inflammatory bowel disease in children

Question 1

presenting features of Crohn’s

Answer 1

diarrhoea ++

rectal bleeding ++

abdo pain +++

fever +

weight loss ++++

growth failure ++++

arthritis ++

mass ++

Question 2

presenting features of UC

Answer 2

diarrhoea +++++ (> a few weeks)

rectal bleeding +++++

abdo pain +++

fever +

weight loss +

growth failure +

arthritis +

mass -

Question 3

diagnosis of IBD

Answer 3

hx and examination - red flag for colitis = nocturnal diarrhoea, bloody diarrhoea

intestinal sx

extra-intestinal manifestations - ulcers, skin rashes, arthrits, erythema nodosum

exclude infection

FHx

growth and sexual development - delayed in Crohn’s

nutritional status

investigations

Question 4

what is this and when is it seen

Answer 4

erythema nodosum

extra-intestinal manifestation

seen more commonly in CD rather than UC

improves w/ IBD

Question 5

oral changes in IBD

Answer 5

angular chelitis

mouth ulcers - in the sulci, tongue

• rolled edge ulcers

Question 6

extra-intestinal manifestations in IBD

Answer 6

erythema nodosum

oral changes - ulcers

perianal changes - tags

Question 7

investigations for IBD

Answer 7

FBC and ESR - anaemia, thrombocytosis, raised ESR

biochemistry - stool calprotectin, raised CRP (acute severe colitis, toxic megacolon), low albumin (crohn’s - protein losing enteropathy)

microbiology - no stool pathogens

Question 8

differences between adult and paeds IBD - IBDU/UC/CD, M vs F

Answer 8

adults: IBDU (unclassified) < CD < UC

F>M

paeds: IBDU < UC < CD

M>F

• disease tends to be more severe and extensive
• greater proportion are IBDU than in adults

Question 9

differences between adult and paeds UC - proctitis

Answer 9

adults: 40%
paeds: 4% <5y/o, 17% 5-17y/o

Question 10

differences between adult and paeds UC - L sided colitis

Answer 10

adults - 40%

paeds - 14%

Question 11

differences between adult and paeds UC - pancolitis

Answer 11

adults - 20%

paeds - >60%

Question 12

differences between adult and paeds CD - isolated ileal disease

Answer 12

adult - 36%

paeds - 6%

Question 13

differences between adult and paeds CD - ileocolonic disease

Answer 13

adult - 50%

paeds - 45%

Question 14

differences between adult and paeds CD - upper GI/panenteric

Answer 14

adult - % - if there are largely lower GI Sx, upper GI endoscopy won’t be done

paeds - 51%, typical presentation in children

Question 15

definitive investigations for diagnosing IBD

Answer 15

radiology (esp CD) - MRI, barium meal and follow through (younger kids)

endoscopy - colonoscopy and upper GI endoscopy, mucosal biopsy, capsule enteroscopy, enteroscopy

Question 16

what is this condition

Answer 16

UC

Question 17

what is this condition

Answer 17

CD

Question 18

what is this condition

Answer 18

mixed picture therefore IBDU

Question 19

what is this condition

Answer 19

granuloma therefore CD

Question 20

what is this condition

Answer 20

crypts and pus therefore UC

Question 21

aims of treatment in IBD

Answer 21

induce and maintain remission

correct nutritional deficiencies

maintain normal growth and development

Question 22

methods of treatment for IBD

Answer 22

medical: anti-inflammatory, immunosuppressive, biologicals (infliximab)

nutritional: immune modulation, nutritional supplementation

surgical

Question 23

bottom up treatment for Crohn’s

Answer 23

Question 24

surgical treatment for Crohn’s

Answer 24

small segment of disease that is affecting growth but not causing a lot of symptoms - resection and end to end anastomosis can work very well