Inflammatory bowel disease

Question 1

what is the difference between the distribution of Crohn’s disease and UC?

Answer 1

Crohns can be anywhere from mouth to anus

UC only in colon and rectum

Question 2

why does IBD occur?

Answer 2

failure to maintain oral tolerance –> breakdown in mucosal barrier –> activates innate and adaptive immune system –> inflammation

Question 3

which type of IBD is transmural?

Answer 3

Crohns

Question 4

which type of IBD destroys glands?

Answer 4

UC (loss of goblet cells, gland destruction, crypt abcess formation)

Question 5

what are granulomas?

Answer 5

spherical areas of chronic inflammation in Crohns

Question 6

what complications can arise with Crohn’s disease?

Answer 6

fistulas
perforations
stricturing (narrowing –> can cause blockages)

Question 7

what complications can arise with UC?

Answer 7

chronic dilation

toxic megacolon

Question 8

which disease may be improved by smoking?

Answer 8

UC (worsens Crohns)

Question 9

can surgery correct Crohns?

Answer 9

depends on distribution

not a cure as it can return

Question 10

what genetic mutation can predispose to crohn’s disease?

Answer 10

NOD2 mutation –> involved in antigen processing

Question 11

What genetic polymorphism can result in crohns or UC?

Answer 11

IL-23R polymorphisms –> involved in regulation of Th1 and Th17 differentiation

Question 12

what are the symptoms of IBD?

Answer 12

diarrhoeas (blood and mucus with UC)
faecal urgency and incontinence
weight loss
abdominal pain/ cramps
fatigue, lethargy
perianal pain and discharge
rectal bleeding
aphthous ulcers in Crohns

Question 13

what are the signs of IBD?

Answer 13

tender abdomen
anaemia
perianal absess
fistulae and anal fissues
vitamin deficiency

Question 14

what are the extra-intestinal manifestations of IBD?

Answer 14

musculoskeletal
dermatologic
occular eg uveitis
hepatobiliary disease
pulmonary
vascular
renal
pancreatitis

Question 15

what basic tests can be used to diagnose IBD?

Answer 15

blood tests:

anaemia, inflammation markers (CRP/calprotectin)

Question 16

which radiology scans can be used to help diagnose IBD?

Answer 16

barium studies

CT/ MRI studies

Question 17

What are the different types of endoscopic tests?

Answer 17

sigmoidoscopy
colonoscopy
gastroscopy and biopsies

Question 18

Why might a patient with IBD need emergency surgery?

Answer 18

sever bleeding
bowel perforation
bowel obstruction
toxic dilation
absess

Question 19

Which IBD can have a protocolectomy and a pouch?

Answer 19

UC (crohns only proteoctomy no pouch)

Question 20

What is proctitis?

Answer 20

UC only in the rectum

Question 21

What is pan-colitis?

Answer 21

UC throughout whole colon and rectum

Question 22

Which drugs induce remission?

Answer 22

steroids (short term eg prednisolone) and short term anti-inflammatory drugs

Question 23

which drugs maintain remission?

Answer 23

immunosuppressants
azathioprine
methotrexate
aminosalicylates

Question 24

how does azathioprine work?

Answer 24

effects apoptosis of T cells

Question 25

how does methotrexate work?

Answer 25

decreases inflammatory cytokine production

Question 26

which drugs could be used for resistant cases of IBD?

Answer 26

biologics
anti-TNF eg infliximab
vedolizumab

Question 27

how does anti-TNF work?

Answer 27

TNF-a is a pro-inflammatory cytokine

anti-TNF binds TNF-a on cell surface –> apoptosis of inflammatory cell

Question 28

How does vedolizumab work?

Answer 28

blocks a4b7 = integrin inhibitor (integrin expressed by t cells)

Question 29

what are other potential treatments for IBD?

Answer 29

worm therapy –> anti-inflammatory cytokines
faecal transplantation
monoclonal antibody therapies