Inflammatory bowel disease

Question 1

Common site of Crohn’s disease?

A) Rectum
B) Lower oesophagus
C) Terminal ileum
D) Jejunum

Answer 1

Answer: C) Terminal ileum

Crohn’s disease appear as skip-lesions and non-continuous ulcerations anywhere from the mouth to the gut.

Question 2

Ulcerative colitis typically affects colon transmural.

1) True
2) False

Answer 2

Answer: 2) False

Ulcerative colitis affects colon mucosa and submucosa.
Crohn’s disease affects transmural colon.

Question 3

What are common complications of Crohn’s disease?

Answer 3

1. Fistula formation (enterovaginal, enterovesical, enterocutaneous, enterovaginal, enteroentero)
2. Strictures from inflammation
3. Perforation +/- peritonitis
4. Colonic adenocarcinoma
5. Malnutrition, medication side effects, electrolyte disturbances

Question 4

Which extra-intestinal manifestations are common?

1) Clubbing, oral ulcers, discoid rash, xanthelsma
2) Scleritis, ankylosing spondylitis, cholesterol stones, PE
3) Jaundice, psoriasis, hepatomegaly, renal failure
4) Peripheral arthritis, gout, autoimmune thyroiditis

Answer 4

Answer: 2) Scleritis, ankylosing spondylitis, cholesterol stones, PE

IBD extra-intestinal manifestations commonly affects lesions of skin, eyes, mouth, joints, hepatobiliary, renal, vascular and vitamin deficiencies.

Question 5

What are common complications of ulcerative colitis?

Answer 5

• Toxic megacolon (+/- perforation risk)
• Haemorrhage
• Colonic adenocarcinoma
• Malabsorption/malnutrition

Question 6

What are colonic pseudopolyps and in which IBD do they occur?

Answer 6

Colonic pseudopolyps are islands of isolated mucosa, caused by areas of regeneration, causing the mucosa to bulge upwards. It is most commonly present in ulcerative colitis.

Note: There is diffused mucosal hyperplasia, hyperaemic and oedematous. Long gutter-like ulcerations between swollen ridges can be seen.

Question 7

List the medications/interventions in order of first line, second line, third line and fourth line of treatment:

Sulfasalazine, infliximab, mercaptopurine, methotrexate, surgical colectomy, carbamazepine, prednisolone, azathiopurine, hydrocortisone

Answer 7

First line: sulfasalazine + prednisolone

Second line: Azathiopurine/mercaptopurine

Third line: methotrexate/infliximab + (if UC) surgical colectomy

Fourth line: hydrocortisone

*Maintenance: sulfasalazine

Question 8

In which IBD do you see ‘cobble stone’ appearance, with non-caseating granulomas?

Answer 8

Crohn’s disease

Question 9

What is C. difficile pseudomembranous colitis? What gram stain is C.diff?

Answer 9

C. diff pseudomembranous colitis is a common nosocomial infection associated with high mortality rates in elderly patients. It is commonly caused by use of antibiotics that alter the normal flora of the gut and allows C. diff growth.

It is gram positive bacteria.

Question 10

Which antibiotics cause C. diff infection colitis? (Three classes that may aim at C. diff gram stain)

Answer 10

Penicillins, cephalosporins (2nd, 3rd gen), clindamycin

Question 11

Which antibiotics can treat C.diff pseudomembranous colitis?

Answer 11

Use vancomycin or metronidazole.