Inflammatory Bowel Disease

Question 1

Within what population is ulcerative colitis most common?

Answer 1

Peak incidence 20-40 years old

More common in females

Question 2

Describe the aetiology of ulcerative colitis

Answer 2

40% attributable to genes (GWAS)

Environmental triggering factors: diet, vaccination history, social factors)

Question 3

How does ulcerative colitis present?

Answer 3

Bloody diarrhoea
Abdominal pain
Weight loss

Question 4

Which of ulcerative colitis and Crohn’s disease causes continuous inflammation and which causes patchy disease?

Answer 4

Ulcerative colitis- continuous

Crohns- patchy

Question 5

Which of ulcerative colitis and Crohn’s disease affects only the colon and which affects the whole GI tract?

Answer 5

Ulcerative colitis- only affects colon

Crohns- affects mouth to anus

Question 6

What are the markers of a severe attack of ulcerative colitis?

Answer 6

>6 stools a day with blood
AND 
Fever
Tachycardia 
ESR raised
Anaemia 
Albumin <30g/L
Leucocytosis 
Thrombocytosis

Question 7

What gender and age group is Crohn’s disease most common in?

Answer 7

Incidence in males equal to females

Two peaks- early adulthood (20-40) and over 60s (F>M)

Question 8

What are the clinical features of Crohn’s disease?

Answer 8

Diarrhoea 
Abdominal pain 
Weight loss 
Malaise 
Lethargy 
Anorexia 
Nausea & vomiting 
Low-grade fever 
Malabsorption

Question 9

What are the complications of Crohn’s disease?

Answer 9

Inflammation
Stricture
Fistula

Question 10

What are the histological differences in ulcerative colitis and Crohn’s disease?

Answer 10

Granulomas present in Crohn’s
Goblet cells depleted in ulcerative colitis
Crypt abscesses more common in ulcerative colitis than Crohn’s

Question 11

What are the potential long term complications of colitis?

Answer 11

Colonic carcinoma (more at risk in pancolitis)

Question 12

How often should surveillance colonoscopy be done in extensive colitis?

Answer 12

8-20 years- 3 yearly
30-40 years- 2 yearly
40+ years- annually

Question 13

What medical management can be given for IBD as out patient?

Answer 13

5ASA
Steroids
Immunosuppression

Question 14

What medical management can be given for IBD in hospital?

Answer 14

Steroids
Anticoagulation
Rest
Other- cyclosporin, infliximab, surgery

Question 15

What criteria would indicate failure of medical therapy or IBD?

Answer 15

Requiring recurrent courses of steroid
Relapse prior to or shortly after stopping therapy
Failure to control symptoms
Unacceptable complications of steroids (diabetes, severe osteoporosis, psychosis)

Question 16

What criteria would be classed as a poor response to medical therapy of IBD?

Answer 16

Fistulae
Fibrotic strictures
Peri-anal disease
Severe fulminating disease

Question 17

What possible surgical interventions are there for Ulcerative colitis?

Answer 17

Total colectomy
Rectal preservation
Ileostomy

Question 18

What are the surgical options for management of Crohn’s?

Answer 18

Small intestine
Ileocaecal area
Colon and rectum
Pouch procedures (?)

Question 19

What are the indications for surgery in Crohn’s disease?

Answer 19

Failure of medical management 
For relief of obstructive symptoms
Management of fistulae
Management of abdominal abscess
Managing anal conditions
Failure to thrive