IBD

Question 1

What is IBD?

Answer 1

Chronic, relapsing-remitting inflammatory disease of the GI tract

Question 2

What part of the GI tract is affected in Crohn’s?

Answer 2

Anywhere from the mouth to the anus - ‘skip lesions’

Most commonly starts in the terminal ileum

Question 3

What part of the GI tract is affected in UC?

Answer 3

Diffuse continuous inflammation from the rectum upwards. Does not spread past the ileocaecal valve

Question 4

Most common age of onset?
Crohns
UC

Answer 4

Crohns: 20-30

UC: 20 or >60

Question 5

How much of the bowel wall?
Crohns
UC

Answer 5

Crohns: full thickness inflammation

UC: intestinal mucosa

Question 6

Effect of smoking?
Crohns
UC

Answer 6

Crohns: risk factor

UC: protective

Question 7

How does it present?

Answer 7

Diarrhoea
Crampy abdo pain
Weight loss
Fever, fatigue, malaise, anorexia
Weight loss
Blood & mucus (UC)

Question 8

Complications

Answer 8

Toxic megacolon
Colon cancer
Perforation
PSC
FIstulae

Question 9

What marker has high sensitivity for GI inflammation?

Answer 9

Faecal calprotectin

Question 10

Investigations

Answer 10

Bloods
Stool sample (exclude C diff)
AXR: mucosal thickening & colonic dilatation
Lower GI endoscopy

Question 11

What are some aggravating factors?

Answer 11

Stress
Some foods
NSAIDs & some antibiotics

Question 12

How is each graded?
Crohns
UC

Answer 12

Crohns: Crohns disease activity index

UC: Truelove & Witts criteria

Question 13

What features are in the Truelove & Witts criteria for UC?

Answer 13

Motions per day
Rectal bleeding
Temperature
Pulse
Haemoglobin
ESR

Question 14

Management of Crohns

Answer 14

Mild-mod: prednisolone

Severe: IV steroids

Azathioprine

Biologics

Surgery (due to drug failure/ obstruction)

Question 15

Treatment of UC

Answer 15

Mild:5-ASA (e.g. mesalazine) as suppository/ enema or PO

Moderate: add oral prednisolone

Severe: IV steroids, cyclosporins/ infliximab

Surgery