Inflammatory Bowel Disease & GI Mucosal Immunology - Treatment of IBD

Question 1

Describe the approach to diagnosis and management of patients presenting with altered bowel habit, diarrhoea or constipation, and rectal bleeding.

Answer 1

a

Question 2

Be able to describe pathological process causing altered bowel habit with reference to ulcerative colitis and Crohn’s disease.

Answer 2

a

Question 3

Be able to describe pathological process causing diarrhoea or constipation with reference to ulcerative colitis and Crohn’s disease.

Answer 3

a

Question 4

Be able to describe pathological process causing rectal bleeding with reference to ulcerative colitis and Crohn’s disease.

Answer 4

a

Question 5

State the pathological appearances of inflammatory bowel disease.

Answer 5

a

Question 6

Describe the pathogenesis of IBD.

Answer 6

• Genome: not Mendelian inherited, multiple SNPs increase susceptibility, 10% risk of offspring developing IBD
• Microbiome
• Environment

Factors though to cause dysbiosis in GIT –> damaged epithelium (leaky barrier), increased bacterial adhesion, translocation (across barrier) -> chronic inflammation (disordered innate and adaptive immune response)

It is still unknown what order this pathogenesis occurs in.

Question 7

Describe the principles of investigation and management of inflammatory bowel disease.

Answer 7

a

Question 8

State the common complications of inflammatory bowel disease.

Answer 8

a

Question 9

Describe the management of acute severe colitis.

Answer 9

a

Question 10

Define IBD.

Answer 10

Chronic, relapsing, remitting inflammation of the GIT.
It can be split into two main types (Crohn’s disease and ulcerative colitis) based on the type and location of inflammation.
These are lifelong conditions that commonly present in teenagers and early adulthood.

Question 11

If someone presents with symptoms of both Crohn’s disease and ulcerative colitis, they are said to have…

Answer 11

Indeterminate colitis.

Question 12

Name three types of IBD other than Crohn’s disease and ulcerative colitis.

Answer 12

1. Microscopic colitis
2. Collagenous colitis
3. Lymphocytic colitis

Question 13

What part of the GIT has most microbiota?

Answer 13

The colon.

Question 14

Describe the extra-intestinal manifestations of IBD.

Answer 14

• Eye disorders
• Skin manifestations: erythema nodosum, pyoderma gangrenous (CD)
• Joint problems: hips, knees, sacral ileitis
• Liver disease: primary sclerosing cholangitis, gallstones and renal stones (CD)

Question 15

Describe the presentation of ulcerative colitis.

Answer 15

• Any age (mainly 20-40 years)
• Male-female ratio is 1:1

Symptoms;
- Bloody diarrhoea
- Abdominal pain (esp. before opening bowel)
- Weight loss
- Fatigue
(+ extra-intestinal symptoms)

Question 16

Describe the investigations of ulcerative colitis.

Answer 16

• Blood test: inflammatory markers (normocytic anaemia, increased CRP/platelets, low albumin)
• Stool culture: rule out infection
• Faecal calprotectin