Surgical Management of IBD

Question 1

Similarities between presentation of UC vs Crohn’s

Answer 1

Abdominal pain
Diarrhoea - unless in the terminal ileum
Weight loss
Aggravated by Stress
Extragastrointestinal manifestations

Question 2

Differences between presentation of UC vs Crohn’s

Answer 2

Location of pain: midgut for Crohn’s and hindgut for UC

Layers of Crohn’s - stricturing as it effects the whole from mucosa to serosa (colicky)

Layers of UC - only effects the mucosal layer (constant)

Bleeding - common in the UC unless Crohn’s colitis

Crohn’s - anal fistulas; colovesical fistula presents with penumoturia; malnutrition (skinny)

UC - cancer is common in UC but can occur if Crohn’s affects the colon

Question 3

Encroachment of mesenteric fat

Answer 3

Present in Crohn’s disease - caused due to excessive immunological activity in the mesentery

Question 4

Treatment for Acute UC and Crohn’s

Answer 4

IV hydrocortisone 7 days 100mg QDS
on discharge - start with 5mg x 8 for 1 week reduce step wise for the next 6 weeks.

Question 5

What type of disease is Crohn’s?

Answer 5

IBD
Granulomatous - aggregation of macrophages

Question 6

Investigations for Crohn’s

Answer 6

Bloods
OGD + colonoscopy
Biopsy of ileum - showing granulomatous disease
MRI
enteroclysis - X-ray of the small bowel

Question 7

Indications for surgery on Crohn’s

Answer 7

enterovesical fistulas
enterovesical fistula
cutaneous fistula
failure of medical treatment
perforation of the terminal ileum

Question 8

surgical options for Crohn’s disease

Answer 8

ileocaecal resection - need B12 treatment for life

Question 9

where does ulcerative colitis start most commonly?

Answer 9

rectum

Question 10

imaging for UC initially

Answer 10

sigmoidoscopy

Question 11

acute treatment for UC

Answer 11

IV steroids
5-day rule
x-ray to check for toxic megacolon
bloodss

Question 12

surgical options for UC

Answer 12

J-pouch: connects the ileum to the anus
ileostomy