IBD - inflammatory bowel disease

Question 1

IBD associated with sudden flare ups and remissions

Answer 1

Crohn’s

Question 2

IBD with skip lesions and anywhere from mouth to anus affected

Answer 2

Crohn’s

Question 3

IBD that is transmural

Answer 3

Crohn’s

Question 4

IBD that is associated with granulomas of macrophages and T cells and causes villi shortening

Answer 4

Crohn’s

Question 5

IBD associated with smoking

Answer 5

Crohn’s

Question 6

IBD prevented by smoking

Answer 6

UC

Question 7

IBD more associated with blood and mucus in diarrhoea

Answer 7

UC

Question 8

IBD with abdominal mass more common

Answer 8

Crohn’s

Question 9

IBD with a gradual onset of weeks of symptoms

Answer 9

UC

Question 10

IBD that is continuous from rectum -> colon

Answer 10

UC

Question 11

IBD associated with shortened and branched crypts with plasma cell infiltrates

Answer 11

UC

Question 12

IBD that affects only mucosa and submucosa usually

Answer 12

UC

Question 13

Extra-intestinal symptoms of IBD more common in _

Answer 13

UC

Question 14

Extra-intestinal symptoms of IBD =

Answer 14

non-rheumatic arthritis
aphthous ulceration
pyoderma gangrenosum
uveitis/episcleritis
IDA

Question 15

IBD with stronger genetic component

Answer 15

Crohn’s

Question 16

Obesity’s effect on gut microbiome =

Answer 16

less diversity an increases proteobacteria

Question 17

Bacteria ___ can infiltrate normally sterile mucus layer in IBD if there is ___ => extra ___

Answer 17

bound to IgA

inflam=> extra inflam

Question 18

NOD2/CARD15(IBD-1) on chromosome ___ are mutated in 10-20% of ___
encodes protein involved in ____

Answer 18

16q12
Crohn’s
bacterial recognition and presenting to T cells

Question 19

UC is __ mediated with ___ and causes too few colonic bacteria to be present

Answer 19

Th1/2 with NKTC

Question 20

Crohn’s is __ mediated and so can’t control ___

Answer 20

Th1

can’t control bacterial numbers

Question 21

Severity markers of UC (Truelove and Witt) =

Answer 21

more than 6 bloody stools in 24hrs and 1 or more of fever/ tachycardia/anaemia/increased ESR

Question 22

which IBD:
on endoscopy is a clear transition zone
pseudopolyps

Answer 22

UC

Question 23

Histology of UC =

Answer 23

enlarged and distorted crypts, abscence of goblet cells, abscesses that only affect mucosa

Question 24

Cobblestonemucosa = which IBD

Answer 24

Crohn’s

Question 25

IBD associated with PSC =

Answer 25

UC

Question 26

Peak incidence of UC is at ages

Answer 26

20-30yo

Question 27

Commonest ages of Crohn's presenting =

Answer 27

90% present 10-40yo

Question 28

Most commonly Crohn's affects the

Answer 28

RHS colon and distal ileum

Question 29

Stenosis in Chron's may be __/__

Answer 29

fibrotic or inflammatory

Question 30

knife-like fissures =

Answer 30

Crohn's

Question 31

Histology of Crohn's -

Answer 31

``` thicker mucosa knife like fissures chronic active colits w non-casseating granuloma increased inflam cells in lamina propria crypt branching ```

Question 32

Complications of Crohn's

Answer 32

``` greater omentum wraps around strictures gallstones fistulas perianal disease ```

