IBD

Question 1

Two subtypes?

Answer 1

Crohn’s disease

Ulcerative colitis

Question 2

Where do the subtypes affect?

Answer 2

UC= only colon 
CD= Any part of GI tract

Question 3

Possible aetiology?

Answer 3

Combo of genetic susceptibility and environmental factors and mucosal immunity

Question 4

Environmental triggers?

Answer 4

Smoking
NSAIDS
Stress
Diet

Question 5

Mucosal immune system cause?

Answer 5

IBD occurs due to an overactive response to luminal antigens eg bacteria

Question 6

IBD patients have a leaky epithelium. True or false?

Answer 6

True
Increased chance of detection of antigens by immune cells

Antigen will be presented to the other T cells = inflammation in the mucosa

• An absence of regulatory T cells
• Overactive effector T cell response

Question 7

Crohns mediated by?

Answer 7

TH1

Question 8

UC mediated by?

Answer 8

TH1/TH2

Question 9

IBD increases the risk of what GI conditions?

Answer 9

• Developing colon
• Toxic megacolon in UC
• Bowel obstruction
• Sclerosing cholangitis

Question 10

Systemic manifestations of IBD?

Answer 10

Eyes= uveitis, episcleritis, conjunctivitis
Skin= Erythema nodosum, pyoderma gangrenosum
Joints= Arthralgia, ankylosing spondlitis
Liver & biliary tree= Sclerosing cholangitis, fatty liver, chronic hepatitis, cirrhosis, GS

Question 11

What is most commonly affected in Crohn’s disease?

Answer 11

Terminal ileum

Question 12

Signs and symptoms of CD?

Answer 12

• Abdo pain
• Diarrhoea (less common blood or mucous)
• Wt loss/ reduced growth
• Fatigue
• Malaise
• Fever
• Mouth ulcers
• Angular stomitis
• Peri-anal disease (later disease development) abscesses, fistulas, strictures

Question 13

CD will only present as chronic. True or False?

Answer 13

FALSE

Chronic or actute but chronic more common in OSCEs

Question 14

Risk factors for CD?

Answer 14

Fam history

Smoking

Question 15

Investigations for IBD?

Answer 15

• Wt loss?
• RIF mass
• Peri-anal signs
• Bloods= CRP, ESR, ferritin, B12
• Endoscopy= OGD/Colonoscopy (cobble stoning, skip lesions=C)
• Biopsy for diagnosis- pathcy, granuloma, loss of villi
• Bowel imaging= MRI, CT (To look for fistulas, strictures)

Question 16

What type of inflammation is seen in Crohn’s?

Answer 16

Transmural inflammation

Cobble stoning

Question 17

1st line Management of Crohn’s?

Answer 17

• Lifestyle (quit smoking)

- 1st line= Steroids (prednisalone, short course 6-8 weeks)

Question 18

2nd line management of Crohns?

Answer 18

Immunosuppressants

• Azathioprine
• methotrexate

Question 19

3rd line management of Crohn’s?

Answer 19

Anti-TNF

• anything ending in -imab
• TNF is a cytokine involved in loads of pathways- it will promote the apoptosis of T cells

Question 20

Surgery for management of Crohn’s?

Answer 20

• Non curative
• Emergency or elective
• Often involves resection of area affected
• RISK= short gut syndrome, parenteral nutrition
• Patient may need stoma

Question 21

Complications of Crohn’s?

Answer 21

• Strictures, fistulas & obstruction
• Periods of flares and remission
• Malnutrition, SGS
• Colon cancer

Question 22

What is UC?

Answer 22

Chronic remitting inflammatory condition affecting just the colon

Question 23

What can UC be?

Answer 23

Proctitis, proctosigmoiditis, left-sided colitis, extensive colitis

Question 24

Macroscopic changes in UC?

Answer 24

• Mucosa looks red & inflammed
• Very friable (easily bleeds)
• Continuous appearance
• Pseudo-polyps
• Thin wall

Question 25

Risk factors for UC?

Answer 25

- Smoking isn't one - Fam history - NSAIDS - No appendectomy

Question 26

Symptoms of UC?

Answer 26

- History of bloody diarrhoea (>6 wks rectal bleeding) - Faecal urgency - Tenesmus (incomplete empty feel) - Abdo pain (LIF) - Pain before defecation, relieved once stool passed) - Non-specific symptoms= malaise, fatigue, fever, anorexia, anaemia

Question 27

Signs of UC?

Answer 27

- Apthous ulcers - Finger clubbing - Pallor - Abdo tenderness in LIF

Question 28

Investigations for UC?

Answer 28

- p-ANCA +ve - FBC- anaemia, high platelets - CRP= raised - LFTs- may be deranged - U&E's- may be deranged - Coeliac serology - Stool culture (excludes infection) - Faecal calprotectin (raised suggests active inflam) - Colonoscopy = diagnostic

Question 29

1st line treatment for UC?

Answer 29

Topical aminosalicylate

Question 30

2nd line treatment for UC?

Answer 30

Oral aminosalicylate

Question 31

3rd line treatment for UC?

Answer 31

Add on topical/oral steroid

Question 32

4th line treatment for UC?

Answer 32

Biologics (eg anti-TNF like infliximab)

Question 33

How to treat an acute exacerbation of UC?

Answer 33

IV steroids

Question 34

What to do when drugs don't work in UC?

Answer 34

Elective colectomy with/without ileostomy or colostomy (stoma)

Question 35

Lifestyle management of UC?

Answer 35

``` Lifestyle Bone health assessment Colonic cancer surveillance Mnitor utrition status Flu, pneumococcal vaccines ```

Question 36

Genetic aetiology?

Answer 36

- FH +ve | - NOD2/CARD15-protein for bacterial recognition

Question 37

Why is gut flora crucial?

Answer 37

There is evidence of altered bacterial flora in IBD

Question 38

SE of prednisalone?

Answer 38

Weight gain Osteoporosis Thinning of skin Hypertension

Question 39

Microscopic changes in UC?

Answer 39

- Inflammation limited to mucosa (superficial) - Goblet cells depleted - Crypt abscesses

Question 40

What does ANCA stand for?

Answer 40

Anti-neutrophil cytoplasmic antibodies