IBD (see DM)

Question 1

what is ulcerative colitis

Answer 1

diffuse mucosal inflammation limited to the colon

Question 2

what is ulcerative proctitis

Answer 2

UC of the rectum

Question 3

what is Crohn’s disease

Answer 3

chronic patchy transmural inflammation of the entire GI tract

Question 4

what is Crohn’s colitis

Answer 4

crohn’s of the colon

Question 5

what happens to the GI tract wall in the initiation stage of IBD (3)

Answer 5

1. loss of epithelial barrier integrity
2. loss of tolerance to enteric comensal bacteria
3. dysbiosis (imbalance in gut microbial communities)

Question 6

UC presentation (6)

Answer 6

1. frequent bloody diarrhoea (the classic symptom);
2. mucous rectally (may be described as snot like or clear phlegm);
3. tenesmus (feeling of wanting to open bowel but without success);
4. abdominal pain;
5. fever;
6. pale (anaemia due to B12 deficency)

Question 7

crohn’s presentation (10)

Answer 7

more diverse than UC
1. fatigue;
2. weight loss;
3. fever;
4. diarrhoea (w/wo bleeding);
5. pain;
6. vomiting;
7. bloating;
8. fistula;
9. abscesses;
10. pale (anaemia)

Question 8

what is the association of an appendicectomy and IBD

Answer 8

appedicectomy is pretective against UC but increases risk of Crohn’s

Question 9

what is the “lead pipe colon” on an AXR and what does it indicate

Answer 9

occurs after a barium enama is give -> complete loss of the haustral markings in the diseased segment of the colon, appearing smooth-walled and cylindrical -> sign of UC in a pt

Question 10

what is the mgx if a dilated transverse colon is seen on AXR

Answer 10

toxic megacolon -> medico-surgical emergency as perforation likely

Question 11

what causes toxic megacolon

Answer 11

loss of the neurogenic tone of the colon, leading to severe dilatation and increasing the risk of perforation (seen in IBD usually)

Question 12

what must be checked before administering ciclosporin

Answer 12

cholesterol and Mg2+ levels -> low is bad

Question 13

aminosalicylates MOA (4)

Answer 13

1. 5-ASA released from carrier molecule after splitting by bacterial enzymes in large intestine
2. inhibit the chemotactic response to leukotriene B4
3. reduce the synthesis of platelet activating factor
4. inhibit leucocyte adhesion molecule upregulation

Question 14

thiopurines MOA

Answer 14

e.g. azathioprine, mercaptopurine -> T cell apoptosis, inhibition of purine synthesis

Question 16

what enzyme does allpurinol inhibit

Answer 16

xanthine oxidase

Question 17

when might surgery be indiacted in chrohn’s disease

Answer 17

1. limited disease
2. penetrating disease
3. perianal disease
4. CD related neoplasia

Question 18

examples of extra-intestinal IBD manifestations

Answer 18

1. mouth ulcers
2. episcleritis
3. uveitis (eye pain, blurred vision, photophobia)
4. erythema nodosum
5. pyoderma grangrenosum
6. arthritis (sponylitis, sacrolilitis, peripheral)