transmural inflammation
Deep knife-like fissuring ulcers
Granulomas (50% non-caseating)
Most common in terminal ileum and colon

Question 6

Ulcerative colitis definition

Answer 6

Chronic inflammatory disorder confined to colon and rectum

Mucosal and submucosal inflammation

Question 7

UC summary

Answer 7

Continuous diffuse disease
Rectal involvement 
Superficial ulceration and inflammation
Chronic active colitis 
No granulomas

Question 8

UC treatments

Answer 8

5 ASA
Steroids
Immunosuppressants
Anti-TNF therapy

Question 9

Crohns’s treatment

Answer 9

Steroids
Immunosuppressants
Anti-TNF therapy

Question 10

5 ASA mechanism of action

Answer 10

Topical affect
Anti-inflammatory properties
Reduces risk of colon cancer
Eg. Sulphasalazine

Question 11

Crohn’s surgery

Answer 11

Minimise amount of bowel resected

Not curative

Question 12

UC surgery

Answer 12

Curative

Question 13

Toxic megacolon

Answer 13

Acute or chronic fulminant colitis
Colon swells up to massive size
Will rupture unless removed
Emergency colectomy

Question 14

Where does Crohn’s occur

Answer 14

Anywhere in GI tract

Question 15

Where does UC occure

Answer 15

Colon and rectum

Question 16

Which form of IBD is patchy

Answer 16

Crohn’s

Question 17

Which form of inflammation is present in Crohn’s

Answer 17

Transmural

Question 18

Which form of inflammation is present in UC

Answer 18

Superficial

Question 19

Granulomas are present in which form of IBD

Answer 19

Crohn’s

Question 20

Fistulas are common in which form of IBD

Answer 20

Crohn’s

Question 21

IBD genetics

Answer 21

Can be familial

NOD2/CARD15 (IBD-1) mutated gene - encodes a protein involved in bacterial recognition

Question 22

Th1 mediated disease

Answer 22

Crohn’s

Question 23

Mixed Th1/2 mediated disease

Answer 23

UC

Question 24

Smoking

Answer 24

Aggravates Crohn’s

Protects against UC

Question 25

NSAIDS

Answer 25

Can cause IBD

Question 26

UC history

Answer 26

``` Recent travel Antibiotics NSAIDS Family history Smoking Skin, eyes, joints ```

Question 27

Primary scleorsing cholangitis

Answer 27

Chronic inflammatory disease of biliar tree 80% have IBD Asymptomatic or rigors

Question 28

Severity of IBD

Answer 28

Truelove and Witt criteria Severe UC = 30% risk of colectomy >6 bloody stools/24 hours + fever, tachycardia, anaemia

Question 29

'Planned' emergency operation

Answer 29

``` UC = subtotal colectomy Crohn's = resection of Crohn's disease ```

Question 30

Unexpected finding 'surprise' operation

Answer 30

Diagnostic laproscopy

Question 31

Crohn's elective operation

Answer 31

Resection Stricturoplasty Fistulas Anal disease

Question 32

UC elective operation

Answer 32

Protocolectomy with end ileostomy | Protocolectomy with ileorectal anastamosis

Question 33

Indications for UC elective surgery

Answer 33

``` Medically unresponsive Intolerability Dysplasia/malignancy Growth retardation in children Attempted resolution of extra-intestinal disease ```

Question 34

Surgery for UC

Answer 34

Satisfying: Patient 'cured' People live with stoma Pouches = good quality of life

Question 35

Indications for Crohn's surgery

Answer 35

``` Stenosis causing obstruction Enterocutaneous fistulas Intra-abdminal fistulas abscesses Bleeding Free perforation ```