Inflammatory Bowel Disease

Question 1

What are the general presenting features of IBD?

Answer 1

• Diarrhoea
• Abdo pain
• Rectal bleeding
• Fatigue
• Weight loss

Question 2

What are the features of Crohn’s?

Answer 2

Crows NESTS
N - No blood or mucus (PR bleeding less common)
E - Entire GI tract affected (from mouth to anus)
S - Skip lesions on endoscopy
T - Terminal ileum most affected and Transmural (full thickness) inflammation
S - Smoking is a risk factor
Associated with strictures and fistulas.

Question 3

What are the features of Ulcerative Colitis?

Answer 3

You see (UC) CLOSEUP
C - Continuous inflammation
L - Limited to colon and rectum
O - Only superficial mucosa affected
S - Smoking may be protective
E - Excrete blood and mucus
U - Use aminosalicylates
P - Primary Sclerosing Cholangitis

Question 4

What are associated conditions with IBD?

Answer 4

• Erythema nodosum
• Pyoderma gangrenosum
• Enteropathic arthritis
• Primary sclerosing cholangitis - particularly with UC
• Red eye conditions e.g. episcleritis, scleritis, anterior uveitis

Question 5

What investigations for IBD?

Answer 5

• Bloods - FBC (anaemia, platelets raised in inflammation), CRP, U&Es, LFTs, TFTs (diarrhoea), anti-TTG
• Stool microscopy and culture - exclude infection
• Faecal calprotectin
• Colonoscopy and intestinal biopsies
• Imaging e.g. CT or MRI to look for complications such as fistulas, abscesses and strictures

Question 6

What is the management for ulcerative colitis?

Answer 6

• Mild to moderate: aminosalicylate e.g. oral or rectal mesalazine 1st line, corticosteroids e.g. oral or rectal prednisolone 2nd line
• Severe acute: IV steroids e.g. IV hydrocortisone, can use IV ciclosporin, infliximab, surgery

Question 7

What are the options for maintaining remission in UC?

Answer 7

• Aminosalicylate e.g. oral or rectal mesalazine 1st line
• Azathioprine
• Mercaptopurine

Question 8

What are the surgical options for UC?

Answer 8

• Panproctocolectomy - removal of entire large bowel and rectum, then permanent ileostomy
• Ileo-anal anastamosis (ileum attached to anus and functions like a rectum)

Question 9

How is remission induced in an exacerbation of Crohn’s?

Answer 9

• Steroids e.g. oral prednisolone or IV hydrocortisone 1st line
• Can add azathioprine, mercaptopurine, methotrexate, infliximab, adalimumab
• Enteral nutrition - treats nutritional deficiencies, improves gut microbiome, removes inflammatory foods

Question 10

What is used to maintain remission in Crohn’s?

Answer 10

• Might involve no medications
• Azathioprine or mercaptopurine
• Methotrexate as alternative

Question 11

What are the surgical options for Crohn’s?

Answer 11

• Resect distal ileum when the disease is located here
• Treating strictures and fistulas