Inflammatory Bowel Disease

Question 1

Name two features of the inflammation in UC

Answer 1

mucousal, crypt abscesses

Question 2

name some systemic features of active IBD

Answer 2

fever, malaise, weight loss, anorexia

Question 3

name some abdominal features of UC

Answer 3

diarrhoea, blood and mucous PR, abdo discomfort, tenesmus, faecal urgency

Question 4

name some abdo features of crohn’s disease

Answer 4

diarrhoea (not usually bloody), abdo pain, weight loss

Question 5

name some abdo signs of crohn’s disease

Answer 5

 Aphthous ulcers, glossitis
 Abdominal tenderness
 RIF mass
 Perianal abscesses, fistulae, tags
 Anal / rectal strictures

Question 6

Define Crohn’s disease

Answer 6

transmural chronic inflammation affecting anywhere in the GI tract from mouth to anus. Patchy - areas of the bowel are unaffected.

Question 7

what would perianal disease point the diagnosis towards

Answer 7

Crohn’s disease

Question 8

which investigations would you carry out in a patient with suspected IBD

Answer 8

• FBC, ESR
• U&E’s, LFTs
• CRP
• Stool cultures + C. Difficile toxin
o Important even in patients who have known IBD as they are at increased risk of gut infections with the damage to their GI tract and are immunocompromised.
• Faecal Calprotectin
o Used as a clue of whether someone has inflammation in their gut
• AXR
• CXR – would give information about a potential perforation: gas under the diaphragm

Question 9

what distribution does UC have?

Answer 9

bimodal

Question 10

what criteria is used to assess the severity of UC?

Answer 10

Truelove and Witts criteria

Question 11

At what level would a patient with severe acute colitis warrant a colectemy?

Answer 11

• Stool frequency >8/day / CRP >45 on day 3 predicts colectomy in 85%