IBD

Question 1

What is ulcerative colitis?

Answer 1

a relapsing and remitting inflammatory disorder of the colonic mucosa, never spreading past the ileocaecal valve, usually causing proctitis

Question 2

What is Crohn’s disease?

Answer 2

a chronic inflammatory disorder characterised by transmural granulomatous inflammation in any part of the GI tract, which may have skip lesions.

Question 3

What are symptoms of IBD?

Answer 3

• Episodic or chronic diarrhoea (blood and mucus in UC)
  
  • Abdominal pain (cramping)
  • Weight loss
  • Fever
  • Urgency/tenesmus with proctitis

Question 4

What are signs of IBD?

Answer 4

Abdominal tenderness/distension

Perianal abscesses/skin tags/mouth ulcers in Crohn’s

Question 5

What are extra-intestinal signs and symptoms of IBD?

Answer 5

Eyes: conjunctivitis and Iritis

Joints: Ankylosing spondylitis or seronegative arthropathy

Liver and biliary: PSC, autoimmune hepatitis

skin: Erythema nodosum and Pyoderma gangrenosum

May also be finger clubbing

Question 6

Why can people with Crohn’s have gallstones?

Answer 6

Crohn’s can affect terminal ileum where bile salts are reabsorbed.

Question 7

What Ix in suspected IBD?

Answer 7

RECORD STOOL FREQUENCY

Bloods: FBC (may be anaemia), CRP, ESR, U+Es

Iron studies, B12, folate, metabolic panel as people with Crohn’s may be deficient due to malabsorption

If fever, blood and stool cultures (can rule out infection)

Faecal calprotectin: sensitive for GI inflammation and 1st line test.

AXR: no faecal shadows, mucosal thickening

Colonoscopy: important to diagnose Crohn’s

Question 8

What criteria is used to evaluate severity of UC?

Answer 8

Truelove and Witts.

Mild, moderate, severe (severe has > 6 bowel movements, visible blood, pyrexia, HR > 90, anaemia)

Question 9

How is UC treated?

Answer 9

Mild-moderate:

• topical/rectal mesalazine (ASA)
• then add oral mesalazine
• then add topical or oral steroid
• can use azathioprine if refractory to steroids

Question 10

How is acute severe UC flare treated?

Answer 10

IV fluids and electrolytes
IV steroids or ciclosporin
LMWH
Infliximab if not recovered by days 3-5

May need colectomy if still refractory

Monitor BP, stools, temp, bloods

Question 11

How is Crohn’s treated?

Answer 11

Stop smoking

• steroids (oral or topical) for remission induction e.g. budesonide
• mesalazine if not effective
• add methotrexate or azathioprine or mercaptopurine if not working
• infliximab for refractory/fistulating crohn’s

azathioprine or mercaptopurine (or methotrexate) to maintain remission

may need surgery

Question 12

What are complications of IBD?

Answer 12

Crohn’s: obstruction, sepsis, toxic megacolon, short bowel syndrome, cancer

UC: toxic megacolon, PSC, cancer, sepsis, infection