Inflammatory Bowel Disease

Question 1

what is the name of the condition which fits neither crohn or ulcerative colitis?

Answer 1

indeterminate colitis

Question 2

what classification is used to indicate the type/severity of IBD?

Answer 2

montreal classification

Question 3

what indicates severe ulcerative colitis?

Answer 3

passage of > 6 stools per day 
tachycardia (pulse > 90)
fever (temp > 37.5)
Anaemia (Hb <105 g/l)
CRP raised
low albumin (<30g/l)
Leukocytosis and thrombocytosis

Question 4

what is the name for UC which is limited to the rectum?

Answer 4

proctitis

Question 5

what are the main differences between UC and crohn’s?

Answer 5

ulcerative colitis is continuous inflammation which extends from the rectum (restricted ti just the colon)
crohn’s can occur from mouth to anus , patchy inflammation.
inflammation of crohns is of full thickness of the wall whereas UC is superficial

Question 6

what feature is present in the histology crohns which isn’t found in UC?

Answer 6

non-caseating granulomas

Question 7

in what age(s) is crohn’s and UC more prominent?

Answer 7

crohn's - 2 peaks of incidence
1. early adulthood 20-40
2. elderly >60 
(can also occur in children)
UC
1. peak at 20-40yrs

Question 8

what are the clinical features of ulcerative colitis?

Answer 8

bloody diarrhoea
abdominal pain
weight loss

Question 9

what are the clinical features of crohn’s?

Answer 9

diarrhoea
abdominal pain
weight loss
malaise, low grade fever, fatigue, anorexia, nausea and vomiting
malabsorption may cause anaemia and vitamin deficiency
slow, progressive, non-specific presentation which is hard for diagnosis

Question 10

what are the complications of crohn’s?

Answer 10

(crohns causes full thickness inflammation making the wall very thin. the inflammation tries to re-heal by fibrosis which can result in strictures and fistulas)

• inflammation
• stritctures
• fistulas

Question 11

what are the differences in histology between UC and crohn’s?

Answer 11

crohns = non caseating granulomas
UC = goblet cells are absenT
Absence of crypt cells more common in UC than in crohns

Question 12

what is the pyramid of treatment for crohns and UC?

Answer 12

(bottom - top)
5-ASA's or sulfasalazine 
prednisolone or budenoside 
immunosuppresseurs (AZA or 6-MP or MTX)
biologic agents
surgery

Question 13

what are people with ulcerative colitis at risk of?

Answer 13

colonic cancer

Question 14

what is the risk of someone with ...
1) pancolitis UC
2) left colitis UC
3) proctitis UC
getting colonic cancer ?

Answer 14

pancolitis 26x normal risk
left colitis 8x normal risk
proctitis = normal risk

Question 15

when do people with extensive UC get surveillance colonoscopy?

Answer 15

people which have had extensive disease for;
8-10 yrs = every 3 years
30-40yrs = every 2 yrs
>40yrs = annually

Question 16

when is surgery for crohns indicated?

Answer 16

failure of medical treatment
obstructive symptoms 
fistula
intra-abdominal abscess
anal conditions
failure to thrive

Question 17

what are the surgical options for acute and chronic ulcerative colitis?

Answer 17

acute; subtotal colectomy with ileostomy and preservation of the rectum
(they will then go on to get further surgery =>)

chronic; proctectomy with ileostomy or ileo-anal pouch procedure (no ileostomy)

Question 18

in what gender is UC and crohns most common in?

Answer 18

UC - F>M

crohns M=F

Question 19

what are the extra intestinal manifestations of IBD?

Answer 19

eyes: uveitis, episcleritis, conjunctivitis 
joint - sacroiliitis, monoarticular arthritis, ankylosing spondylitis 
renal calculi (crohns)
liver and biliary tree - gallstones, primary scleroing cholangitis, pericholangitis ,fatty change
skin - pyoderma gangrenous, erythema nodosum, vasculitis

Question 20

what marker in stool can detect IBD?

Answer 20

calprotectin

protein which is an inflammatory marker

Question 21

what is the aetiology of IBD?

Answer 21

unknown
environmental triggers i.e. diet
genetic susceptibility

Question 22

what are the complications of ulcerative colitis?

Answer 22

haemorrhage
perforation
toxic dilatation (toxic megacolon)

Question 23

what is the management for a severe attack of ulcerative colitis?

Answer 23

asses fluid status
IV hydrocortisone
prophylactic anticoagulation