Inflammatory Bowel Disease

Question 1

Ulcerative colitis - where is it confined to ?

Answer 1

The colon and the rectum

Question 2

What age(s) is ulcerative colitis most common?

Answer 2

15-25 years

55-65 years

Question 3

Chrons - where is it confined to?

Answer 3

Can be anywhere in the GI tract from the lips to the anus but the majority of cases involved the colon, the ileum or a combination of two (ileocolonic)

Question 4

What can increase the risk of chrons?

Answer 4

smoking

genes (more so than ulcerative colitis)

Question 5

Other investigations we can do with patients with IBD?

Answer 5

• faecal cal protection - a stool test to detect inflammation in the intestines and is usually raised with patients with active disease
• CRP - raised in active disease
• FBC - patients can often be anaemic. Patients with CD affecting their terminal alum are at risk of fit B12 deficiency since this is where the vitamin is absorbed.

Question 6

Methotrexate can be used for chrons or ulcerative colitis?

Answer 6

CHRONS ONLY

Question 7

Aminosalicylates are more effective in

Answer 7

ulcerative colitis or patients with churns which is restricted to the colon.
They also reduce the risk of colon cancer associated with UC.

Question 8

What levels are checked before starting azathioprine or mercaptopurine??

Answer 8

Thiopurine -methyltransferase (TPMT)
dose reductions are needed in patients with intermediate activity and these drugs should be avoided in patients with low or no TPMT activity.

Question 9

What patients are candidates for surgery?

Answer 9

Patients that are dependant on steroids and relapse when they stop taking them

Question 10

How are acute exacerbations of UC treated?

Answer 10

• Depends on the severity but it is usually:
• hydrocortisone 100mg QDS which is then switched to oral prednisolone 40mg daily which is continued for 2 weeks until tapered
• hydration due to diarrhoea
• electrolyte replacement - usually K+ and Mg.
• LMWH even if there is blood in the stools they are a high risk of VTE.

Question 11

What would we do if pt did not respond to steroids in a flare up of UC

Answer 11

• biologic - infliximab
• IV ciclosporin (unlicensed indication)
• emergency colectomy

Question 12

How do we treat an acute exacerbation of chrons?

Answer 12

• If it is just colonic involvement then we treat it the same as UC.
• If it is more bowel we can give dietary advice
• also offer smoking cessation to this cohort of people.
• biologic - infliximab

Question 13

What effect dose smoking having on IBD?

Answer 13

• it has a positive effect of UC

- it worsens chrons disease

Question 14

Perianal abscesses may be seen in patients with UC?

Answer 14

False

Question 15

What blood parameters may change in patients with active ileocolonic chrons disease?

Answer 15

• raised CRP
• weight loss
• raised plts (infection)
• vit B12 defeciency.

Not bloody stools?

Question 16

What is the following long-term treatment options for management of UC?

Answer 16

mesalazine
azathioprine
infliximab
Adalimumab

NOT METHOTREXATE

Question 17

What is the most appropriate first line options for maintaining remission in patients with ileocolonic chrons disease?

Answer 17

azathioprine

Question 18

Should a pt with bloody stools be given a LMWH?

Answer 18

YES - high risk of VRE

Question 19

Aminosalicylates compounds work better in UC than chrons disease?

Answer 19

Yes

Question 20

Long term use of aminosalicylates with UC reduce the risk of colon cancer?

Answer 20

Yes