Inflammatory Bowel Disease

Question 1

Contrast the epidemiology of Crohn’s and UC.

Answer 1

Crohn’s:

• 5-10/10,000 per year
• male=female
• peaks at 15yrs-30yrs and at 60yrs-80yrs

UC:

• 10-20/100,000 per year
• male=female
• peaks at 10yrs-40yrs

Question 2

Contrast the site and aetiology of Crohn’s and UC.

Answer 2

Crohn’s:

• genetic component (15% +ve FHx)
• smoking increases risk x 3-4
• entire GI tract (usually terminal ileum)

UC:

• unknown aetiology (?response to environmental triggers in genetically susceptible individuals)
• in rectum and colon only

Question 3

Contrast the signs and symptoms of Crohn’s and UC.

Answer 3

Crohn’s: depends on area of GI tract affected

• malaise
• anorexia
• weight loss
• intermittent diarrhoea/constipation
• abdominal pain
• mouth ulcers
• recurrent perianal abscesses
• fistula symptoms
• mucus in stool
• uveitis
• ankylosing spondylitis
• erythema nodosum

UC:

• (bloody) diarrhoea
• abdominal pain
• urgency
• malaise
• fever
• weight loss
• joint pain
• sore eyes
• cutaneous symptoms

Question 4

Contrast the treatment of Crohn’s and UC.

Answer 4

Crohn’s:

• medical: topical/enema/PO/IV steroids + mesalazine + azathioprine + methotrexate
• surgical indications: failed medical treatment, fistula +/- abscess, obstruction secondary to strictures, cancer, haemorrhage, perforation, growth retardation
• surgery not curative (can reoccur anywhere along GI tract)

UC:

• medical: topical/enema/PO/IV steroids + mesalazine + ciclosporin + infliximab
• surgical indications: failed medical treatment, haemorrhage, perforation, cancer, extra-intestinal manifestations
• surgical resection: ileostomy/pouch operation

Question 5

What is short bowel syndrome?

Answer 5

Repeated small bowel resections (or dysfunction of large segments of bowel) causes malabsorption (weight loss, diarrhoea, steatorrhoea, fluid loss, abdominal pain, fatigue, etc.).

Leave at least 50cm of bowel to avoid (20cm-25cm of small bowel and colon)

Question 6

What are the types of inflammatory bowel disease?

Answer 6

• Crohn’s/ulcerative colitis
• pseudomembranous colitis
• C. difficile enteritis
• diverticular disease (acute)
• sarcoidosis
• TB enteritis
• radiation enteritis
• typhoid
• shigella

Question 7

What are the key investigations in IBD?

Answer 7

• FBC ?leucocytosis
• CRP
• AXR
• CT scan
• small bowel barium enema: NG + barium; look for strictures/fistulae
• US
• colonoscopy/flexible sigmoidoscopy
• capsule endoscopy: rule out strictures first

Question 8

What are the key investigations in IBD?

Answer 8

• FBC ?leucocytosis
• CRP
• AXR
• CT scan
• small bowel barium enema: NG + barium; look for strictures/fistulae
• US
• colonoscopy/flexible sigmoidoscopy
• capsule endoscopy: rule out strictures first

Question 9

What is Hartmann’s procedure?

Answer 9

Sigmoid colectomy where proximal end of bowel is brought out as an end-colectomy and rectal stump is stapled/oversewn and left (can later re-operate to close stoma or re-anastomose)