Inflammatory Bowel Disease

Question 1

Inflammatory bowel disease mainly comprises of two idiopathic chronic inflammatory diseases - what are they?

Answer 1

Crohn’s disease
Ulcerative colitis

Question 2

There is a stronger genetic link in UC than Crohn’s disease. True/False?

Answer 2

False
Stronger genetic link in Crohn’s (36%) than UC (16%)

Question 3

Smoking aggravates Crohn’s disease + UC. True/False?

Answer 3

False
Aggravates Crohn’s but no effect on/may even protect UC

Question 4

Which age range is typical peak incidence of UC?

Answer 4

20-40s but variable

Question 5

Where does the inflammation start in UC?

Answer 5

Rectum

Question 6

Does UC produce skip lesions?

Answer 6

No
Continuous proximal inflammation from rectum to stop point

Question 7

List typical symptoms of UC

Answer 7

Diarrhoea + bleeding
Increased bowel frequency
Urgency, tenesmus, incontinence
Night rising
Lower abdo pain (LIF)

Question 8

What is the classic sign of mucosal inflammation/oedema on an AXR?

Answer 8

Thumbprinting

Question 9

How does toxic megacolon arise?

Answer 9

Persistent inflammation causes loss of muscle tone of the colon, resulting in distention

Question 10

What are some extra-intestinal manifestations of UC?

Answer 10

Primary sclerosing cholangitis
Apthous ulcers
Erythema nodosum
Uveitis

Question 11

Which age range is typical for Crohn’s disease?

Answer 11

Young children to 40 year olds

Question 12

The inflammation in Crohn’s and UC is transmural, i.e. it breaches the mucosa and goes beyond muscle layer. True/False?

Answer 12

False
Inflammation in Crohn’s is transmural; inflammation in UC is confined to mucosa/submucosa

Question 13

Does Crohn’s disease produce skip lesions?

Answer 13

Yes
Can affect anywhere from mouth to anus

Question 14

Can fistulas occur in Crohn’s and UC?

Answer 14

Yes
Leads to abscess formations, especially peri-anally

Question 15

Symptoms of Crohn’s disease are dependent on where the disease occurs. List some common symptoms

Answer 15

Abdominal cramps
Diarrhoea
Weight loss
Painful ulcers
Abscesses

Question 16

How common is granuloma in Crohn’s disease?

Answer 16

50% of patients

Question 17

Where does Crohn’s disease most commonly occur?

Answer 17

Terminal ileum
Colon

Question 18

Fissures are associated with which IBD - Crohn’s or UC?

Answer 18

Crohn’s disease
Deep, knife-like fissures

Question 19

List some complications of Crohn’s disease

Answer 19

Malabsorption
Short bowel syndrome
Vitamin deficiencies, anaemia
Fistulas

Question 20

What are the 4 treatments available (excluding surgery) for UC and Crohn’s disease, in order of step-up therapy?

Answer 20

5-ASA (mesalazine - UC ONLY)
Steroids
Immunosuppression
Anti-TNF drugs

Question 21

How can mesalazine be administered?

Answer 21

Orally
Topically as a rectal suppository/enema

Question 22

Give an example of an anti-TNF drug used?

Answer 22

IV Infliximab

Question 23

What is an ileostomy?

Answer 23

Small intestine is diverted to an opening in the abdomen and a bag is placed externally to collect waste products

Question 24

What is a pouch? (AKA ileo-anal pouch; J/W/S pouch)

Answer 24

Loops of small intestine are folded and stapled on itself to create a reservoir, restoring normal function of the rectum

Question 25

Surgery for UC is well tolerated. True/False?

Answer 25

True
Most live well with a stoma

Question 26

Surgery for Crohn’s is well tolerated. True/False?

Answer 26

False