Inflammatory Bowel Disease

Question 1

What are the definitions for mild, moderate and severe UC?

Answer 1

mild: < 4 stools/day, only a small amount of blood
moderate: 4-6 stools/day, varying amounts of blood, no systemic upset
severe: >6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)

Question 2

First line mild-moderate UC affecting rectum and left side of colon?

Answer 2

Topical (rectal) aminosalicylate

Question 3

Mild-moderate UC affecting rectum and left side of colon management if topical aminosalicylate not achieved remission within 4 weeks?

Answer 3

Oral aminosalicylate

Question 4

Third line mild-moderate UC affecting rectum and left side of colon

Answer 4

Oral aminosalicylate and steroid
Stop topical treatment

Question 5

First line management for mild-moderate UC affecting widespread throughout the colon

Answer 5

Oral aminosalicylate and topical aminosalicylate

Question 6

First line management for severe UC

Answer 6

Hospital admission
IV corticosteroids or IV ciclosporin

Question 7

Second line management for severe UC

Answer 7

If no improvement within 72 hours
IV corticosteroids AND IV ciclosporin
OR
Surgery

Question 8

Mild-moderate UC flare maintenance therapy affecting left side of colon or rectum

Answer 8

topical (rectal) aminosalicylate alone (daily or intermittent)
OR
an oral aminosalicylate plus a topical (rectal) aminosalicylate
OR
an oral aminosalicylate by itself: this may not be effective as the other two options

Question 9

What systemic therapies are second and third line in UC?

Answer 9

Azathioprine
Mercaptopurine

Question 10

When would patients be prescribed azathioprine or mercaptopurine for UC?

Answer 10

Severe relapse
OR
2 or more exacerbations in the past year

Question 11

What are the absolute indications for surgery in UC?

Answer 11

Complications such as toxic megacolon, perforation, uncontrolled severe haematochezia, or multiorgan dysfunction

Question 12

Is methotrexate recommended in UC?

Answer 12

No

Question 13

What is used to induce remission in Crohn’s?

Answer 13

Steroids

Question 14

Second line management to induce remission in Crohn’s

Answer 14

5-ASA drugs (e.g. mesalazine)

Question 15

Other immunosuppresant drugs used to induce remission in Crohn’s

Answer 15

Azathioprine, mercaptopurine or methotrexate can be added
Not as monotherapy

Question 16

When are monoclonal antibodies added for Crohn’s?

Answer 16

Refractory disease
Fistulating disease

Question 17

What monoclonal antibody is used in Crohn’s?

Answer 17

Infliximab

Question 18

Do people continue on immunosuppressant with monoclonal antibodies?

Answer 18

Yes

Question 19

Management of isolated peri-anal crohns?

Answer 19

Metronidazole

Question 20

First line maintenance therapy in crohn’s?

Answer 20

Azathioprine
OR
Mercaptopurine

Question 21

Second line maintenance therapy in crohn’s?

Answer 21

Methotrexate

Question 22

What enzyme activity needs tested before prescribing azathioprine and mercaptopurine?

Answer 22

TPMT

Question 23

Peri-anal fistula investigation

Answer 23

MRI

Question 24

Peri-anal fistula medication

Answer 24

Metronidazole

Question 25

Complex fistula surgical management

Answer 25

Seton suture

Question 26

Perianal abscess management

Answer 26

Incision and drainage and antibiotics
Seton suture if tract indentified

Question 27

Which is most associated with colon cancer?

Answer 27

UC