Tuesday [28/9/22]

Question 1

what does TPMT stand for? [1]

Answer 1

Thiopurine methyltranferase

Question 2

What is TPMT? [1]

Answer 2

An enzyme that in metabolises thiopurine drugs like 6-mercaptopurine/azithiopurine/6-thioguanine

Question 3

How common is TPMT mutation? [1]

Answer 3

1 in 300

Question 4

What can defects in TPMT lead to? [1]

Answer 4

Defects in the TPMT gene leads to decreased methylation and decreased inactivation of 6MP leading to enhanced bone marrow toxicity which may cause myelosuppression, anemia, bleeding tendency, leukopenia & infection

Question 5

what type of drug is given for mild-to-moderate flare up of crohns? [1]

Answer 5

topical aminosalicylate alone or oral plus topical

Question 6

What should be given to patients following severe relapse or over 2 exaerbations in the past year? [2]

Answer 6

oral azathioprine or oral mercaptopurine

Question 7

Can you give MTX in UC? [1]

Answer 7

No, but you can crohns

Question 8

Complication risk of a patient with UC [1]

Answer 8

colon ca

Question 9

factors causing higher risk of cancer [4]

Answer 9

disease duration > 10 years
patients with pancolitis
onset before 15 years old
unremitting disease
poor compliance to treatment

Question 10

S and S for IBD

Answer 10

In adults, it has a sensitivity of 93% and specificity of 96% for IBD. In children, the specificity falls to around 75%

Question 11

What are some other causes of raised faecal calprotectin?

Answer 11

In addition to IBD, other causes of a raised faecal calprotectin include:
bowel malignancy
coeliac disease
infectious colitis
use of NSAIDs

Question 12

What will the barium enema look like for a patient with crohn’s? [2]

Answer 12

loss of haustrations
superficial ulceration, ‘pseudopolyps’
long standing disease: colon is narrow and short -‘drainpipe colon’

Question 13

Radiology sign for Crohn’s

Answer 13

Small bowel enema
high sensitivity and specificity for examination of the terminal ileum
strictures: ‘Kantor’s string sign’
proximal bowel dilation
‘rose thorn’ ulcers
fistulae

Question 14

Radiology sign for Crohn’s

Answer 14

Small bowel enema
high sensitivity and specificity for examination of the terminal ileum
strictures: ‘Kantor’s string sign’
proximal bowel dilation
‘rose thorn’ ulcers
fistulae

Question 15

What is a futuro splint? [1]

Answer 15

stabilises weak joints

Question 16

Inflammation in CD [2]

Answer 16

No inflammation beyond submucosa (unless fulminant disease) - inflammatory cell infiltrate in lamina propria
neutrophils migrate through the walls of glands to form crypt abscesses
depletion of goblet cells and mucin from gland epithelium
granulomas are infrequent

Question 17

Inflammation in UX [4]

Answer 17

Inflammation in all layers from mucosa to serosa
increased goblet cells
granulomas

Question 18

inducing remission CD [2]

Answer 18

GLucocorticoids first line
then 5)ASA
then azathiopurine/mercaptopurine

Question 19

Surgery for CD [2]

Answer 19

The commonest disease pattern in Crohn’s is stricturing terminal ileal disease and this often culminates in an ileocaecal resection. Other procedures performed include segmental small bowel resections and stricturoplasty. Colonic involvement in patients with Crohn’s is not common and, where found, distribution is often segmental. However, despite this distribution segmental resections of the colon in patients with Crohn’s disease are generally not advocated because the recurrence rate in the remaining colon is extremely high, as a result, the standard options of colonic surgery in Crohn’s patients are generally; sub total colectomy, panproctocolectomy and staged sub total colectomy and proctectomy. Restorative procedures such as ileoanal pouch have no role in therapy.

Crohn’s disease is notorious for the developmental of intestinal fistulae; these may form between the rectum and skin (perianal) or the small bowel and skin. Fistulation between loops of bowel may also occur and result in bacterial overgrowth and malabsorption. Management of enterocutaneous fistulae involves controlling sepsis, optimising nutrition, imaging the disease and planning definitive surgical management.

Question 20

Cx for CD

Answer 20

As well as the well-documented complications described above, patients are also at risk of:
small bowel cancer (standard incidence ratio = 40)
colorectal cancer (standard incidence ration = 2, i.e. less than the risk associated with ulcerative colitis)
osteoporosis