Question 33

Extra-intestinal symptoms/signs are rare in which IBD

Answer 33

Crohn's

Question 34

Which IBD is more ac=ssociateed with colorectal cancer

Answer 34

UC

Question 35

IBD that causes a thin wall

Answer 35

UC

Question 36

Crohn's 3 steps of treatment

Answer 36

steroids>immunosuppression> anti-TNF therapy

Question 37

UC 4 steps of treatment =

Answer 37

5-ASA>steroids>immunosuppression>anti-TNF therapy

Question 38

___ is effective in UC but not in treating Crohn's

Answer 38

5-ASA

Question 39

examples of 5-ASA drug names: | routes =

Answer 39

sulfasalazine, balsalazide, mezavant = prodrugs asacol = pH release pentasa = delayed release all PO can get suppositories and enemas

Question 40

Compare suppositories and enemas of 5-ASA for UC

Answer 40

``` suppository = morning, coats less than 20cm but better mucosal adherence enema = night, reflex contraction aids proximal spread ```

Question 41

for acute flare of UC give 5-ASA in ___ approach

Answer 41

top and tail | PO + enema/suppository

Question 42

Steroids used in UC and Crohn's eg.s used for flare ups so start ___ and ___ over 6-8wks dont ____ as could get Addison's crisis

Answer 42

budesonide, prednisolone high dose, taper down DON'T stop immediately

Question 43

Immunosuppression eg.s used in IBD In Crohn's used as ___ In UC used as ___

Answer 43

azathioprine/mecaptopurine(6-MP), methotrexate Crohn's = maintenance therapy UC = steroid sparing agents

Question 44

IS in IBD mechanism of action =

Answer 44

purine analogues and interfere with DNA synthesis

Question 45

If hetero/homozygous for low ___ then giving mercaptopurine(6-MP) in IBD could be toxic as 6MP not converted to ___ which balances out toxic effects of 6-TGN which is formed by ___ breakdown of 6-MP

Answer 45

TPMT 6-MMP HPRT

Question 46

Don't prescribe ___ with IS for IBD because it inhibits xanthine oxidase which ___

Answer 46

allopurinol | breaks down 6-MP to 6-TU for clearance

Question 47

IS for IBD has a slow/rapid onset so __

Answer 47

slow - 16wks | start when start steroids then when they end IS should take over

Question 48

TNFα is a ____ | functions =

Answer 48

pro-inflam cytokine causes Th0 to differentiate modulates MadCAM-1 on vessel walls which pull T cells to site of inflam

Question 49

eg. of anti TNFs used in IBD | mechanism

Answer 49

IV infliximab S/C adalimumab block TNFα and increase apop of activated T cells

Question 50

anti TNFs have a slow/rapid onset | give on day 0 then __ then __ then every ___ after that

Answer 50

rapid wk 2 wk6 every 6-8wks to maintain

Question 51

if give then can reactivate tb | must never have had tb to be put on them

Answer 51

anti-TNF therapy | for IBD/ rheumatoid arthritis

Question 52

one side effect =may develop HACA

Answer 52

infliximab (antiTNF therapy)

Question 53

biosimilars to infliximab that are cheaper =

Answer 53

inflectra and remsima

Question 54

Which IBD: If operate rarely see again also doesn't cure ___ symptoms

Answer 54

UC | extra-intestinal

Question 55

in toxic megacolon most likely part to perforate is __ because ___

Answer 55

caecum as it is most thin walled

Question 56

2 methods of panproctocolectomy

Answer 56

with ileostomy | leave sphincter and make J/S pouch with at least 30cm of bowel

Question 57

surgery for IBD is if -

Answer 57

no response to drugs, obstruction, abscess, fistulae = emergency no response to drugs, dysplasia of mucosa = elective

Question 58

If operate on this IBD is likely to come back within 10 yrs

Answer 58

Crohn's

Question 59

Peri-anal fistulae are more common in which IBD

Answer 59

Crohn's

Question 60

Surgery that can be done for strictures

Answer 60

stricturoplasty - cut longitudinally and stitch horizontally to widen = non-functioning any more

Question 61

for terminal ileal disease in Crohn's the surgery done =

Answer 61

R hemicolectomy

Question 62

Fistula are common in which ibd

Answer 62

Crohns