Inflammatory Bowel Disease

Question 1

Smoking aggravates ___1____ but is protective for ___2____

Answer 1

1 crohns

2 ulcerative colitis

Question 2

What group of drugs can aggravate IBD symptoms?

Answer 2

NSAIDs

Question 3

Ulcerative colitis confined to the rectum is called ___1___

If it affects the rectum and descending colon it is called ___2___ If it affects the whole colon it is called ___3___

Answer 3

1 proctitis
2 left sided colitis
3 pancolitis

Question 4

Thumbprinting on X ray means patient is at risk of

Answer 4

toxic megacolon

Question 5

Toxic megacolon is risk if

Answer 5

Transverse >5.5cm or Caecum >9cm

Question 6

What happens in crohns peri-anal disease?

Answer 6

• Recurrent abscess formation
• Pain
• Can lead to fistula with persistent leakage
• Damaged sphincters

Question 7

Presentation of crohns disease?

Answer 7

Diarrhoea, abdominal pain, weight loss, malaise, lethargy, anorexia, vomiting and low grade fever. On examination patients may have mouth ulcers and anal tags, fissures or abscesses. Anaemia is also common.

Question 8

What lifestyle advice is given to those with Crohns?

Answer 8

Counselling about smoking and diet advice

Question 9

Drugs steps in Crohns?

Answer 9

1 Steroids
2 Immunosuppressants
3 Anti-TNF therapy

Question 10

When are steroids used in Crohns and UC?

Answer 10

When the patient is having an acute flare up.

Question 11

What steroids are usually given in IBD? What are the side effects?

Answer 11

Prednisolone
• MSK side effects: avascular necrosis, osteoporosis, GI
• Cutaneous: Acne and thinning of skin
• Metabolic: weight gain, diabetes risk, hypertension risk, neuropsychiatric disturbances (high on steroids or depression), cataracts, growth failure

Budesonide can be given if can’t tolerate prednisolone

Question 12

What are immunosuppressants used for in Crohns? What is the main agent?

Answer 12

Maintenance therapy

Azathioprine

Question 13

Anti-TNF therapy examples? What are they used for?

Answer 13

Infliximab and Adalimumab
Crohns and UC
Get as injections as part of long term strategy in conjunction with other treatment

Question 14

Is surgery for crohns curative? What do you need to do?

Answer 14

Not curative so need to minimise the amount of bowel you take out

Question 15

Major symptom of UC? What may patients also suffer from?

Answer 15

Diarrhoea with blood and mucus, sometimes accompanied by lower abdominal discomfort

Patients may also suffer from malaise, leathery and anorexia with weight loss.

Question 16

What may patients complain of if they only have proctitis?

Answer 16

Urgency as well as tenesmus

Question 17

Stepwise drug treatment of UC?

Answer 17

1) 5ASA (mesalazine)
2) Steroids
3) Immunosuppressants
4) Anti-TNF Therapy

Question 18

Describe 5ASA?

Answer 18

Works topically on the mucosal layer with anti-inflammatory properties and reduction in colon cancer risk. Some patients get side effects of diarrhoea and nephritis.

Question 19

When are immunosuppressants used in UC?

Answer 19

When need to suppress inflammation more than with just steroids

Question 20

Is surgery in ulcerative colitis curative? What does it eliminate?

Answer 20

It is curative and it eliminates the long term risk of cancer

Question 21

Indications for UC surgery?

Answer 21

Acute attack due to failure of medical treatment, toxic dilatation, haemorrhage, imminent perforation, unresponsive to treatment or steroid dependent and dysplasia observed on surveillance colonoscopy

Question 22

Examples of surgery for UC?

Answer 22

Colectomy (this can be semi, subtotal or total) with end ileostomy, protectomy (take out colon and rectum) with permanent ileostomy or ileoanal pouch