Inflammatory bowel disease

Question 1

Causes of IBD:

Answer 1

Unknown, weakened immune system, genetics

Question 2

RF of IBD:

Answer 2

genetics, smoking, NSAIDs, FH, chronic stress, depression, good hygeine

Question 3

What are the macroscopic and microscopic characteristics of ulcerative colitis?

Answer 3

Macroscopic: affects the colon up to the ileoceacal valve, continuous inflammation, no skip lesions, ulcers
Microscopic: no granulomas, depleted goblet cells

Question 4

What are the macroscopic and microscopic characteristics of Crohn’s disease?

Answer 4

Macroscopic: not continuous, have skip lesions, cobblestone appearance, affects any part of GI tract gum to bum
Microscopic: inflammation extends all layers, granulomas present, goblet cells present

Question 5

What is a colectomy?

Answer 5

An operation to divert one end of the colon through an opening in the stomach. the opening is called a stoma and a pouch is placed over it to collect stools. Usual location is left iliac fossa.

Question 6

What are the components of an abdominal exam? What would you find in a crohn’s/ UC patient?

Answer 6

1. inspection
2. palpation
3. percussion
4. auscultation

UC: lower left abdominal tenderness, pain and distension
Crohn’s: lower right abdominal tenderness, pain and distension

Question 7

What are some extra intestinal signs of UC?

Answer 7

clubbing, oral ulcers, erythema nodusum, amyloidosis

Question 8

what are some extra intestinal signs of Crohn’s?

Answer 8

aphthous oral ulcers, clubbing, skin/ joint/ eye problems.

Question 9

What are the generalised signs of IBD?

Answer 9

cramps, diarrhoea, abdominal pain, weight loss, malaise, anorexia

Question 10

How would you investigate IBD?

Answer 10

Bloods (anaemia, raised ESR/ CRP)
Faecal calprotectin
pANCA (negative in crowns and positive in uc)
colonoscopy with biopsy

Question 11

How do you treat Crohn’s?

Answer 11

Corticosteroids eg. budenoside
glucocorticoids eg. prednisolone
IV hydrocortisone