Inflammatory Bowel Disease: Crohn's vs UC

Question 1

What is the hallmark of IBD

Answer 1

Excess infiltrating lymphocytes

Question 2

What drives inflammation and tissue damage in IBD?

Answer 2

Overactive TNF-alpha

Question 3

Crohn’s vs UC: Location

Answer 3

Crohn’s: Anywhere in the GI (mouth to anus) EXCEPT rectum
UC: Confined to the colon (sometimes distal ileum for backwash ileitis)

Question 4

Crohn’s vs UC: Wall

Answer 4

Crohn’s: Transmural involvement, skip lesions, thickening
UC: Continuous, limited to mucosa/submucosa

Question 5

Crohn’s vs UC: Histology

Answer 5

Crohn’s: Non-caseating granulomas, lymphocytic infiltrate, crypt abscesses
UC: NO granulomas, mononuclear infiltrate, crypt abscesses

Question 6

Crohn’s clinical patterns (3)

Answer 6

1. Fibrostenotic
2. Fistulizing
3. Inflammatory

Question 7

Crohn’s vs UC: Radiographic finding

Answer 7

Crohn’s: string sign (lumen narrowing)
UC: lead pipe sign (loss of haustra)

Question 8

Spectrum of severity for ulcerative colitis (names and symptoms)

Answer 8

Mild: Proctitis
- Intermittent bleeding
- Constipation
- Tenesmus
- Few daily stools

Moderate: Left-sided colitis
- More bleeding
- More daily stools
- Left-sided cramps

Severe: Extensive colitis
- Frequent daily stools
- Pain, fevers
- Significant bleeding
- Megacolon

Question 9

What is the most severe case of ulcerative colitis?

Answer 9

Toxic megacolon

Question 10

Complications of Crohn’s (4)

Answer 10

• Fistula, abscess
• Strictures, adhesions, obstruction
• Malabsorption, fat soluble vitamin deficiency, B12 deficiency
• Gallstones, kidney stones

Question 11

Complications of UC (2)

Answer 11

• Primary sclerosing cholangitis
• Colorectal cancer

Question 12

Treatment for Crohn’s (3)

Answer 12

• Steroids
• Immunomodulators (azathioprine, methotrexate, thiopurines)
• Anti-TNF agents

Question 13

Treatment for UC (4)

Answer 13

• Steroids
• Anti-TNF agents
• Mesalazine (5-ASA)
• Colectomy

Question 14

Extraintestinal manifestations of IBD (CHEATS)

Answer 14

C: Cholangitis (primary sclerosing cholangitis)
H: Hematologic
E: Eyes
A: Arthritis
T: Thromboembolism
S: Skin

Question 15

Hematologic extraintestinal manifestations of IBD (4)

Answer 15

• Anemia
• Hemolysis
• Thrombocytopenia
• Amyloidosis

Question 16

Eye extraintestinal manifestations of IBD

Answer 16

• Episcleritis
• Uveitis
• Iritis

Question 17

Arthritis extraintestinal manifestations of IBD

Answer 17

• Inflammatory peripheral arthritis
• Spondyloarthropathy

Question 18

Skin extraintestinal manifestations of IBD

Answer 18

• Erythema nodosum
• Pyoderma gangrenosum
• Aphthous