Inflammatory Bowel Disease

Question 1

What is IBD? 2 Main conditions?

Answer 1

Chronic inflammation of the bowel with a relapsing-remitting disease course. Consists of Crohn’s Disease (CD) and Ulcerative Colitis (UC)

Question 2

Which part of the bowel is commonly affected in Crohns?

Answer 2

Terminal ileus

Question 3

Cause of IBD?

Answer 3

Unknown. Believed to be a mixture of genetics, immune system and environment.

Question 4

Classical presentation of Crohns? (4)

Answer 4

• weight loss
• abdominal pain
• low grade fever
• diarrhoea

Question 5

Which IBD is more likely to cause bloody diarrhoea?

Answer 5

Ulcerative Colitis

Question 6

Skin extra-intestinal manifestations in IBD? (2)

Answer 6

Erythematus nodosum (painful purple/red nodules on shins) 
Pyoderma gangrenosum (nodules full of pus with black edges)

Question 7

Musculoskeletal extra-intestinal manifestations in IBD? (1)

Answer 7

IBD/enteropathic arthritis - peripheral or Ankylosing spondylitis

Question 8

Eyes extra-intestinal manifestations in IBD? (3) Which ones are most common in Crohns and UC?

Answer 8

Uveitis (more common in UC)
Episcleritis (more common in Crohns)
Conjunctivitis

Question 9

Which is more common - Crohns or UC?

Answer 9

Ulcerative Colitis

Question 10

Mouth extra-intestinal manifestations in IBD?

Answer 10

Aphthous ulcers

Question 11

Hepatobilliary extra-intestinal manifestations in IBD?

Answer 11

Primary Sclerosing Cholangitis

Question 12

Gold standard for the diagnosis of IBD?

Answer 12

Colonoscopy and biopsy

Question 13

Macroscopic changes in Crohns? (3)

Answer 13

1. Cobblestone appearance
2. Skip lesions
3. fistula formation

Question 14

Which of the 2 diseases causes a continuous inflammatory pattern?

Answer 14

UC

Question 15

Which of the 2 diseases causes a intermittent inflammatory pattern (skip lesions)?

Answer 15

Crohn’s disease

Question 16

Which of the 2 diseases causes a transmural disease?

Answer 16

Crohn’s

Question 17

Which of the 2 diseases only affects the mucosa?

Answer 17

UC

Question 18

Which of the 2 diseases can affect the entire GI tract (from mouth to anus)?

Answer 18

Crohn’s

Question 19

Bedside investigations for IBD?

Answer 19

1. obs
2. stool culture (MSC, ova, cysts, parasites, C.diff toxin)
3. urinalysis
4. Faecal calprotectin
5. ECG

Question 20

Bloods for IBD?

Answer 20

FBC, CRP, U&E, LFTs, Haematinics, Bone profile, clotting

Question 21

What can an Abdo X-ray show in Crohns?

Answer 21

Bowel wall thickening, perforation, free-fluid

Question 22

What can an Abdo X-ray show in UC?

Answer 22

Perforation, dilatation

Question 23

What are we particularly worried about if a patient with UC comes in with severe abdo pain, distension and systemically unwell?

Answer 23

Toxic megacolon

Question 24

Management to induce remission in Crohns? (4)

Answer 24

1. Exclusive Enteric Nutrition
2. Budesonide
3. Systemic Steroids (e.g. Prednisolone)
   Severe - Azathioprine, Methotrexate or Biologics

Question 25

Management to maintain remission in Crohns?

Answer 25

1. Thiopurines (e.g. Azathioprine) 2. Methotrexate 3. Biologics - monoclonal antibodies (e.g. Infliximab)

Question 26

What test must you do before starting Azathioprine (and other thiopurines?)

Answer 26

TMTP enzyme

Question 27

Classical presentation of UC? (6)

Answer 27

``` Bloody diarrhoea Abdominal pain Bowel distension Weight loss Febrile Tenesmus/Urgency ```

Question 28

Which part of the bowel is commonly affected in UC?

Answer 28

Rectum (proctitis)

Question 29

Management to induce remission in UC?

Answer 29

1. 5- ASA (e.g. mesalazine, sulphasalazine) 2. Steroids (e.g. Prednisolone) 3. Biologics Severe - IV Hydrocortison or IV Ciclosporin

Question 30

1. How is the 5-ASA delievered in patients with a localised rectum inflammation (proctitis) in UC? 2. How is it delivered if they have pancolitis or left sided colitis?

Answer 30

1. suppository only | 2. suppository and orally

Question 31

Management to maintain remission in UC? (3)

Answer 31

1. Thiopurines 2. Biologics 3. 5-ASA may be continued if used to induce

Question 32

Complications of UC? (4)

Answer 32

1. Toxic megacolon 2. Colorectal cancer 3. Osteoporosis (malabsorption) 4. Pouchitis (from ileoanal anastomosis/J pouch)

Question 33

Complications of Crohn's? (6)

Answer 33

1. Fistulas 2. strictures 3. vitamin b12 (malabsorption due to terminal ileitis) 4. osteoporosis (malabsorption) 5. renal stones (high oxalate due to calcium malabsorption) 6. Colorectal cancer

Question 34

Surgery that is used in UC? What can be made (2)?

Answer 34

1. Proctocolectomy | 2. End ileostomy or Ileoanal anastomosis (J-pouch)

Question 35

Which of the 2 diseases commonly present with perianal disease?

Answer 35

Crohn's

Question 36

What type of perianal disease can patients with Crohn's present with?

Answer 36

1. fistula 2. abscess 3. anal canal stenosis 4. fissures

Question 37

Complication in patients who have undergone ileo-anal anastomosis (J-pouch)?

Answer 37

Pouchitis

Question 38

Severity scoring tool used in UC? What factors does it look at?

Answer 38

1. Truelove and Witts | 2. Number of bowel motions, amount of blood in stools