IBD

Question 1

5 types of bowel disease classified as IBD

Answer 1

UC
CD
Ischaemic colitis 
Radiation colitis 
Appendicitis 

Chronic conditions resulting from inappropriate and persistent activation of the mucosal immune system driven by normal gut bacteria

Question 2

Where does UC affect?

Answer 2

Limited to the colon, kinda

Appendix can be involved

Question 3

When does UC peak (ages)

Answer 3

20-30
Then
70-80

Question 4

What’re pseudopolyps?

Answer 4

No polyps (growths) but islands of tissue left when the rest has ulcerated away

Question 5

S+S of UC

Answer 5

UC, AND?
Ulceration
Crypt abscess, architectural disarray of crypts

Atrophy of mucosal layer
No granulomas
Dysplasia classified as either high or low grade (high=malignancy risk)

Question 6

Where does CD affect?

Answer 6

Anywhere from mouth to anus

Question 7

S+S of CD

Answer 7

CROHNS

Cobblestone ulceration
Rose thorn ulceration 
Obstruction of bowel
Hyperplasia of mesenteric lymph nodes
Narrowing of intestinal lumen
Skip lesions

Question 8

Which kind of metaplasia is seen in CD?

Answer 8

Paneth cell

Question 9

What is ischemic enteritis?

Answer 9

Occlusion of one of one the 3 major arteries leads to infarction

Question 10

RFs for ischemic enteritis

Answer 10

Arterial thrombosis 
Arterial embolism 
Non-occlusive ischaemia 
-cardiac failure
-shock
-dehydration

Question 11

S+S of ischemic enteritis

Answer 11

Oedema
Nuclei indistinguishable
Initial absence of inflammation
Vascular dilation

Question 12

What happens in chronic ischemia?

Answer 12

Mucosal inflammation
Ulceration
Sub mucosal inflammation
Fibrosis 
Stricture

Question 13

What is impaired in radiation colitis?

Answer 13

Normal proliferation

Question 14

What kind of radiation is normally the cause of radiation colitis?

Answer 14

Rectum -pelvic

Question 15

S+S of radiation colitis?

Answer 15

Anorexia
Abdominal cramps
Diarrhoea
Malabsorption 
Bizzare cellular changes
Ulceration
Necrosis 
Haemorrhage 
Perforation

Question 16

What’s the appendix?

Answer 16

Lymphoid tissue which regresses with age due to fibrous obliteration

Question 17

What can cause ischemia in the appendix?

Answer 17

Increased intralumenal pressure

Question 18

What’re the extra-intestinal manifestations of IBD?

Answer 18

Arthritis
Painful nodes that’ll big and red/purple
Gall/ renal stones

Question 19

Tx for acute severe colitis in the first 24 hours

Answer 19

IV glucocorticoid 
LMWH 
-3x increased risk of thromboembolism
AXR
IV hydration 
No steroidal analgesics 
3-4 stool cultures for c.difficile

Question 20

Ix

Answer 20

Bloods for inflammation markers
Stool culture to rule out infection if diarrhoea 
Faecal caprotectin
Colonoscopy 
MRI small bowel study 
Capsule endoscopy

Question 21

UC Tx

Answer 21

Aminosalicylates (5-ASA)

• mezaline
• work by blocking prostaglandins and leukotrienes]

Steroids

• prednisolone
• bedenoside

Biologics

Elemental feeding (nutrients in liquid form)

Question 22

CD Tx

Answer 22

Steroids

• prednisolone
• budenoside

Immunomodulation
-azathioprine

Methotrexate

Biologics

Elemental feeding

Surgery

Question 23

Indications for surgery in CD

Answer 23

Failure of medical management
Relief of obstructive symptoms 
Management of a fistula 
Management of intra abdominal abscess
Managing anal conditions
Failure to thrive

Question 24

What qualifies as failure of medical therapy in UC

Answer 24

Recurrent courses of steroids
Relapse prior to or shortly after stopping
Unacceptable side effects
Acute severe colitis not responding top 72hrs high dose IV fluids +/- biologic rescue therapy

Question 25

Tx strategies for IBD

Answer 25

Target lymphocytes directly
Target single cytokines
Target migration of immune cells to GI mucosa
Target multiple cytokines
Target cytokine intracellular signalling pathways
Modulation of microbacteria