Inflammatory Bowel Disease

Question 1

ESSENCE

Answer 1

Umbrella term for two main diseases causing inflammation of GI tract - ulcerative colitis and Crohn’s disease

Both cause inflammation and associated with periods of remission and exacerbation

Question 2

Featires of Crohns to differentiate it from UC

Answer 2

• Remember crows NESTS
  
  • No blood or mucus (less common)
  • Entire GI tract
  • ‘Skip lesions’ on endoscopy
  • Terminal ileum most affected and Transmural (full thickness) inflammation
  • Smoking is rest factor
• Also associated with weight loss, structures and fistulas

Question 3

Features of ulcerative colitis to differentiate from Crohns

Answer 3

• Remember u-c CLOSEUP
  
  • Continuous inflammation
  • Limited to colon and rectum
  • Only superficial mucosa affected
  • Smoking is protective
  • Excrete blood and mucus
  • Use aminosalicylates
  • Primary sclerosing cholangitis

Question 4

CLINICAL FEATURES

Presentation

Answer 4

• Diarrhoea
• Abdominal pain
• Passing blood
• Weight loss

Question 5

INVESTIGATIONS

First choice

Answer 5

• Bloods for anaemia, infection, thyroid, kidney and liver function
  
  • CRP indicates inflammation and active disease
• Faecal calprotectin
  
  • Released by intestine when inflammed
• Endoscopy (OGD and colonoscopy) with biopsy is diagnostic
• Imaging with US, CT and MRI can be used for complications

Question 6

COMPLICATIONS

Answer 6

• Fistulas
• Abscesses
• Strictures