UC and crohns

Question 1

tell me about Ulcerative colitis (UC)

Answer 1

form of inflammatory bowel disease. Inflammation always starts at rectum (hence it is the most common site for UC), never spreads beyond ileocaecal valve and is continuous. The peak incidence of ulcerative colitis is in people aged 15-25 years and in those aged 55-65 years

Question 2

Symptoms of Ulcerative colitis (UC)

Answer 2

bloody diarrhea
urgency
tenesmus
abdominal pain, particularly in the left lower quadrant

Question 3

extra-intestinal features of

Answer 3

Primary sclerosing cholangitis is much more common in UC

Uveitis is more common in UC

Question 4

Risk factors / causes

Answer 4

genetic
unknown
more common in non-smokers/ex

Question 5

Common in both Crohns and UC

Answer 5

related to disease activity 
Arthritis: pauciarticular, asymmetric
Erythema nodosum
Episcleritis
Osteoporosis

not related to disease activity
Arthritis: polyarticular, symmetric
Uveitis
Pyoderma gangrenosum
Clubbing
Primary sclerosing cholangiti

Question 6

investigations

Answer 6

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

Question 7

Genes associated with UC

Answer 7

HLADR103

Question 8

Investigations

Answer 8

FBC - Anaemia

ESR

CRP

Faecal Calprotectin

Stool sample

Blood cultures

Sigmoidoscopy

Endoscopy/ Colonoscopy for biopsy

Radiology

Question 9

When is ESR elevated

Answer 9

In exacebrations or because of abscess in IBD

Question 10

What can we benefit from CRP

Answer 10

Helpful in monitoring Crohn’s disease activity

Question 11

Why would you want a stool sample in IBD?

Answer 11

Help to exclude superimposed infections in exacebrations

Question 12

What is sigmoidoscopy

Answer 12

Looks at rectum and sigmoid colon.

Question 13

What can sigmoidoscopy show in UC

Answer 13

Loss of vascular pattern

granularity

Friability

Ulceration

Question 14

What can sigmoidoscopy show in Crohn’s

Answer 14

Patchy inflammation with discrete, deep ulcers, perianal disease or rectal sparing occurs

Cobble stone appearance

Question 15

What Radiological investigations can help in IBD investigations

Answer 15

Barium enema - can show ulcers or strictures

CT - colongram

MRI - staging

AXR - dilation of colon, mucosal oedema, perforation

USS - thickened small bowel, stricture in Crohn’s disease.

Question 16

Surgical treatment of UC

Answer 16

60% of UC will require surgery

Panproctocolectomy with ileostomy or proctocolectomy with ileal–anal pouch anastomosis cures the patient

Question 17

Surgical treatment of Crohn’s

Answer 17

Operations are often necessary to deal with fistulae, abscesses and perianal disease, or to relieve small or large bowel obstruction

Surgery is not curative compated to UC, and recurrence is a rule

Question 18

IBD prognosis

Answer 18

Now life expectancy is similar to general population and patients can live normal life

Question 19

A 35 year old male presents with weight loss, diarrohoea, and abdominal pain. On examination he has apthous ulcers in the mouth and a palpable mass in the right illiac fossa.

Answer 19

Crohn’s disease

Question 20

Risk factors for Crohn’s

Answer 20

More common in smokers

Question 21

Symptoms of crohn’s disease

Answer 21

Diarrhoea/urgency “I get up at 4am and go 5-6 times in the next 45 mins”

Abdominal pain, weight loss, fever, malaise, anorexia.

“I can be fine one minute and deathly the other”

Question 22

Signs of Crohn’s

Answer 22

Apthous ulcers

Abdominal tenderness/mass

Fistulae

perianal abscess

skin tags

Anal strictures

Question 23

tell me about crohns disease

Answer 23

Crohn’s disease is a form of inflammatory bowel disease. It commonly affects the terminal ileum and colon but may be seen anywhere from the mouth to anus.

Question 24

general points about crohns

Answer 24

patients should be strongly advised to stop smoking
some studies suggest an increased risk of relapse secondary to NSAIDs and the combined oral contraceptive pill but the evidence is patchy

Question 25

Inducing remission in Crohn’s

Answer 25

glucocorticoids (oral, topical or intravenous) are generally used to induce remission. Budesonide is an alternative in a subgroup of patients

enteral feeding with an elemental diet may be used in addition to or instead of other measures to induce remission, particularly if there is concern regarding the side-effects of steroids (for example in young children)
5-ASA drugs (e.g. mesalazine) are used second-line to glucocorticoids but are not as effective
azathioprine or mercaptopurine* may be used as an add-on medication to induce remission but is not used as monotherapy. Methotrexate is an alternative to azathioprine
infliximab is useful in refractory disease and fistulating Crohn’s. Patients typically continue on azathioprine or methotrexate
metronidazole is often used for isolated peri-anal disease

Question 26

Maintaining remission in Crohn’s

Answer 26

stopping smoking is a priority (remember: smoking makes Crohn’s worse, but may help ulcerative colitis)
azathioprine or mercaptopurine is used first-line to maintain remission
methotrexate is used second-line
5-ASA drugs (e.g. mesalazine) should be considered if a patient has had previous surgery

Question 27

other risks in Crohns

Answer 27

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

Question 28

tell me about Aminosalicylate drugs 5-aminosalicyclic acid (5-ASA)

Answer 28

Sulphasalazine and Mesalazine

very bad side effects

Question 29

most important side effects of Aminosalicylate drugs

Answer 29

pancreatitis is x7 more common in Mesalazine