Inflammatory Bowel Disease

Question 1

what 2 main diseases does this encompass

Answer 1

crohn’s and UC

Question 2

what is causes

Answer 2

genetic (stronger in crohns)
impaired mucosal immunity
environmental (smoking causes crohn’s but makes UC better)

Question 3

genes linked to IBD

Answer 3

NOD2/CARD15 on chromosome 16

Question 4

how is it diagnosed

Answer 4

increased CRP
decreased Hb and albumin 
stool microscopy/culture 
malabsorption deficiencies (vit B12)
AXR in UC to query toxic megacolon

Question 5

how are they treated

Answer 5

5-ASA (mesalazine - mostly UC)
steroids (prednisolone/budesonide)
immunosuppression (azathioprine/methotrexate)
anti-TNF (IV infliximab)
surgery

Question 6

difference in location

Answer 6

crohns - anywhere

UC - colon and rectum

Question 7

difference in skip lesions

Answer 7

crohns - common

UC - rarely skips

Question 8

difference in bowel wall

Answer 8

crohns - thickened bowel and stricture

UC - mucosal ulceration and thin wall

Question 9

difference in inflammation

Answer 9

crohns - transmural

UC - superficial

Question 10

difference in granulomas

Answer 10

crohns - present

UC - none

Question 11

difference in fistula

Answer 11

crohns - common

UC - rare

Question 12

difference in cancer risk

Answer 12

crohns - moderate

UC - high

Question 13

what is pathological appearance of crohns

Answer 13

cobblestone appearance
pseudopolyps 
fissures 
non-caseting granuloma in 50%
TH1 mediated

Question 14

age range of crohns

Answer 14

most in 20s and male

Question 15

symptoms of crohns

Answer 15

abdominal cramps 
diarrhoea 
weight loss
bleeding PR
anaemia 
painful ulcers 
abscesses

Question 16

how is crohns diagnosed

Answer 16

endoscopy - patchy, segmental disease with skip lesions and cobblestone appearance

mucosal biopsy - transmural inflammation, deep knife like fissuring ulcers, patchy

Question 17

surgery used in crohns

Answer 17

resection
stricturoplasty
fistula repair

Question 18

what are complications of crohns

Answer 18

malabsorption 
short bowel syndrome 
vitamin deficiencies - anaemia 
fistulas 
bowel obstruction 
perforation 
malignancy 
amyloidosis

Question 19

pathology of UC

Answer 19

distorted crypt architecture (crypt abscesses)
inflammatory cell infiltrate
TH1 and TH2 mediated

Question 20

age range for UC

Answer 20

20-40 year olds but variable

Question 21

symptoms for UC

Answer 21

diarrhoea + bleeding + mucus
increased bowel frequency 
urgency 
tenesmus 
incontinence 
night rising 
LIF pain 
weight loss

Question 22

how to define severe UC

Answer 22

> 6 bloody stools/day and 1 of fever, tachycardia or anaemia

Question 23

how is UC diagnosed

Answer 23

endoscopy - diffuse continuous disease

biopsy - diffuse mucosal colitis, inflammatory cells, basal lymphoplasmatic infiltrate with irregular shaped branching crypts (may become abscesses)

Question 24

what surgery used to treat UC

Answer 24

proctocolectomy (remove colon and rectum) with end ileostomy / with ileorectal anastomosis / with pouch

Question 25

what are complications of UC

Answer 25

toxic megacolon (persistent inflammation causes loss of muscle tone leading to distension)
primary sclerosing cholangitis
extra-intestinal manifestations
colorectal cancer