Inflammatory Bowel Disease

Question 1

UC affected areas

Answer 1

Proctitis, left-sided colitis or pancolitis

Almost never proximal to ileocaecal valve

Question 2

UC pathology

Answer 2

Continuous inflammation limited to mucosa

Hyperaemic/haemorrhagic affected area ±pseudopolyps

Question 3

UC signs/symptoms

Answer 3

Diarrhoea + abdo cramps
Bowel frequency related to severity
Nutritional defects
Extraintestinal signs e.g. clubbing, aphthous ulcers

Question 4

UC tests

Answer 4

Stool culture excludes c diff + other bacterial infection
Faecal calprotectin test for GI inflammation, more useful for progression as low specificity
Lower GI endoscopy can assess extent
FBCs for anaemia

Question 5

UC Classification

Answer 5

Mild: <4 motions/day, apyrexial, Hb >110g/L
Moderate: 5 motions/day, 37.1-37.8°C, Hb 105-110g/L
Severe: >6 motions/day, >37.8°C, Hb <105g/L

Question 6

UC complications

Answer 6

Acute: Toxic dilatation of colon with perforation risk, VTE
Chronic: Colonic cancer so colonsocopies to monitor, most people with PSC have UC

Question 7

UC mild treatment

Answer 7

Mesalamine PR for distal disease, PO for widespread

Question 8

UC moderate treatment

Answer 8

Remission with prednisolone 40mg/d for 1 week then taper by 5mg per week for 7 weeks
Maintain on mesalamine

Question 9

UC severe treatment

Answer 9

IV hydration, IV hydrocortisone 100mg/6h, rectal steroids
VTE prophylaxis
Exclude stool infections and monitor bloods, transfusion if Hb<80g/L
5th day of 6+ motions or CRP>45, ciclosporin/infliximab
Subtotal colectomy if fulminant colitis with toxic dilatation or medical therapy not working, then protectomy (permanent stoma) or temp stoma (ileo-anal pouch)

Question 10

Crohn’s affected area

Answer 10

Generally starts in terminal ileum, but can affect any part of gut

Question 11

Crohn’s pathology

Answer 11

Skip lesions with transmural granulomatous inflammation

Question 12

Crohn’s signs/symptoms

Answer 12

Diarrhoea, abdo pain, weight loss

Bowel ulceration, abdo tenderness, anal skin tags/strictures

Question 13

Crohn’s complications

Answer 13

Small bowel obstructions
Gallstones

Fistulae

Colon cancer
PSC (rarer than in UC)
Toxic dilatation (rarer than in UC)

Question 14

Crohn’s tests

Answer 14

FBCs, B12, INR, Ferritin
Stool cultures and faecal calprotectin
Colonoscopy and biopsy even if mucosa looks normal
Capsule endoscopy for distal small bowel
Kantor’s string sign and cobblestone colon on barium swallow

Question 15

Crohn’s treatment (mild-moderate)

Answer 15

Systemically well: prednisolone 40mg/day for 1week, taper by 5mg/week for 5 weeks
Quit smoking

Question 16

Crohn’s treatment (severe)

Answer 16

IV hydration/hydrocortisone 100mg/6h
VTE prophylaxis
Consider need for transfusion

Azathioprine 2mg/kg/day if steroids don’t work
Infliximab if no improvement but not for malignancy
Mercaptopurine/methotrexate if nothing working

Surgery to resect if drug failure/complications, no permanent stoma for distal disease due to inc recurrence