IBD, IBS

Question 1

What is ulcerative colitis?

Answer 1

Relapsing and remitting inflammatory disorder of the colonic mucosa.

Question 2

What is a crypt abscess and what disease does it indicate on histology?

Answer 2

Abscesses which get clogged up with neutrophilic exudate. Occurs in UC. http://www.medicalmediareview.com/inflammatory-bowel-disease/

Question 3

Give a risk factor for ulcerative colitis.

Answer 3

15-30 years old; living in northern europe, UK, north america. Slightly higher in females. (note: smoking decreases risk x3!)

Question 4

Give 4 symptoms of UC.

Answer 4

Episodic or chronic diarrhoea +/- blood or mucus
Crampy abdominal discomfort
Bowel frequency relates to severity
Urgency (suggests rectal UC)

Question 5

What is Crohn’s disease?

Answer 5

Chronic inflammation at any point in the GI tract or wall (-transmural; ‘skip lesions’)

Question 6

What part of the bowel is mainly affected by Crohn’s disease?

Answer 6

Terminal ileum (70%). (OHCM)

Question 7

Give 5 symptoms of Crohn’s disease.

Answer 7

Diarrhoea/urgency; abdominal pain; weight loss; fever; malaise, anorexia. Fine one minute, ill the next. (OHCM)

Question 8

Give 5 signs of Crohn’s disease.

Answer 8

Ulcers
Abdominal tenderness/mass
Perianal abscess; fistulae; skin tags
Anal stricures
Non-gut: 
clubbing
skin, joint and eye problems

Question 9

What investigations would you do for suspected Crohn’s disease?

Answer 9

Bloods: FBC, ESR, CRP, U&E, LFT, INR, B12, folate, ferritin.
Stool microscopy to exclude infection
Colonoscopy and rectal biopsy to differentiate between UC and Crohns and assess disease extent
(OHCM)

Question 10

Give a risk factor for Crohn’s disease.

Answer 10

Age 15-30, smoking (3-4x increased risk), more prevalent in north europe/UK/north america. (PTS OHCM)

Question 11

What is the management for Crohn’s disease?

Answer 11

Holistic approach - what affects the patient.
Stop smoking; optimise nutrition
Mild: oral prednisolone
Severe: admit for IV steroids and nil by mouth.
If steroid side effects and multiple relapses, Azathioprine is a long term treatment.
(OHCM)

Question 12

What is the cause of UC?

Answer 12

Unknown but there is some genetic susceptibility. (OHCM)

Question 13

What is irritable bowel syndrome (IBS)?

Answer 13

A mixed group of abdominal symptoms for which no organic cause can be found.

Question 14

What are 5 symptoms of IBS?

Answer 14

1. Abdominal pain, relieved by defecation or associated with bowel/stool changes
2. Diarrhoea and/or constipation (may alternate)
3. Urgency
4. Incomplete evacuation
5. Abdominal distension/ bloating
   All symptoms lasting >6 months, worse after food, exacerbated by stress, menstruation, or gastroenteritis.
   (OHCM)

Question 15

Give 2 signs of IBS

Answer 15

Exam can be normal or show abdominal tenderness
Abdominal distension/ bloating
Mostly history-based - see symptoms

Question 16

Describe the management of IBS.

Answer 16

Treatment rarely successful so extra emphasis on explanation and reassurance to make symptoms less intrusive.
DIET
- FODMAP diet - avoid Fermentable Oligo, Di, Mono and Polysaccarides.
- Avoid insoluble fibre
(GP)

Question 17

Give 3 risk factors for IBS.

Answer 17

Age <40 years, female:male 2:1.

Question 18

What investigations would you do if you suspect a patient has IBS?

Answer 18

FBC, ESR, CRP, LFT, coeliac serology.
If >50 years: colonoscopy
If prominent diarrhoea: stool culture, B12/folate.

Question 19

Describe the management of UC - give classes and examples of drugs

Answer 19

Mild UC: 5-asa eg sulfasalazine; steroids eg prednisolone
Moderate UC: PO prednisolone + sulfasalazine.
Severe UC: Admit for nil by mouth and IV hydration, hydrocortisone PR, monitor (vital signs, bloods and stool).
Surgery - needed in 20%; colestomy.

Question 20

What would you do to differentiate IBD from infectious diarrhoea eg shigella?

Answer 20

Stool microscopy, culture and sensitivity (MC&S)

Question 21

What is the mechanism of action of corticosteroids?

Answer 21

Upregulates anti-inflammatory genes and down-regulates pro-inflammatory genes.

Question 22

Give 3 side-effects of long-term corticosteroid use.

Answer 22

Proximal muscle weakness
Hypertension
Mood disturbance, insomnia
Diabetes mellitus
Weight gain
Thin skin and nails.