Inflammatory bowel disease

Question 1

What are the histological features of Crohn’s?

Answer 1

Transmural distribution with skip lesions
focal inflammation
+/- non caseating granulomas
deep fissuring + aphthous ulcerations, strictures
Glands intact

Question 2

3 radiologic features of Crohn’s

Answer 2

1. Cobblestone mucosa
2. Frequent strictures and fistulae
3. AXR: Bowel wall thickening “String sign”

Question 3

3 Cx of Crohn’s

Answer 3

1. Strictures
2. Fistulae
3. Perianal disease

Question 4

Risk of colon cancer in Crohn’s

Answer 4

Increased if >30% of colon involved (but not as high as UC)

Question 5

Px of Crohn’s (esp C.f. UC)

Answer 5

• common fever
• common recurrence after surgery
• uncommon rectal bleeding
• less prevalent diarrhoea
• post-prandial/colicky abdo pain
• frequent RLQ palpable mass

Question 6

Px of UC (esp c.f. Crohn’s)

Answer 6

• very common rectal bleeding (90%)
• frequent small stool diarhoea
• less common abdo pain
• uncommon fever
• common urgency/tenesmus
• rare palpable mass
• no recurrence post-colectomy

Question 7

Endoscopic features of UC

Answer 7

• continuous diffuse inflammation
• erythema
• friability
• loss of normal vascular pattern
• pseudopolyps

Question 8

Histological features of UC

Answer 8

• mucosal distribution
• continuous disease (no skip lesion)
• granulomas absent (c.f. Crohn’s)
• gland destruction
• crypt abscess

Question 9

Radiologic features of UC

Answer 9

• lack of haustra

- strictures are rare & suggests complicating cancer

Question 10

Cx of UC

Answer 10

Toxic megacolon

Question 11

Colon cancer risk in UC

Answer 11

Increased except in proctitis (inflammation of rectum & anus)

Question 12

What are the endoscopic features of Crohn’s disease?

Answer 12

Ulcers (aphthous, stellate, linear)
patchy lesions
pseudopolyps
cobblestoning