IBD

Question 1

Pathological features of UC

Answer 1

Colon only

Always starts distally (in the rectum) and is continuous

Mucosal and submucosal inflamm

Question 2

Clinical features of UC

Answer 2

Proctitis- rectum always involved (symptoms of urgency and frequency of defecation due to rectal irritibility; bloody mucus mixed with loose stools)

Left-sided colitis- disease up to splenic fixure. Rectal irritation + extensive bloody mucus in stools, left sided abdo pain, cramps

Pancolitis- Disease involving entire colon. Diarrhoea predominant feature- systemic features

Question 3

Pathological features of Crohns

Answer 3

Any part of GI tract

skip lesions

Involves full thickness of bowel

Histology shows chronic inflammatory cell infiltrate with granuloma formation

Question 4

Clinical Features of Crohns

Answer 4

Inflammatory features (fever, malaise, abdo pain RIF)

Anaemia

Failure to thrive in children

Fistulizing features

Stenosing features- colicky abdo pain, wt loss

Anal disease- atypical anal fissure

Question 5

What Ix would you do and how would you diagnose for UC?

Answer 5

Bloods

AXR

Proctosigmoidoscopy (diagnosis)

Biopsies

Question 6

Management of UC?

Answer 6

IV steroids +/- rectal steroid drip
Adcal D3 (?bisphosphonates)
Start 5-ASA medication  mesalazine
Thrombo-prophylaxis
Surgery  (needing an ileostomy after)

Question 7

Faecal calprotectin

Answer 7

• Neutrophil protein detected in stool sample
• Raised in the presence of inflammation
• Predictor of prelapse

Question 8

What toxic mega colon?

Answer 8

Complication that can arise from UC

Toxic colitis with dilated colon above 6cm

systemic toxicity

Question 9

Give an example of a 5-ASA and route

Answer 9

Mesalazine (PO or PR)

Question 10

What are the indications for surgery in UC?

Answer 10

Fulminant colitis

Colitis unreponsive to medical therapy

Steroid dependence

Dysplasia/Malignancy

Question 11

Pouch operation

Answer 11

Ileal pouch-anal anastomosis (IPAA)

Only an option in UC- curative

Reservoir made from doubled back ileum to stimulate rectum

Question 12

Complications from pouch operation

Answer 12

Pouchitis 
Cuffitis 
Poor pouch function 
Dysplasia
Fertility 
Turns out to be Crohns

Question 13

What Ix would you do and how would you diagnose for Crohns?

Answer 13

Bloods

Endoscopy and biopsy- DIAGNOSIS

Small bowel imaging

MRI

Capsule endoscopy

Question 14

Management of CD?

Answer 14

Elemental diet

Steroids/budesonide

Immunomodulators
Azathioprine / mercaptopurine

Methotrexate

Anti-TNF (infliximab, adalimumab)

Newer biologics (vedolizumab, ustekinumab)

Surgery