U.C or Crohns?

Question 1

What is the Pathophysiology Of UC?

Answer 1

**U.C - **Normal flora activate TH2 cells to stimulate B cells to make autoantibodies

Question 2

What are the symptoms of UC?

Answer 2

U.C -

Frequent small stools and an urgency (Tenesmus)

Rectal bleeding and bloody diarrhoea

Pain in lower left groin/iliac fossa

Weight loss

Question 3

What is the distribution of UC?

Answer 3

**U.C - **Only colon.

Proctitis (Colon)

Left sided colitis (Up to spenic flexure)

Pan colities (all of colon)

It is CONTINUOUS

Question 4

What is the aetiology of UC?

Answer 4

U.C -

Genetic traits

Usually in F>M and in younger people, 20-25

Smoking is protective

Question 5

What are the macroscopic findings for UC?

Answer 5

**U.C - **Only the mucosal layer is affected and it is continuous. This mucosal layer breaksdown into unaffected islands before complete detruction

Backwash iliitis but not pure ileum

Question 6

Microscopic findings of UC

Answer 6

U.C - Crypt abscesses and mucin depletion from mucosal layer damage

Symmetrical inflammation

Question 7

What are the Extra intestinal features for UC and both?

Answer 7

UC - Primary sclerosing cholangitis, toxic megacolon

**Both - **Weight loss, fever, e.nodosum, p.gangrenosum, arthralgia, arthritis, uveitis

Question 8

What are the investigations for

1. Both
2. UC
3. Crohns

Answer 8

Both - FBC ?Anaemia, CRP/ESR, infection

X-Ray

U.C - LFTs and ANCAS

Crohns - ASCA

Question 9

What is the prognosis for them both?

Answer 9

U.C - Remission

Crohns - Can be disabling - worse prognosis

Question 10

What is the pathophysiology of Crohns?

Answer 10

Crohns - Infections agent of host activate TH1 cells to activate macrophages, cytokines and free radicals for tissue damge

Question 11

What are the symptoms of Crohns?

Answer 11

Crohns -

Bleeding less common but diarrhoea

Pain in lower right iliac fossa which is more severe. Malnourised so anaemia, osteoporosis

Question 12

What is the distribution of Crohns?

Answer 12

This is the whole GI tract but is usually RECTAL SPARING. It is NON CONTINUOUS and shows SKIP LESIONS.

Normally at the ileocecal valve

Question 13

What is the aetiology of Crohns?

Answer 13

Genetic traits

Appears in 20s and again in 50-70

Smoking is causative

Question 14

What are the macroscopic findings for crohns?

Answer 14

Non continuous skip lesions

Strictures, fistulas (vagina, bladder, bowel) and anal fissures

Question 15

What are the extra intestinal features for crohns?

Answer 15

Crohns - Mouth ulcers

Question 16

What are the extra intestinal features for UC?

Answer 16

U.C - Primary sclerosin cholangitis, toxic megacolon

Question 17

Microscopic findings of crohns?

Answer 17

Granulomas, all layers

Question 18

What is UC treatment?

Answer 18

Mild (

Moderate (

Severe (>6) Admit and hydrocortisone

Consider surgery or infliximab/ciclosporin

Question 19

What is the Crohns treatment

Answer 19

judgment made on systemic symptoms eg Tachy, low alub, raised WCC/CRP .

Predinsolone if mild

If severe give hydrocortisone/metronidazole (titrate down to pred if better)

Consider azathioprine, sulfasalazine, surgery