Inflammatory Bowel Disease

Question 1

What is inflammatory bowel disease?

Answer 1

Umbrella term for the two main diseases that cause inflammation of the GI tract

Question 2

What are the 2 main inflammatory bowel diseases?

Answer 2

Ulcerative colitis and Crohn’s disease.

Question 3

What are the main features of Crohn’s disease? (NESTS)

Answer 3

N – No blood or mucus (these are less common in Crohns.)
E – Entire GI tract
S – “Skip lesions” on endoscopy
T – Terminal ileum most affected and Transmural (full thickness) inflammation
S – Smoking is a risk factor (don’t set the nest on fire)

Question 4

What are the main features of ulcerative colitis? (CLOSE UP)

Answer 4

C – Continuous inflammation
L – Limited to colon and rectum
O – Only superficial mucosa affected
S – Smoking is protective
E – Excrete blood and mucus
U – Use aminosalicylates
P – Primary sclerosing cholangitis

Question 5

What features could cause you to suspect IBD in children and teenagers?

Answer 5

• Perfuse diarrhoea
• Abdominal pain
• Bleeding
• Weight loss
• Anaemia.

Question 6

How might children and teenagers present during flares of IBD?

Answer 6

Fevers
Malaise
Dehydration

Question 7

What are the extra-intestinal manifestations of IBD?

Answer 7

• Finger clubbing
• Erythema nodosum
• Pyoderma gangrenosum
• Episcleritis and iritis
• Inflammatory arthritis
• Primary sclerosing cholangitis (ulcerative colitis)

Question 8

What is the gold standard investigation for IBD?

Answer 8

Endoscopy (OGD and colonoscopy) with biopsy

Question 9

What would be raised that might indicate IBD?

Answer 9

Faecal calprotectin

Question 10

What would indicate active infection?

Answer 10

A raised CRP

Question 11

What is used to induce remission in Crohn’s disease?

Answer 11

Steroids (e.g. oral prednisolone or IV hydrocortisone).

Question 12

If steroids don’t induce remission, what can be given alongside them?

Answer 12

Add immunosuppressant medication

Question 13

What immunosuppressant medication can you give for Crohn’s disease to induce remission?

Answer 13

• Azathioprine

* Mercaptopurine

Question 14

What can be given to maintain remission in Crohn’s disease?

Answer 14

• Azathioprine

* Mercaptopurine

Question 15

When might you consider surgery in someone with Crohn’s disease?

Answer 15

When it affects the distal ileum

Question 16

What can occur secondary to Crohn’s disease in the distal ileum?

Answer 16

Strictures and fistulas

Question 17

What is used to induce remission in mild to moderate ulcerative colitis?

Answer 17

Aminosalicylate (e.g. mesalazine oral or rectal)

Question 18

What is used to induce remission in severe ulcerative colitis?

Answer 18

IV corticosteroids (e.g. hydrocortisone)

Question 19

What is used to maintain remission

Answer 19

Aminosalicylates: Azaithoprine or Mesalazine

Question 20

Where does crohn’s disease affect?

Answer 20

Affects anywhere from mouth to colon- mainly the terminal ileum

Question 21

What type of inflammation is present with crohn’s disease?

Answer 21

Transmural inflammation

Question 22

Where does ulcerative colitis affect?

Answer 22

Limited to colon and rectum (usually rectum), only affects the submucosa

Question 23

What type of inflammation is present with UC?

Answer 23

Continuous inflammation

Question 24

What will be positive in in UC but negative in Crohn’s diseas?

Answer 24

p-ANCA

Question 25

What would you find on a barium enema in someone with UC?

Answer 25

Loss of haustrations

Question 26

What is used to assess the severity of a flare up of ulcerative colotis?

Answer 26

Truelove and Witts criteria