Inflammatory Bowel Disease (LM)

Question 1

Inflammatory bowel dsease?

Answer 1

• IBD is a group of idiopathic chronic, relapsing-remitting inflammatory intestinal conditions
• Disrupts the body’s ability to digest food, absorb nutrition and eliminate waste

Question 2

Types of inflammatory bowel disease?

Answer 2

1. Crohns
2. Ulcerative colitis

Question 3

Ulcerative colitis?

Answer 3

• Disease is limited to the large intestine (colon) and the rectum
• The inflammation occurs only in the innermost layer of the intestinal lining,

Question 4

Spread of ulcerative colitis?

Answer 4

Usually begins in the rectum and the lower colon but may also spread continuously to involve the entire colon; but may spread continuously to involve the entire colon.

Question 5

Truelove and Witts severity index for ulcerative colitis?

Answer 5

THE MHB
1. Temperature
2. Heart rate
3. ESR
4. Movements/day (bowel movements)
5. Hb
6. Blood in stool

Question 6

Mild UC?

Answer 6

T - apyrexia
HR <70/min
ESR<30
Movements<4
Hb>11g/dl
Blood in stool - none or small

Question 7

Moderate UC?

Answer 7

T - 37.1-37.8
HR - 70-90/min
ESR<30
Movements - 4-6
Hb - 10.5-11g/dl
Blood in stool - moderate

Question 8

Severe UC?

Answer 8

T>37.8
HR>90/min
ESR>30
Movements - 7-6
Hb <10.5g/dl
Blood in stool - large

Question 9

Crohns disease?

Answer 9

There is transmural inflammation of the GI mucosa which can affect any part of the GI tract

Question 10

Spread of Crohns disease?

Answer 10

• Most commonly affects the terminal ileum and colon
• Skip lesions present (affects some areas of the GI tract while leaving other sections completely untouched)
• prone to strictures, fistulas and adhesions

Question 11

Why is CD associated with strictures?

Answer 11

inflammation occurs in all layers down to the serosa

Question 12

UC vs CD?

Answer 12

CD - skip lesions
UC - continuous colonic involvement beginning in rectum

Question 13

Indeterminate colitis?

Answer 13

• In some, it is difficult to determine whether their symptoms are due to Crohn’s disease or ulcerative colitis.
• There is no evidence of small bowel involvement, fistula or perianal disease. There is no diagnostic criteria for CD or UC by microscopy.

Question 14

Epidemiology?

Answer 14

The peak age of onset of UC and CD is 15 to 30 years.
Second peak 60 to 80
Male:female UC 1:1 and CD 1.1:1.8
Smoking is associated with a two-fold increased risk of CD
If one has IBD the lifetime risk that a first degree relative will be affected is 10%.
More common in white people than in African or Asians ; higher risk in Jews- Ashkenazi jews have higher risk than Sephardic jews

Question 15

Risk factors in IBD?

Answer 15

• Smoking associated with earlier age of onset of disease and more frequent need for immunosuppression among women with Crohn’s disease but not men
• Smoking cessation is associated with an increased risk of ulcerative colitis.

Question 16

Etiology of IBD?

Answer 16

1. genetic predisposition
2. mucosal immune system immuno-regulatory defect
3. environmental triggers
   - luminal bacteria
   - infcetion
   - NSAIDs
   - smoking

Question 17

Causes of IBD?

Answer 17

1. Diet
   - fat intake, fast food, milk and fiber consumption
2. Infection
   - CD: mycobacterium paratuberculosis UC after episodes of infective diarrhoea
   Enteric microflora is altered in IBD
3. Genetics
   - HLA, first degree relatives and monozygotic twins
4. Antibiotics
5. Cigarette smoking
6. Appendectomy
7. Stress

Question 18

UC symptoms?

Answer 18

1. altered bowel movements
   - increased stool frequency
   - decreased stool frequency
2. abdominal pain
   - LLQ cramping, relieved with defecation
   - tenesmus
3. hematochezia

Question 19

CD symptoms?

Answer 19

1. altered bowel movements
   - chronic or nocturnal diarrhea
2. abdominal pain
   - postprandial RLQ abdominal pain
   - distension
3. weight loss
4. fever

Question 20

Clinical features of UC?

Answer 20

1. colon only
2. rectal involvement
3. muscosal disease
4. diffuse ulceration, granularity, friability, bleeding, exudate
5. no fistulas or granulomas

Question 21

Clinical features of CD?

Answer 21

1. any segment
2. rectal sparing
3. skip lesions
4. transmural
5. apthous ulcers, serpiginous ulcers, cobble stoning
6. fistulae
7. granulomas

Question 22

Extraintestinal manifestations of UC?

Answer 22

1. joint pain or arthralgia
2. aphthous ulcer
3. ankylosing spondylitis
4. pyoderma gangronesum
5. erythema nodosum
6. iritis
7. uveitis

Question 23

Extraintestinal manifestations of CD?

Answer 23

1. joint pain or arthralgia
2. inflammatory peripheral arthritis
3. ankylosing spondylitis
4. Sweets syndrome
5. iridocyclitis
6. espiscleritis
7. uveitis
8. pyoderma gangronesum
9. erythema nodosum

Question 24

Extra-intestinal manifestations of IBD?

Answer 24

A PIE SAC
1. Aphthous ulcers
2. Pyoderma gangrenosum
3. Iritis
4. Erythema nodosum
5. Sclerosing cholangitis
6. Arthritis
7. Clubbing of fingertips

Question 25

Complications of UC?

Answer 25

1. massive bleeding 2. late hose pipe appearance fibrosis 3. rare to have perforation 4. rare to have penetration that develops to a fistula 5. malignant change

Question 26

Complications of CD?

Answer 26

1. usually non-massive bleeding 2. early obstruction 3. perforation 4. penetration leading to fistula 5. rare to have malignant change