Inflammatory bowel disease

Question 1

Inflammatory bowel disease

Answer 1

• Associated with:
  
  • Erythema nodosum
  • Uveitis
  • Apthous ulcers
  • Clubbing
  • Arthritis

Question 2

Crohn’s

Answer 2

• Features
  
  • Diarrhoea usually non-bloody
  • Weight loss more prominent
  • Upper gastrointestinal symptoms, mouth ulcers, perianal disease
  • Abdominal mass palpable in the right iliac fossa
• Extra-intestinal features
  
  • Gallstones are more common secondary to reduced bile acid reabsorption
  • Oxalate renal stones
    
    • Impaired bile acid rebsorption increases the loss calcium in the bile. Calcium normally binds oxalate.
• Complications
  
  • Obstruction
  • Fistula
  • Colorectal cancer
• Pathology
  
  • Lesions may be seen anywhere from the mouth to anus
  • Skip lesions
• Histology
  
  • Inflammation in all layers from mucosa to serosa
  • Increased goblet cells
  • Granulomas
• Endoscopy
  
  • Deep ulcers
  • Skip lesions
  • ‘Cobble-stone’ appearance

Question 3

Ulcerative colitis

Answer 3

• Features
  
  • Bloody diarrhoea more common
  • Abdominal pain in the left lower quadrant
  • Tenesmus (constant feeling of needing to go)
• Extra-intestinal features
  
  • Primary sclerosing cholangitis more common
• Complications
  
  • Risk of colorectal cancer higher than in Crohn’s
• Pathology
  
  • Inflammation always starts at rectum and never spreads beyond ileocaecal valve
• Histology
  
  • No inflammation beyond submucosa
  • Neutrophils form crypt abscesses
  • Depletion of goblet cells
• Endoscopy
  
  • Widespread ulceration