Inflammatory Bowel Disease

Question 1

which has a sharp cut-off?

Answer 1

ulcerative colitis

U | C

Question 2

spread of UC

Answer 2

starts at rectum, continuously moves distally

no further than ileocaecal valve

Question 3

which just affects mucosa and has NO granuloma?

Answer 3

UC - continuous and shallow

Question 4

What is Chron’s associated with?

Answer 4

altered cell-mediated immunity
smoking increases risk
NSAIDs may exacerbate disease

Question 5

features chron’s

Answer 5

deep fissuring ulcers (transmural granulomatous inflammation)
fibrous scarring and cobblestone
narrow lumen, thickened wall

Question 6

location of Chron’s

Answer 6

discontinuous
anywhere from mouth to anus

esp. terminal ileum

Question 7

fibrous scarring and cobblestone

narrow lumen, thickened wall

Answer 7

Chron’s

Question 8

epidemiology

Answer 8

most common in western

Px usually teens + twenties

Question 9

IBD aetiology

Answer 9

1. genetic susceptibility,
2. the environment
3. host immune response

Question 10

smoking

Answer 10

increases risk for CD

reduced risk for UC

Question 11

host immune response

Answer 11

IBD results from defective mucosal immune system producing an abnormal response to luminal antigens

Question 12

Clinical features CD

Answer 12

depend on region of involved bowel

ileocaecal is the most common

abd pain, weight loss, diarrhoea, fever etc.

Question 13

Clinical features UC

Answer 13

diarrhoea, often bloody and mucus

Question 14

blood tests

Answer 14

anaemia is common

Acute CD: raised ESR, CRP and platelets

Question 15

radiology + imaging

Answer 15

rigid or flexible sigmoidoscopy

rectal biopsy

colonoscopy
SB imaging

Question 16

Tx mild UC

Answer 16

5-ASA e.g.sulfasalazine

Question 17

Tx moderate UC

Answer 17

if 4-6 motions/day but otherwise well, try prednisolone

Question 18

Tx severe UC

Answer 18

> 6 months.

admit for NBM & IV hydration

hydrocortisone
rectal steroids

Question 19

Tx for proctitis (inflammation of rectum + anus)

Answer 19

suppositories

Question 20

surgery for UC

Answer 20

proctocolectomy + terminal ileostomy

Question 21

Tx mild attacks in CD

Answer 21

prednisolone

Question 22

what kind of diet for CD?

Answer 22

low residue diets

Question 23

Tx severe attacks in CD

Answer 23

admit for IV steroids, NBM
hydrocortisone
? blood transfusion