IBD

Question 1

IBS symptoms

Answer 1

In presceding 12m, 12 consecutive weeks of abdominal discomfort/pain, with 2/3 of…
relieved with defecation
onset associated with change in frequency of stool
onset associated with change in form of stool

Other symptoms…
Bloating
Passage of mucus
Stool passage symptoms: tenesmus, incomplete evacuation
Associated gynaecological symptoms: dysmenorrhoea/dyspareunia
Urinary symptoms: frequency, urgency, nocturia
Back pain

Question 2

Crohn’s epidemiology

Answer 2

50/100,000
Incidence peaks at 15-30, then 60y
Risk factors: poor diet, smoking, altered immune states

Question 3

Crohn’s pathology

Answer 3

Mouth to anus inflammation (commonly ileum and ascending colon)
One/multiple areas
Involved bowel: narrow, thickened wall, deep ulcers, involving all layers of the bowel
Fistulae + stenosis common
Cobblestone appearance on CT
Histological: transmural inflammation, lymphoid hyperplasia and granulomas

Question 4

Crohn’s clinical features

Answer 4

Abdominal pain (varying)
Steatorrhoea: ileal disease 
Bloody diarrhoea: colonic disease 
Weight loss/failure to thrive 
Severe apthous ulceration of the mouth (early sign) 
Anal complications (fissure, fistula, haemorrhoids, skin tags, abscesses) 
Extra GI manifestations 
Can present with acute RIF pain/mass

Question 5

Ulcerative colitis epidemiology

Answer 5

100-200/100,000
Incidence peaks at 15-30, then 60y
Smoking is protective
F>M

Question 6

Ulcerative colitis pathology

Answer 6

Inflammation beginning in rectum, extending proximally along the colon (proctitis affects rectum alone)
Inflammation of terminal ileum (backwash ileitis
Inflammation only affects mucosa: excessively ulcerated
Adjacent mucosa has appearance of inflammatory polyps
Histological: mucosal inflammation, crypt abscess and goblet cell depletion

Question 7

Ulcerative colitis clinical features

Answer 7

Crampy lower abdominal discomfort
Gradual onset diarrhoea (often bloody)
Urgency and tenesmus (if disease confined to rectum)
Extra GI symptoms

Question 8

IBD investigations

Answer 8

Bloods: FBC, U&E, CRP/ESR, LFT, serum iron/B12/folate if anaemia
Stool studies: stool chart, MCSxs (infective causes), calprotectin (rule out IBD in general practice)
Radiology: AXR/CXR (acute), CT in Crohn’s
Endoscopy: rigid/flexible sigmoidoscopy in UC, colonoscopy, endoscopic rectal biopsy

Question 9

General IBD complications

Answer 9

Bowel perforation
Lower GI haemorrhage
Toxic dilatation (more common in UC)
Colonic carcinoma: crohn’s>UC

Question 10

Toxic dilatation presentation

Answer 10

Persistent pyrexia, tachycardia, loose blood-stained stool
Falling albumin/K+
AXR: dilated >6cm colon with mucosal islands
Perforation imminent

Question 11

Crohn’s disease complications

Answer 11

Small bowel obstruction
Fistulae (10%)
Abscess formation
B12/folate/iron deficiency

Question 12

Extra-colonic manifestations of IBD

Answer 12

Eye’s : conjunctivitis/episcescleritis/iritis
Joints: arthralgia of large joints
Skin: erythema nodosum, pyoderma gangrenosum
Venous thrombosis
Fatty liver

Associated: autoimmune hepatitis, gallstones, renal calculi, primary sclerosing cholangitis (UC), cholangiocarcinoma (UC), ankylosing spondylitis (HLA B27 +ve crohns)