Inflammatory Bowel Disease

Question 1

What is IBD?

Answer 1

Chronic, relapsing, remitting inflammation of gastrointestinal tract
Crohns and ulcerative colitis

Question 2

What is the main difference between CD and UC?

Answer 2

UC always starts at the rectum and only effect colon

CD can effect anywhere in GIT from mouth to anus

Question 3

What are the extra-intestinal maifestations of IBD?

Answer 3

Eye manifestations
Skin - erythema nodosum
Prone to joint problems (e.g. arthritis)
CD - increased risk of gallstones and renal stones

Question 4

What are the symptoms of ulcerative colitis?

Answer 4

Bloody diarrhoea
Abdominal pain
Weight loss
Fatigue

Question 5

What are the investigations for ulcerative colitis?

Answer 5

Bloods - inflammation markers
Stool culture - rule out infection
Faecal calprotectin
Colonoscopy and colon mucosal biopsies

Question 6

What is proctitis?

Answer 6

inflammation of the rectum
Frequency, urgency, incontinence
Small volume of mucus and blood
Constipation
Topical therapy

Question 7

What is done in the first 24 hours that acute severe colitis?

Answer 7

IV glucocorticoids
LMWH - higher risk of thromboembolism
AXR
IV hydration
avoid/stop NSAIDS, opiates
3-4 stool cultures for c. diff

Question 8

What are the clinical features of the CD?

Answer 8

Diarrhoea
Abdominal pain
Weight loss
Malaise, lethargy, anorexia, nausea + vomiting, low-grade fever
Malabsorption (anaemia, vitamin deficiency)

Question 9

What are the investigations done for the CD?

Answer 9

Blood - inflammation markers
Stool culture
Faecal calprotectin
Colonoscopy
MRI 
Capsule endoscopy
CT if acutely unwell

Question 10

How does histology vary between CD and UC?

Answer 10

CD - granulomas, transmural inflammation

UC - depleted goblet cells

Question 11

What are the symptoms of perianal CD?

Answer 11

Perianal pain
Pus secretion
Unable to sit down

Question 12

What are the investigations for perianal CD?

Answer 12

MRI pelvis

Examination under anaesthetic

Question 13

What are the treatments for perianal CD?

Answer 13

Surgery - drain abscess

Medical - antibiotics + biological therapy (anti-TNF)

Question 14

What is a long term complication of colitis?

Answer 14

Colonic carcinoma

Question 15

What role do aminosalicylates play in UC?

Answer 15

Block prostaglandins and leukotrienes
Topical to colonic mucosa
Release mechanisms lead to colonic delivery
Not effective in CD

Question 16

What role do steroids play in UC and CD?

Answer 16

Maintenence treatment

Can damage bones so calcium/vit D required

Question 17

When is surgery used in IBD?

Answer 17

Emergency

Elective - frequent relapses, can’t tolerate medical therapy, steroid dependent, patient choice

Question 18

What are the surgical indications for crohns?

Answer 18

Failure of medical management
Relief of obstructive symptoms
Management of fistulae
Management of intra-abdominal abscess
Management of anal conditions
Failure to thrive