Ulcerative Colitis And Chron's

Question 1

Where does UC start and how does it spread?

Answer 1

Rectum, spreads proximally

Question 2

Symptoms of UC

Answer 2

Bloody watery diarrhoea
Abdo pain
Weight loss
Erythema nodosum

Question 3

Associated diseases with UC

Answer 3

(anything inflammatory really)
Renal calculi
Vasculitic diseases
Gallstones
Uveitis
Sacroilitis
Sclerosing cholangitis
Pyoderma gangrenosum
Conjunctivitis
Monoarticular arthritis

Question 4

What would you see in UC colonoscopy?

Answer 4

Crypt abscesses
Ulceration
Submucosal fibrosis
Dysplasia
Pseudopolyps

Question 5

Complications of UC

Answer 5

Heamorrhage
Perforation
Toxic dilatation
Carcinoma

Question 6

Pathogenesis of UC

Answer 6

Strong immune response to gut flora

9% increased risk if relative affected

Question 7

Diagnosis of UC

Answer 7

pANCA in 75%
Stool calprotectin of over fifty
High ESR and CRP
Low heamoglobin and albumin
Loss of haustra on X-ray

Question 8

Specific UC treatment and then rest of treatment

Answer 8

Cyclosporin to prevent bacterial overgrowth
Anticoagulation with heparin or warfarin

5 aminosalicylate
Immunosuppressants (Tacrolismus, ciclosporin, mycophenate, metronidazole)
Biologics (IL13+IL13 blockers, anti TNF alpha antibodies (infliximab, adalimumab), vedolicumab
Steroids (prednisolone, budenoside)

Question 9

Chrons specific treatment then rest of treatment

Answer 9

Methotrexate to induce remission

5 aminosalicylate
Immunosuppressants (Tacrolismus, ciclosporin, mycophenate, metronidazole)
Biologics (IL13+IL13 blockers, anti TNF alpha antibodies (infliximab, adalimumab), vedolicumab
Steroids (prednisolone, budenoside)

Question 10

What do 5ASAs do?

Answer 10

5 aminosalicylates reduce number and severity of relapses, reduces colorectal cancer risk and maintains remission

Question 11

What sort of drugs are 5 ASAs?

Answer 11

Prodrugs

Question 12

Name some 5ASAs

Answer 12

Mesalazine
Balsalazide
Olzalazine
Sulfalazine

Question 13

What do thiopurines do in inflammatory bowel diseases?

Answer 13

Induce and maintain remission

Question 14

Azithiopurine complications

Answer 14

Leukopenia
Hepatotoxicity
Pancreatitis
Lymphoma

Question 15

Chrons presentation

Answer 15

Anorexia
Weight loss
Diarrhoea
Malaise
Pyrexia
Anemia
Vitamin deficiencies
Malabsorption
Erythema nodosum

Question 16

Chrons associated diseases

Answer 16

Carcinomas
Renal calculi
Gallstones
Uveitis
Sacroilitis
Sclerosing cholangitis
Pyoderma gangrenosum
Conjunctivitis
Monoarticular arthritis
Episcleritis
Biliary disease
Pericholangitis
Ankylosing spondylosis
Clubbing
Paneth cell metaplasia
Lymphangiectasia

Question 17

Spread of Chrons disease

Answer 17

Non-ceseating granulomatous spread that gives skip lesions and has systemic effects

Question 18

Chrons disease colonoscopy and exploration

Answer 18

COBBLESTONE APPEARANCE ON COLONOSCOPY
Abscesses
Thickened, fibrotic, odematous mesenteries
Polyps
Atrophy
Perforation
Stricture
Fistulas
Transmural inflammation
Apthous ulceration
Granular serosa

Question 19

Pathogenesis of Chrobs

Answer 19

Persistent activation of the mucosal immunity driven by intraluminal forces.

Question 20

Diagnosis of Chrons

Answer 20

Cobblestone appearance on colonoscopy
pANCA in 11%
Stool has calprotein over fifty
High ESR + CRP, platelets and WCC
Low heamoglobin and albumin