Inflammatory Bowel Disease

Question 1

What are the different types of Inflammatory Bowel Disease?

Answer 1

Ulcerative colitis and Crohn’s disease

Question 2

What is ulcerative colitis?

Answer 2

Inflammation and ulceration of the inner lining of the colon and rectum (the large bowel)

Question 3

What is the clinical presentation of ulcerative colitis? Give 3 signs and symptoms?

Answer 3

Symptoms - recurrent diarrhoea often with blood and mucus, colicky pain and some extra GI manifestations. Signs - Dehydration, distension, tachycardia and fever

Question 4

What is the pathophysiology of ulcerative colitis?

Answer 4

Mucosal inflammation originating in the anus continuously progressing proximally. No granulomata. Goblet cell depletion. Crypt abscesses

Question 5

What is the aetiology of ulcerative colitis?

Answer 5

Genetics, environmental - stress/depression and attacks, immune response

Question 6

How does the immune response cause ulcerative colitis?

Answer 6

Effector T cell predominate over regulatory T cells, proinflammatory cytokines and they stimulate macrophages to produce IL1, IL6 and TNF a. Neutrophils, mast cells and eosinophils activated, release of inflammatory mediators causing cell damage

Question 7

Who normally presents with UC?

Answer 7

Usually teens and 20s

Question 8

What is the relationship with UC and smoking?

Answer 8

Smoking protects against UC

Question 9

What diagnostic tests are done for UC?

Answer 9

Sigmoidoscopy, rectal biopsy, X-Ray, CT

Question 10

What is the treatment for UC?

Answer 10

5-aminosalicylic acid (mesalazine), immunomodulators Surgical resection

Question 11

What does 5-aminosalicylic acid do?

Answer 11

They are chemically related to aspirin, and work by damping down the inflammatory process, so allowing damaged tissue to heal.

Question 12

What are the complications of UC?

Answer 12

Psychosocial and sexual problems as well as frequent relapse

Question 13

What is the sequelae for UC?

Answer 13

Colorectal cancer is twice as likely

Question 14

What is Crohn’s disease?

Answer 14

Crohn’s disease is a condition that causes inflammation of the wall of the gut (gastrointestinal tract). Any part of the gut can be affected. Intermittent chronic inflammation of the entire GI tract

Question 15

What is the clinical presentation of Crohn’s disease? Give 3 signs and symptoms

Answer 15

Symptoms - the symptoms depend on the part of the gut affected, with the small bowel - weight loss, abdominal pain, with the terminal ileum - right iliac fossa pain mimicking appendicitis Blood and mucus with diarrhoea and pain

Question 16

What is the pathophysiology of Crohn’s disease?

Answer 16

Transmural inflammation with granulomata in 50% of cases. Occurs anywhere in the GI tract with skip lesions. Deep ulcers and fissures giving a cobblestone appearance

Question 17

What is the aetiology of Crohn’s disease?

Answer 17

Genetics, environmental and immune response

Question 18

What is the association between Crohn’s disease and smoking?

Answer 18

Smoking is a risk factor and causes damage

Question 19

What is the diagnostic test for Crohn’s disease?

Answer 19

Sigmoidoscopy, CT and rectal biopsy

Question 20

What is the treatment for Crohn’s disease?

Answer 20

Stop smoking, corticosteroids to induce remission, thiopurines maintain remission and Azathioprine (DMARDs)

Question 21

What are the complications of Crohn’s disease?

Answer 21

Bowel obstruction from strictures and causes growth problems in children

Question 22

What is the sequelae of Crohn’s disease?

Answer 22

Osteoporosis

Question 23

What IBD condition is associated with this endoscope image?

Answer 23

Crohn’s

Question 24

What IBD condition is associated with this endoscopy image?

Answer 24

Ulcerative colitis