Inflammatory Bowel Disease

Question 1

What are the common sites of inflammation in Crohn’s?

Answer 1

Transmural granulomatous inflammation of entire GIT especially at terminal ileum and proximal colon

Question 2

What are the main symptoms of Crohn’s?

Answer 2

• Abdominal pain• Prolonged diarrhea/urgency “I get up at 4am, go 5-6 times in the next 45 mins”• Perianal lesions• Weight loss, fever, failure to thrive, anorexia, malaise “I can be fine one minute, then deathly ill the next”• The disease progresses with relapses and remissions

Question 3

What types of fistulae can occur in Crohn’s?

Answer 3

Fistulae are present in app 10% of patients: colovesical (blader), colovaginal, perianal, enterocutaneous

Question 4

What investigations and results would you expect to see in Crohn’s pt?

Answer 4

a. FBC (anaemia, leukocytosis)b. Iron studies (iron deficiency anaemia)c. Serum vit B12 (normal or low)d. Serum folate (normal or low)e. Comprehensive metabolic panel (hypoalbunaemia, hypocholesterolaemia, hypocalcaemia)f. CRP elevated g. Stool test for infectionh. CT abdo for skil lesions, bowel wall thickening, surround inflammation, abscess, fistulaei. MRI (same as above)j. Yersinia enterocolitica serology

Question 5

What are the main signs of Crohn’s?

Answer 5

• Apthous ulcerations• Abdo tenderness/mass• Perianal abscess/fistulae/skin tags• Anal strictures

Question 6

What is the management of Crohn’s?

Answer 6

1. Vaccination: due to immunosuppressive effect of many of the treatments of IBD, pts recommended:• Influenza• Pneumococcal 23 valent polysaccharide vaccine• Hep B• HPV• Varicella vaccine2. • Corticosteroids• Mesalazine (5-ASA) compounds• Immnosuppressants (azathioprine, methotrexate) • Biologicals (monoclonal Ab)• Surgery if failure to respond to medical therapy or worsening symptoms

Question 7

What is Ulcerative Colitis?

Answer 7

relapsing and remitting inflammatory disorder of the colonic mucosa

Question 8

Where does UC usually start?

Answer 8

Affects the large bowel starting at the rectum and proceeding proximally (i.e. no skip lesions)

Question 9

UC is classified by extent, what are they:

Answer 9

• Ulcerative proctitis: limited to the rectum (50%)• Left-sided UC: inflammation up to the splenic flexure extends to involve part of the colon (30%) • Pancolitis (extensive UC): inflammation beyond the splenic flexure

Question 10

What are the main symptoms of UC?

Answer 10

• Episodic or chronic diarrhea• Frequent episodes of rectal bleeding/blood in stool• Cramp abdominal discomfort• Bowel frequency relates to severity• Urgency / tenesmus (sensation of incomplete bowel emptying) are features of distal disease • Systemic symptoms in attacks: fever, malaise, anorexia