Inflammatory Bowel Disease

Question 1

Inflammatory bowel disease is an umbrella term encompassing which two conditions?

Answer 1

1. Crohn’s disease
2. Ulcerative colitis

Question 2

Which three main factors contribute to IBD?

Answer 2

1. Mucosal immune system
2. Genetic predisposition
3. Environmental triggers

Question 3

Which gene, when mutated, gives a greatly increased risk of Crohn’s disease?

Answer 3

NOD2

(it codes for bacterial recognition)

Question 4

Crohn’s disease is mediated by which immune cell type?

Answer 4

TH1

Question 5

Ulcerative colitis is mediated by which immune cell types?

Answer 5

TH1 and TH2

Question 6

How does smoking affect both Crohn’s and UC?

Answer 6

Crohn’s - aggravates

UC - protects

Question 7

How do NSAIDS impact IBD?

Answer 7

Causes aggravtion

Question 8

What are the main symptoms of UC?

Answer 8

• Diarrhoea and bleeding
• Increased bowel frequency
• Tenesmus
• Incontinence
• Lower abdominal pain

Question 9

A rash on the front of the shins is indicative of what?

Answer 9

UC

Question 10

How is severe UC defined?

Answer 10

>6 bloody stools daily plus 1 of:

• Fever (>37.8 degrees)
• Tachycardia (>90/min)
• Anaemia (haemoglobin <10.5g/dl)
• Elevated ESR (>30mm/hr)

Question 11

How can UC be investigated and assessed?

Answer 11

• Bloods - CRP, albumin
• Plain CXR - thumb printing
• Endoscopy
• Histology

Question 12

Why is there an increased risk of cancer long term with UC?

Answer 12

• Severity of inflammation
• Duration of disease
• Disease extent

Question 13

Where else in the body may UC signs manifest?

Answer 13

• Skin - erythema nodosum, pyoderma gangrenosum
• Joints - axial and peripheral
• Eyes
• Deranged LFTs
• Oxalate renal stones

Question 14

Which disease can affect the whole GI tract?

Answer 14

Crohn’s

Question 15

Why is resection minimised for Crohn’s patients?

Answer 15

It is a non curative disease and can recur

Question 16

What are the main symptoms of Crohn’s disease?

Answer 16

• Abdominal cramps
• Diarrhoea - with or wthout blood
• Weight loss
• Painful mouth ulcers
• Swollen lips
• Angular cheilitis
• Peri-anal pain and abscess

Question 17

What can happen to red blood cells if the terminal ileum is affected in IBD?

Answer 17

They become macroscopic

Vitamin B12 absorption is disrupted

Question 18

How does the greater omentum interact with the colon during Crohn’s?

Answer 18

It has a cobblestoning effect and wraps arong the colon

Question 19

In which IBD are the haustra of the colon lost?

Answer 19

UC

Question 20

Which IBD involves a thickened gut wall?

Answer 20

Crohn’s

Question 21

How can the small bowel be assessed?

Answer 21

Barium follow through

Small bowel MRI

Technetium-labelled white cell scan - such cells can be followed to areas of inflammation