Inflammatory Bowel Disease

Question 1

What are the two types of IBD?

Answer 1

Ulcerative Colitis

Crohn’s disease

Question 2

What does Crohn’s clinically present with?

Answer 2

Abdominal pain

Peri-anal disease

Question 3

What does UC clinically present with?

Answer 3

Diarrhoea

Bleeding

Question 4

What are the genetic factors in IBD?

Answer 4

NOD2/ CARD15 (IBD-1)

Question 5

What is the genetic pathology underlying IBD?

Answer 5

A mutated form of NOD2
Encodes a protein involved in bacterial recognition
NOD2 contributes to normal mucosal defences.

Question 6

What is the role of gut flora in IBD?

Answer 6

Diverting faecal stream helps Crohn’s.

Altered bacterial flora in colons with UC.

Question 7

What is the effect of overactive effector T-cells cause?

Answer 7

Inflammation/ Disease

Question 8

What is the effect of absent regulatory T-cells?

Answer 8

Uncontrolled Inflammation/ Aggressive Disease

Question 9

Which form of IBD is a Th1 mediated disease?

Answer 9

Crohn’s

Question 10

Which form of IBD is a mixed Th1/ Th2 mediated disease?

Answer 10

UC

Question 11

Which form of IBD is associated with natural killer T-cells?

Answer 11

UC

Question 12

What is the effect of smoking on Crohn’s disease?

Answer 12

Aggravates disease

Question 13

What is the effect of smoking of Ulcerative Colitis?

Answer 13

Protects against UC

Question 14

What type of drug is associated with contributing to IBD?

Answer 14

NSAIDs

Question 15

What is UC?

Answer 15

Inflammation of the colon.

Question 16

What age is the peak incidence?

Answer 16

20s-30s

Question 17

Which type of IBD affects rectum extending proximally?

Answer 17

UC

Question 18

What are the common diseases of UC?

Answer 18

Pancolitis
Proctitis
Left-sided colitis

Question 19

What are the symptoms of UC?

Answer 19

Diarrhoea
Bleeding
Increased bowel frequency
Urgency
Tenesmus
Incontinence
Night rising
Lower abdominal pain (esp. LIF)

Question 20

What symptom can proctitis cause?

Answer 20

Constipation

Question 21

What tests would you do for UC?

Answer 21

FBC
CRP
Albumin
Plain AXR
Endoscopy
Histology

Question 22

What would you see on AXR for UC?

Answer 22

Stool distribution: Absent in inflamed colon.
Mucosal oedema/ “thumb-printing”
Toxic megacolon

Question 23

What would you see on endoscopy for UC?

Answer 23

Confluent inflammation extending proximallty from anal margin to a “transition zone”
Loss of vessel pattern
Granular mucosa
Contact bleeding

Question 24

Which form of IBD causes loss of vessel pattern (seen on endoscopy)?

Answer 24

UC

Question 25

Which form of IBD causes confluent inflammation extedning proximally from anal margin to a "transition zone"?

Answer 25

UC

Question 26

Which type of cancer does UC give an increased risk of?

Answer 26

Colorectal caner

Question 27

What determines the risk of developing colorectal cancer from UC?

Answer 27

Severity of inflammation Duration of disease Disease extent

Question 28

What extra-intestinal manifestation(s) of UC would present in the patient's mouth?

Answer 28

Stomatitis | Apthou ulcers

Question 29

What extra-intestinal manifestation(s) of UC would present in the patient's eyes?

Answer 29

Episcleritis | Uveitis

Question 30

What is primary sclerosing cholangitis? | PSC

Answer 30

Chronic inflammatory disease of biliary tree | associated with IBD

Question 31

What symptoms are caused by primary sclerosing cholangitis?

Answer 31

Itch | Rigors

Question 32

What effect does primary sclerosing cholangitis have on LFTs?

Answer 32

Causes cholestatic LFTs

Question 33

Which form of IBD causes skip lesions?

Answer 33

Crohn's

Question 34

Which form of IBD causes Transmural inflammation?

Answer 34

Crohn's

Question 35

What is involved in peri-anal disease?

Answer 35

Recurrent abscess formation Pain Can lead to fistula with persistent leakage Damaged sphincters

Question 36

What are the consequences of long-term crohn's disease?

Answer 36

Stricture Fistula Abscess

Question 37

What are the symptoms of Crohn's disease affecting the small intestine?

Answer 37

Abdominal cramps Diarrhoea Weight loss

Question 38

What are the symptoms of Crohn's disease affecting the colon?

Answer 38

Abdominal cramps Diarrhoea with blood Weight loss

Question 39

What are the symptoms of Crohn's disease affecting the mouth?

Answer 39

Painful ulcers Swollen lips Angular chielitis

Question 40

What are the symptoms of Crohn's disease affecting the anus?

Answer 40

Peri-anal pain | Abcess

Question 41

What blood tests would you carry out for suspected crohn's

Answer 41

``` CRP Albumin Platelets B12 Ferritin ```

Question 42

What would colonoscopy show for crohn's disease?

Answer 42

"cobblestoning" thickened wall fat-wrapping (fissure?)

Question 43

What would colonoscopy show for UC?

Answer 43

Ulceration Surviving Mucosa (Pseudopolyps) Loss of haustra

Question 44

Which form of IBD may be present unrecognised for years?

Answer 44

Crohn's

Question 45

Which form of IBD has recurring periods of "flare-ups" and remission?

Answer 45

Crohn's

Question 46

Which form of IBD has a history of weeks

Answer 46

UC

Question 47

Which form of IBD causes vomitting and nausea??

Answer 47

Crohn's

Question 48

Which form of IBD is continuous from rectum up to colon?

Answer 48

UC

Question 49

Which form of IBD affects terminal ileum and may involve colon, stomach, mouth etc?

Answer 49

Crohn's

Question 50

What is seen histologically with Crohn's disease?

Answer 50

Granuloma

Question 51

What is seen histologically with UC?

Answer 51

Shortened and branched crypts | Plasma cell infiltrates

Question 52

What symptom of IBD affects the skin?

Answer 52

Pyoderma gangrenosum

Question 53

What effect does IBD have on the blood?

Answer 53

Anaemia

Question 54

First line drug for IBD? | for decades

Answer 54

5-AS