Inflammatory bowel disease- clinical

Question 1

What do UC and Crohn’s differ in?

Answer 1

Pathology
Clinical presentation:
Crohn’s: abdominal pain and peri-anal disease
UC: diarrhoea and bleeding

Question 2

What three factors contribute to the pathogenesis of IBD?

Answer 2

Genetic predisposition
Mucosal immune system
Environmental triggers

Question 3

Which gene has been recognised has a IBD susceptibility gene?
Where is it found?
What does this gene encode?

Answer 3

NOD2/CARD15 (IBD-1)
It is found on chromosome 16q12
It encodes a protein involved in bacterial recognition

Question 4

a) Which immune cell mediates Crohn’s disease?

b) Which immune cells mediate UC?

Answer 4

a) Th1

b) Mixed Th1/Th2 and NKTC

Question 5

Is there reduced or increased antimicrobial activity compared to normal in a) Crohn’s and b) UC?

Answer 5

a) Reduced

b) Increased- body produces its own “antibiotics” in the cells lining the intestine

Question 6

How does smoking affect a) Crohn’s disease and b) UC?

Answer 6

a) Aggravates

b) Protects against

Question 7

What is the effect of NSAIDs on IBD?

Answer 7

They can aggravate it as they break down the mucous lining

Question 8

How is severe ulcerative colitis identified?

Answer 8

If there are at least 6 bloody stools per day as well as one or more of:
Fever (>37.8)
Tachycardia (>90)
Anaemia (Hb < 10.6 g/ld)
Elevated ESR (> 30mm/hr)

Question 9

How wide is a toxic colon in a) the transverse colon and b) the caecum?

Answer 9

a) >5.5 cm

b) >9cm

Question 10

What is a longterm complication of ulcerative colitis?

What is this determined by?

Answer 10

Increased risk of colorectal cancer.
Risk determined by:
Severity of inflammation
Duration of disease
Disease Extent

Question 11

What is primary sclerosing cholangitis (in IBD)?

Answer 11

The pipes which drain bile out of the liver are inflamed in tandem with the gut. Causes cirrhosis of the liver very rapidly and people require a liver transplant.

Question 12

What perianal disease can be present in Crohn’s disease?

Answer 12

Recurrent abscess formation
Pain
Can lead to fistula formation with persistent leakage
Damaged sphincters

Question 13

What percentage of Crohn’s patients require surgery in 8-10 years?

Answer 13

75%

50% of these patients require a second operation

Question 14

What are the symptoms of UC?

Answer 14

Diarrhoea + bleeding
Increased bowel frequency (HOW OFTEN?)
Urgency
Tenesmus
Incontinence
Night rising
Lower abdo pain (esp. LIF)
(proctitis can cause constipation)

Question 15

What determines the symptoms in Crohn’s?

Answer 15

The site of the disease

Question 16

What are symptoms of Crohn’s disease?

Answer 16

Small intestine:
Abdominal cramps (peri-umbilical)
Diarrhoea, weight loss
Colon:
Abdominal cramps (lower abdomen)
Diarrhoea with blood
Wt loss
Mouth:
Painful ulcers, swollen lips, angular chielitis
Anus:
peri-anal pain, abscess

Question 17

How can the small bowel be assessed?

Answer 17

Barium follow through
Small bowel MRI
Technetium-labelled white scan