Inflammatory Bowel Disease

Question 1

diarrohoea

Answer 1

more than three episode of loose stool within 24 hours

Question 2

IBD

Answer 2

2 idiopathic chronic inflammatory diseases

ulcerative colitis
crohns disease

Question 3

IBD - commonalities

Answer 3

epidemiology
clinical
therapeutic characteristics

Question 4

IBD - differences

Answer 4

clinical -
abdominal pain and peri-anal disease = crohns
diarrhoea and bleeding = ulcerative colitis

pathology

Question 5

pathogenesis of IBD

Answer 5

genetic predisposition
environmental triggers
mucosal immune system

Question 6

NOD2/CARD15 (IBD-1)

Answer 6

disease susceptibility gene located on chromosome 16q12

mutated form of NOD2 found in 10-20% of Caucasian patients with crohns disease

homozygotes - 20-40
heterozygotes - 2-4

encodes a protein involved in bacterial recognition

Question 7

gut flora

Answer 7

indispensible to the development of animal models of colitis

antibiotics effective in the treatment of peri-anal crohns disease

diverting faecal stream helps crohns

altered bacterial flora in colons with UC

Question 8

crohns immunological factors

Answer 8

Th1 mediated disease

Question 9

ulcerative colitis immunological factors

Answer 9

mixed Th1/Th2 mediated disease

Question 10

environmental factors

Answer 10

smoking - aggravates crohns disease but protects against ulcerative colitis

NSAIDS

Question 11

UC

Answer 11

peaking incidence in 20-30s

affects rectum extending proximally
procitis, left-sided colitis, pancolitis

Question 12

UC - symptoms

Answer 12

diarrhoea and bleeding

increased bowel frequency
urgency
tenesmus
incontinence
night rising
lower abdominal pain

proctitis can cause constipation

Question 13

UC -history

Answer 13

recent travel
antibiotics
NSAIDS
family history 
smoking
skin, eyes, joints

get multiple stool samples

Question 14

UC - severity

Answer 14

> 6 bloody stools in 24 hours

plus
fever
tachycardia
anaemia
elevated ESR

bloods
CRP
albumin

plain AXR
endoscopy
histology

Question 15

plain AXR

Answer 15

stool distribution - absent in inflammed colon

mucosal oedema/’thumb-printing’
patient is at risk of developing toxic megacolon

Question 16

endoscopy

Answer 16

define extent

confluent inflammation extending proximally from anal margin to a transition zone

loss of vessel pattern
granular mucosa

contact bleeding

Question 17

pseudopolyps in UC

Answer 17

might disappear once inflammation calms down

never extends past mucosal layer

Question 18

UC longterm complication

Answer 18

increased risk of colorectal cancer

determined by severity of inflammation duration of disease
disease extent

Question 19

UC - extra-intestinal maifestations

Answer 19

skin
joints
eyes
deranged LFTs
oxalate renal stones

Question 20

primary sclerosis cholangitis

Answer 20

chronic inflammatory disease of biliary tree

Question 21

distribution of Crohns disease

Answer 21

can affect any region of GI tract from mouth to anus

transmural inflammation

colonic crohns increasing in incidence

Question 22

peri-anal disease

Answer 22

recurrent abscess formatoin
pain
can lead to fistula with persistent leakage
damaged sphincters

Question 23

crohns symptoms

Answer 23

small intestine
abdominal cramps (peri-umbilical), diarrhoea, weight loss

colon
abdominal cramps (lower abdomen), diarrhoea with blood, weight loss

mouth
painful ulcers, swollen lips, angular chielitis

anus
peri-anal pain, abscess

Question 24

crohns further assessment

Answer 24

clinical exam
evidence of weight loss, RIF mass, peri-anal signs

bloods
CRP, albumin, platelets, B12 (t, ileum), ferritin

stage disease extent

colonoscopy - save to have bowel prep

Question 25

small bowel assessment

Answer 25

barium follow-through
small bowel MRI
technetium-labelled white cell scan

Question 26

IBD clinical summary

Answer 26

common conditions
known differences between UC and cronhs
know how to assess severity of acute flare
further reading required