IBD

Question 1

what are the two inflammatory bowel conditions?

Answer 1

crohns disease and ulcerative colitis

Question 2

which type of IBD can affect the mouth to anus?

Answer 2

crohns disease is a pan-GI condition. it can affect anywhere from mouth to anus. usually affects the terminal ilium.

Question 3

presenting features of crohns disease?

Answer 3

weight loss, lethargy, mucus in stool, diarrhoea (no blood), RIF pain (terminal ilium), oral ulcers, peri-anal disease (skin tags)

Question 4

what are some extra-intestinal features of crohns disease?

Answer 4

finger clubbing, erythema nodosum, uveitis, inflammatory reactive arthritis

Question 5

crohns disease is associated with high risk of colorectal cancer? T/F

Answer 5

false!
crohns - low risk colorectal cancer
UC - high risk colorectal cancer

Question 6

pathological features in crohns disease

Answer 6

which type of IBD has skip lesions, transmural inflammation, cobble-stoning of the mucosa, non-caseating granulomas and deep fissures, increased number of goblet cells

Question 7

investigations for crohns?

Answer 7

blood test (anaemia, raised CRP/ESR), endoscopy and biopsy, stool samply

Question 8

what stool investigations should be perfromed?

Answer 8

culture - if you suspect C.diff toxin

microscopy - if you suspect parasite

Question 9

what are two stool markers found in active intestinal disease?

Answer 9

raised calprotectin/lactoferrin

Question 10

treatment for crohns disease?

Answer 10

steroids to induce remission
immunosuppression with azathioprine
B12 supplementation

iv methylprednisolone and bowel resection if severe

Question 11

bowel resection is curative in crohns? T/F

Answer 11

false

surgery is curative in Ulcerative Colitis, not crohns

Question 12

what is procitis and what condition is it seen in?

Answer 12

inflammation of the rectum

seen in US

Question 13

which parts of the GI tract does UC affect?

Answer 13

colon and rectum

Question 14

which age does UC typically present

Answer 14

young and elderly people

Question 15

pathological features of UC?

Answer 15

continuous lesions ascending from the rectum to the iliocecal valve
no inflammation beyond the submucosa
goblet cell depletion
no granulomas

Question 16

clinical features of UC

Answer 16

bloody diarrhoea
night rising
procitis (urgency and tenesmus)
LIF abdominal pain

Question 17

investigations for UC

Answer 17

bloods (raised WBC/CRP/ESR, iron deficiency)
stool test (raised fecal calprotectin)
barium enema (loss of haustrations= drain pipe colon)
AXR (toxic megacolon)
colonoscopy and biopsy

Question 18

how wide does the colon need to be for diagnosis of toxic megacolon?

Answer 18

> 6cm

Question 19

when should you never do a colonoscopy?

Answer 19

during flare up - risk of perforation

Question 20

treatment for UC?

Answer 20

induce remission (5-ASA, Mesalazine)
maintain remission
surgery (protectomy with end iliostomy)

Question 21

is surgery curative in UC?

Answer 21

yes - protectomy with iliostomy

Question 22

primary sclerosing cholangitis is associated with which type of IBD?

Answer 22

80% of PBS cases are associated with ulcerative colitis

Question 23

what is primary sclerosing cholangitis?

Answer 23

fibrotic stricture of the common bile duct. risk of cholangiocarcinoma.

Question 24

‘drain/lead pipe colon’ is seen in which IBD?

Answer 24

ulcerative colitis. Lead pipe colon is seen due to loss of bowel haustrations.