Inflammatory Bowel Disease

Question 1

what are the two types of IBD? which is most common?

Answer 1

crohns

ulcerative colitis- most common

Question 2

when do Crohns and UC present?

Answer 2

bimodal peak for crohns: - 15-30 years - 60-80 years

UC mainly 15-25 years. Small peak again 55-65 years

Question 3

where in the GI tract does Crohns affect? where is the most common site?

Answer 3

can affect any part of GI tract (from mouth to anus)

most common site is the terminal ilieum

Question 4

describe the inflammation in crohns disease

Answer 4

transmural inflammation (affects all layers of the bowel) produces deep ulcers + fissures - “cobblestone mucosa” discontinuous inflammation - “skip lesions”

non-caseating granulomatous inflammation

Question 5

Where in the GI tract does UC affect?

Answer 5

large bowel only

• begins in the rectum and extends proximally

Question 6

describe the inflammation in UC

Answer 6

Continuous inflammation

Affects mucosa only

Crypt abscess formation

Goblet cell hypoplasia

Psuedopolyp formation

Question 7

outline the histological differences between crohns + UC

Answer 7

Question 8

how does smoking affect crohns and UC

Answer 8

smoking is a risk factor for crohns but protective against UC

Question 9

presentation of Crohns

Answer 9

abdominal pain + diarrhoea

weight loss

oral ulcers

perianal features e.g. skin tags, abscesses

Question 10

presentation of UC

Answer 10

bloody diarrhoea

PR bleeding

Abdo pain - left lower quadrant

Increased frequency/urgency of defecation

tenesmus

Question 11

fistuals are seen in which type of IBD

Answer 11

Crohns

Question 12

skin manifestations of IBD

Answer 12

erythema nodosum - tender red/purple nodules on patients shins

pyoderma gangrenosum- erythematous papules that develop into ulcers

Question 13

primary sclerosing cholangitis is a complication of which condition

Answer 13

UC

• fibrosis of bile ducts

Question 14

which test has a good sensitivity and specificity for IBD

Answer 14

faecal calprotectin

Question 15

diagnostic investigation for Crohns

Answer 15

Endoscopy (OGD + colonoscopy) + biopsy

Question 16

Diagnostic investigation for UC

Answer 16

flexible sigmoidoscopy + biopsy usually sufficient

• full colonoscopy if diagnosis unclear

Question 17

how many bowel movements per day indicate

• Mild UC
• Mod UC
• Severe UC

Answer 17

mild UC = <4

mod UC = 4-6

sev UC = >6

Question 18

therapy for inducing remission in mild-moderate UC

• 1st line
• 2nd line
• 3rd line

Answer 18

1st line: rectal mesalazine (aminosalicylate- 5ASA)

2nd line if remission not achieved within 4 weeks: add oral mesalazine

3rd line if remission still not achieved: add rectal / oral predinisolone

Question 19

therapy for inducing remission in severe UC

Answer 19

need hospital tx with IV hydrocortisone

Question 20

therapy used to maintain remission in UC

Answer 20

1st line: rectal Mesalazine or combo of rectal + oral mesalazine

2nd line: Azathioprine / infliximab if recurrent episodes (>2 a year)

Question 21

therapy for inducing remission in Crohns

Answer 21

1st line: prednisolone

2nd line: add mesalazine / azathioprine / methotrexate

Question 22

therapy for maintaining remission in Crohns

Answer 22

Azathioprine 1st line (mercaptopurine as an alternative)

Methotrexate 2nd line

Question 23

what surgical procedure can cure UC

Answer 23

Total proctocolectomy

• removes colon + rectum
• patient left with permanent ileostomy or ileo-anal anastamosis (J-pouch)

Question 24

what surgical procedures might crohns patients require

Answer 24

70-80% of patients will require surgery at some point, however it is not curative

• Ileocaecal resection: removal of terminal ilieum + caecum with primary anatasomosis
• Segmental resections
• Stricturoplasty: division of stricture that is causing bowel obstruction
• Surgery for peri-anal disease e.g. abscess drainage

Question 25

ulcer at a stoma site in IBD patient is caused by what

Answer 25

pyoderma gangrenosum