Inflammatory Bowel Diseases - Crohn's Disease And Ulcerative Colitis

Question 1

Briefly describe inflammatory bowel disease aetilology

Answer 1

1. Food intolerance
2. Persisting viral infection/immune activation
3. Smoking
4. Genetic

Not all causes are known

Question 2

Infection with What bacteria is associated with crohn’s ?

Answer 2

Mycobacteria - paratuberculosis

Question 3

What parts of the GI tract can crohn’s affect?

Answer 3

Any

Question 4

What is a popular site affected by crohn’s and how can this impact the body?

Answer 4

Ileocecal region - can result in vitamin B12 malabsorption

Question 5

What sites does ulcerative colitis affect?

Answer 5

Only found in the colon

- rectum always involved

Question 6

What are the 7 main differences between ulcerative colitis and Crohn’s disease?

Answer 6

Ulcerative colitis:

• disease continuous (crohn’s discontinuous)
• rectum always involved (crohn’s 50%)
• Anal fissures 25% (crohn’s 75%)
• ileum involves 10% (crohn’s 30%)
• mucosa gran. And ulcers (crohn’s mucosa cobbled and fissures)
• vascular (crohn’s non-vascular)
• serosa normal (serosa inflamed)

Question 7

What are the key microscopic features of UC and crohn’s?

Answer 7

UC:

1. Mucosal
2. Vascular
3. Mucosal abscesses

Crohn’s:

1. Transmural
2. Oedematous
3. Granulomas

Question 8

Describe crohn’s appearance

Answer 8

1. Cobbled or “quilted” effect

2. Mucosal tagging

Question 9

Describe UC appearance

Answer 9

Red and inflamed patches

Question 10

What are symptoms of ulcerative colitis?

Answer 10

1. Diarrhoea
2. Abdominal pain
3. Rectal bleeding

Question 11

What are symptoms of Crohn’s disease in different areas of the GI track?

Answer 11

1. Colonic disease - same as UC
2. Small bowel disease
   - pain
   . Obstruction

• malabsorption
  . Anal disease

3. Mouth
   - orofacial granulomatosis

Question 12

What investigations can be carried out for inflammatory bowel disease?

Answer 12

1. Blood tests
   - anaemia, C Reactive Protein, Erythrocyte segmentation rate
2. Faecal Calprotectin
   - inflammatory protein which can be used to monitor activity in inflammatory bowel disease (often rises before symptoms occur)
3. Endoscopy
   - sometimes too hard to get far enough through the bowels in which case:
   . Leukocyte scran
   . Barium studies
   . Bullet endoscopy

Question 13

What is a complication of inflammatory bowel disease?

Answer 13

Ulcerative Colitis develops carcinoma
- risk increases with time 
- judgement as to whether colectomy is justified
. Attitude to risk
. Carcinoma surveillance potential

Question 14

What are the main methods for treatment of inflammatory bowel disease?

Answer 14

1. Medical treatment (immunosuppressive)
   - systemic steroids (prednisolone)

• local steroids (rectal administered - colorectal disease only)
• anti inflammatory drugs
  . 5-amino salacyclic acid (ASA) based drugs - Pentasa, mesalazine, sulphasalazine
• non steroid immunosuppressants
  . Azathioprine
  . Methotrexate
• anti TNFalpha therapy
  . Infliximab, adalimumab (biological drugs)

Question 15

What are surgical treatments for inflammatory bowel disease?

Answer 15

1. Colectomy
   - cures ulcerative colitis
2. Crohn’s disease - palliate symptoms
   - remove obstructed bowel segments
   - drain abscesses
   - close fístulas - especially perianal

Usually results in stoma/bag (may be reversible)

Question 16

What condition presents with lip and oral swelling noted from other causes of increased capillary leakage?

Answer 16

Orofacial granulomatosis

Question 17

What are some triggers for orofacial granulomatosis?

Answer 17

Food preservatives and additives

• benzoate
• sorbate
• cinnamon