IBD - UC and Crohn's

Question 1

which one is known for bloody diarrhoea?

Answer 1

UC

Question 2

which one is weight loss a more prominent feature?

Answer 2

Crohns

Question 3

in which one is tenesmus a feature?

Answer 3

UC

Question 4

mouth ulcers, perianal disease?

Answer 4

Crohns

Question 5

abdominal mass palpable in RIF?

Answer 5

Crohns

Question 6

skip lesions may be present?

what do skip lesions look like on AXR?

Answer 6

Crohns

cobblestone appearance

Question 7

abdominal pain in LLQ?

Answer 7

UC

Question 8

extra-intestinal features of UC?

Answer 8

primary sclerosing cholangitis

Question 9

widespread ulceration with pseudopolyps?

Answer 9

UC

Question 10

inflammation through all layers from mucosa to serosa?

Answer 10

Crohns

Question 11

On AXR looks like drainpipe colon with loss of haustrations?

Answer 11

UC

Question 12

In UC - inflammation starts where and can end where?

Answer 12

starts at rectum and ends at ileo-caecal valve

Question 13

peak incidence of UC is between which ages?

2 peaks

Answer 13

15-25

55-65

Question 14

which one is HLA-B27 +ve?

Answer 14

UC

Question 15

RF for UC

Answer 15

not smoking
NSAIDs
FHx
Infection

Question 16

Features of UC?

Extra-intestinal features of UC?

Answer 16

urgenyc, tenesmus
LLQ pain
bloody discharge with mucus
cramping

uveitis
primary sclerosing cholangitis
arthritis

Question 17

what stool study can you do to show increase in bowel inflammation?

why is this good?

Answer 17

faecal calprotectin (increases)

correlates to disease severity

Question 18

UC

if acute - what imaging would you do?

if not responding to tx - what imaging would you do?

Answer 18

flexible sigmoidoscopy

colonoscopy

Question 19

acute complications of UC?

chronic complication of UC?

Answer 19

Toxic megacolon (dilatation of >6cm) with risk of perforation.

colon cancer (x6 risk)

Question 20

UC Tx - mild and moderate

if severe (systemically unwell)?

Answer 20

5-ASA (mesalazine) PO or oral steroids

IV steroids
if CRP >45 for 3 days: give infliximab or ciclosporin

if that fails - urgent colectomy

Question 21

where does disease lie in 70% of crohn’s patients?

Answer 21

terminal ileum

Question 22

RF for crohn’s disease

Answer 22

white 
FHx 
Smoking 
NSAIDs
OCP (x1.7)

Question 23

Features of Crohn’s

Extra-intestinal Features of Crohn’s?

Answer 23

weight loss/failure to thrive
RLQ pain if terminal ileum
cramping and constipation
perianal disease and mouth ulcers

uveitis
arthritis
episcleritis

Question 24

which one is ASCA +VE

Answer 24

Crohns

Question 25

which one is ANCA +ve

Answer 25

UC

Question 26

complications of Crohn’s

Answer 26

small bowel obstruction

small bowel cancer

Question 27

what will blood tests show in Crohn’s?

Answer 27

anaemic
low ferritin
serum folate is low
CRP/ESR raised

Question 28

Imaging of choice for Crohns

Answer 28

Colonoscopy

Question 29

whats imaging of choice for terminal ileum in crohns?

what sign would you find?

Answer 29

small bowel enema AXR

Kantor’s string sign (narrowed terminal ileum)

Question 30

Tx of Crohns

would you tell them to quit smoking?

what medication would you give?

what medication do you give in
refractory disease?

if they have isolated perianal disease?

Answer 30

YES but in UC - it will make it worse

1st line oral steroids
5ASA as 2nd line if they aren’t as effective.

Infliximab

Metronidazole

Question 31

surgical Tx of UC

Answer 31

sub total colectomy

is usually successful as UC is only

Question 32

what is hartmann’s procedure?

Answer 32

done in emergency

end colostomy + a stumped rectum