Inflammatory bowel disease

Question 1

What part of the body does IBD affect

Answer 1

the large bowl

Question 2

What are the 2 common IBD conditions

Answer 2

Crohn’s disease

Ulcerative colitis

Question 3

How does age and gender affect liklihood of having Crohn’s or ulcerative colitis

Answer 3

15-25yrs
50-80yrs
Crohn’s = male> female
UC= female>male

Question 4

What factors play a role in the aetiology of IBD

Answer 4

• immunological
• psychological
• smoking
• genetic

Question 5

What is the aetiology of crohn’s disease

Answer 5

Granulomatous inflammation

• food intolerance
• persisting viral infection/immune activation
• ? infection with mycobacteria

Question 6

What is Johne’s disease? why is it relevant?

Answer 6

Crohn’s in cattle

• infection with M. paratuberculosis
• suggestion of zoonotic infection from cows to people
• pasturisation doesn’t get rid of M.paratuberculosis therefore possibly involved in Crohn’s

Question 7

What does Crohn’s look like

Answer 7

Lumps on the mucosa, also cobblestoning

Question 8

Why does Crohn’s look like it does

Answer 8

Lumps caused by oedema because granulomas blocking lymphatics therefore preventing drainage of normal tissues, causes cobblestoning

Question 9

Where does Crohn’s affect

Answer 9

Whole GI tract from mouth to anus?

Question 10

Where does UC affect

Answer 10

colon and rectum?

Question 11

Which of UC and C is the disease continuous

Answer 11

UC (starts from rectum and works its way up)

Question 12

Which of UC and C is the disease discontinuous

Answer 12

C (skip areas in GI tract)

Question 13

Which of UC and C is the rectum always involved

Answer 13

UC

Question 14

Which of UC and C is the rectum always involved 50%

Answer 14

C

Question 15

Which of UC and C has anal fissures 25%

Answer 15

UC

Question 16

Which of UC and C has anal fissures 75%

Answer 16

C

Question 17

Which of UC and C is the ileum involved 10%

Answer 17

UC

Question 18

Which of UC and C is the ileum involved 30%

Answer 18

C

Question 19

Which of UC and C does the mucosa have granulomas and ulcers

Answer 19

UC

Question 20

Which of UC and C does the mucosa have cobbled and fissures

Answer 20

C

Question 21

Which of UC and C is vascular

Answer 21

UC

Question 22

Which of UC and C is non-vascular

Answer 22

C

Question 23

Which of UC and C is the serosa (smooth tissue membrane) normal

Answer 23

UC

Question 24

Which of UC and C is the serosa (smooth tissue membrane) inflamed

Answer 24

C

Question 25

Which of UC and C has superficial inflammation and which extends through the entire thickness of the bowel wall

Answer 25

``` UC = superficial inflammation C = extends through entire thickness ```

Question 26

What are the microscopic features of UC

Answer 26

- mucosa - vascular - mucosal abcesses

Question 27

What are the microscopic features of C

Answer 27

- transmural - oedematous - granulomas

Question 28

What other condition has the same histology as C

Answer 28

OFG

Question 29

What are the features of a C's patient's intestine compared to a healthy one

Answer 29

- cobblestone appearance of mucosal surface due to linear ulceration - narrowed lumen - thickened wall - abcesses

Question 30

What are the features of a UC's patient's intestine compared to a healthy one

Answer 30

- affects mucosal layer only - absence of goblet cells - crypt distortion and abscess

Question 31

What are the different severities of UC called

Answer 31

- proctitis - proctosigmoidtitis - distal colitis - pancolitis - backwash ileitis

Question 32

What does proctitis mean

Answer 32

UC involving only the rectum

Question 33

What does proctosigmoidtitis mean

Answer 33

UC involving the rectum and sigmoid colon

Question 34

What does distal colitis mean

Answer 34

UC involving only the left side of the colon

Question 35

What does Pancolitis mean

Answer 35

UC involving the entire colon

Question 36

What does backwash iletis mean

Answer 36

UC involving the distal ileum

Question 37

Symptoms of UC

Answer 37

- diarrhoea - abdominal pain - PR bleeding

Question 38

Symptoms of C

Answer 38

colonic disease - same as UC small bowel disease - pain - malabsorption - obstruction - anal disease mouth - ofg

Question 39

How might ofg indicate other problems

Answer 39

- red thick looking gingiva, not a plaque related problem - commonly seen in children, tend not to chase bowel problems until symptoms - the younger people get OFG the more likely they'll get IBD

Question 40

Investigations for IBD

Answer 40

- blood tests - faecal calprotectin - endoscopy - leukocyte scan - barium studies - bullet endoscopy

Question 41

Why is calprotectin tested for in IBD

Answer 41

Calprotectin is released on inflammation, released into bowel, gives an idea of whether bowel is inflamed or not without doing an endoscopy (should work in significant cases)

Question 42

What are complications of IBD

Answer 42

Ulcerative colitis develops carcinoma - risk increases with time - judgement as to whether colectomy is justified

Question 43

Treatment for IBD

Answer 43

1. Immunosuppressive medical treatment - systemic steroids - local steroids (rectal administered) - anti-inflammatory drugs - non steroid immunosuppresants - anti TNFalpha therapy (e.g. infliximab) ``` 2. surgery Ulcerative colitis: colectomy cures Crohn's: pallitate symptoms - remove obstructed bowel segments - drain abscesses - close fistulae, especially perianal ``` usually results in stoma/bag, may be reversible