Inflammatory Bowel Disease

Question 1

Aetiology of IBD

Answer 1

-Genetic factors (genes associated with immune function) -Environmental factors (reduced biodiversity of enteral bacteria)

Question 2

T cell types involved in Crohn’s and UC

Answer 2

Crohns - Th 1 and Th17 UC - Th2 and Th17

Question 3

Difference between Crohn’s and UC

Answer 3

Question 4

Which is which?

Answer 4

Question 5

Which is which?

Answer 5

Question 6

Clinical presentation

Answer 6

Question 7

Investigations for IBD (2)

Answer 7

1. Stool analysis (leukocytes, occult blood)
2. Endoscopy w/biopsy

Question 8

Non-pharmacological management of IBD (2)

Answer 8

1. Probiotics
2. Faecal transplant

Question 9

Pharmacological management of IBD (3)

Answer 9

1. Prednisolone/methylprednisolone
   * Budesonide in elderly and children
2. Mesalazine
3. Other steroid-sparing immunosuppresive drugs

• TNF inhibitors
• Azathioprine
• Methotrexate (Crohn’s only)
• 6-mercapopruine

Question 10

Indications for surgery (12)

Don’t have to remember

Answer 10

1. Failed medical therapy
2. Fistulae
3. Free perforation
4. Carcinoma
5. Bowel obsturction
6. Fulminant colitis
7. Massive bleeding
8. Extra-colonic manifestations
9. Intra-abdominal abscess
10. Toxic megacolon
11. Carcinoma prevention
12. Growth retardation (children)

Surgeries involve bowel resection, strictureplasty and temporary or permanent bypass

Question 11

Complications of UC (4)

Answer 11

1. Toxic megacolon
2. Pyoderma gangrenosum
3. Primary slerosing cholangitis
4. Colorectal cancer

Question 12

Complications of Crohn’s (6)

Answer 12

1. Perforation
2. Fistula formation
3. Malnutrition - anaemia, osteoporosis
4. Arthritis
5. Non-thyroidal illness syndrome
6. Uveitis

Crohn’sh as a high recurrence and is incurable.