inflammatory bowel disease

Question 1

what are examples of inflammatory bowel diseases?

Answer 1

chrons
IC
ulcerative colitis

Question 2

aetiology of IBD

Answer 2

environmental trigger- role of bacteria, diet
genetically susceptible people
unknown

Question 3

what ages are affected by ulcerative colitis?

Answer 3

any age

Question 4

whos more likely to get ulcerative colitis

Answer 4

females

Question 5

what does ulcerative colitis present with

Answer 5

Bloody diarrhoea
Abdominal pain
Weight loss

Question 6

what are clinical features of ulcerative colitis?

Answer 6

Markers of a severe attack
Stool frequency:	>6 stools/day with blood
AND
Fever:			>37.5ºC
Tachycardia:		>90/min
ESR(CRP):			raised
Anaemia:			Hb <10g/dl
Albumin:			<30g/l
Leucocytosis, thrombocytosis

Question 7

where does ulcerative colitis effect?

Answer 7

colon

Question 8

whos more likely to get chrons disease?

Answer 8

equal

Question 9

clinical features of chrons disease

Answer 9

Diarrhoea
Abdominal pain
Weight loss. 
Malaise, lethargy, anorexia, N&V, low-grade fever
Malabsorption
Anaemia, vitamin deficiency

Question 10

what would you find in the blood with inflammatory indices?

Answer 10

High ESR & CRP
High platelet count
High WCC
Low Hb
Low albumin

Question 11

what would you find in the stools with inflammatory indices?

Answer 11

Calprotectin
<50 Normal
50-200 Equivocal
>200 Elavated

Question 12

extra-intestinal manifestations of the eyes

Answer 12

uveitis, episcleritis, conjunctivitis

Question 13

extra-intestinal manifestations of the joints

Answer 13

sacroiliitis, monoarticular arthritis, ankylosing spondylitis

Question 14

extra-intestinal manifestations of the renal calculi

Answer 14

only in CD

Question 15

extra-intestinal manifestations of the liver and biliary tree

Answer 15

fatty change, pericholangitis, sclerosing cholangitis, gallstones

Question 16

extra-intestinal manifestations of the skin

Answer 16

pyoderma gangrenosum, erythema nodosum, vasculitis

Question 17

differential diagnosis to IBD

Answer 17

Chronic diarrhoeas
Malabsorption
Malnutrition
Ileo-caecal TB
Colitis must be distinguished from 
infective, amoebic and ischaemic colitis

Question 18

long term complications of colitis

Answer 18

Colonic carcinoma
Risk Factors
Extent
Pancolitis 26 x normal
Left colitis 8 x normal
Proctitis minimal
Duration 
< 10 yrs minimal risk
- 20 yrs 23 x normal
- 30 yrs 32 x normal

Question 19

medical management of IBD in hospital

Answer 19

Steroids
Anticoagulation
Rest
Other
Cyclosporin
Infliximab
Surgery

Question 20

medical management of IBD in out patients

Answer 20

5ASA
Steroids
Immunosuppression
Azathioprine
Mercaptopurine
Methotrexate
Infliximab

Question 21

failure of medical therapy

Answer 21

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 22

poor response to medical therapy

Answer 22

Fistulas
Fibrotic strictures
Peri-anal disease
Severe fulminating disease

Question 23

surgery for severe colitis

Answer 23

otal colectomy
Rectal preservation
Ileostomy

Question 24

what is pouch surgery?

Answer 24

mobilise and lengthen small bowel. then contrict pouch

Question 25

chrons surgical indications

Answer 25

Failure of medical management
Relief of obstructive symptoms (small bowel)
Management of fistulae - e.g. bowel to bladder
Management of intra-abdominal abscess
Management anal conditions
Failure to thrive