Week 4.4 - Inflammatory Bowel Disease

Question 1

What is microscopic colitis?

Answer 1

type of IBD need microscope to see inflammation. less common less problematic

Question 2

What are 2 types of microscopic colitis?

Answer 2

• collagenous colitis (increased thickness of sub-epithelial collagen band)
• lymphocytic colitis - increased no. of lymphocytes

Question 3

What are symptoms of microscopic colitis?

Answer 3

chronic, non bloody, waterry diarrhoea in mostly women usually 60’s.

Question 4

What causes microscopic colitis and what is it associated with?

Answer 4

• associated with many autoimmune disorders - coeliac, thyroid disorders, rheumatoid arthritis
• also medications - PPI’s, NSAIDS, SSI’s

Question 5

How do you treat microscopic colitis?

Answer 5

• take patient off PPI’s, NSAIDs or SSI’s if using.
• if not cause, use first line budesonide steroid
• if still not settles, use stronger immunosuppressant

Question 6

What is the pathogenesis of IBD?

Answer 6

• genetics, microbiome, environment, smoking, diet, history of gastroenteritis
• genetic SNP’s in genes coding for epithelial barriers, immune response and bacterial handling
• dysbiosis

Question 7

What are UC symptoms?

Answer 7

bloody diarrhoea, abdominal pain, weight loss, fatigue

Question 8

What are names for when UC is limited to a specific region?

Answer 8

• proctisis - rectum only
• proctosigmoiditis
• left sided colitis up to splenic flexure
• extensive colitis up to hepatic flexure
• pancolitis entire rectum and large colon

Question 9

What is the prognosis of UC?

Answer 9

20-30% require colectomy within 10 years

Question 10

What is a differential diagnosis for proctitis?

Answer 10

chlamydia and gonorrhoea - do rectal swab

Question 11

how do we score severity of UC?

Answer 11

• truelove and witts criteria
• mild, moderate, severe or fulminant disease

Question 12

What investigations do we carry out for UC?

Answer 12

• bloods - CRP, WBC, platalets, low albumin - inflammation
• stool cultures - infection
• faecal calprotectin
• colonoscopy and mucosa biopsy

Question 13

What is calprotectins importance?

Answer 13

• protein marker of colitis found in faeces. tells us likely IBD over IBS. high in other colitis tho..
• 0-50 normal. 50-200 equivocal. 200+ elevated

Question 14

What is management of acute severe colitis?

Answer 14

• bloods, stool for c.diff, stool chart etc.
• stop NSAID’s, opiates and anti diarrhoea med
• give IV glucocorticoids - methylprednisolone 2x daily
• give potassium may be low due to diarrhoea, heparin for risk of thromboembolism,
• xray for toxic dilatation and faecal loading

Question 15

What is acute severe colitis?

Answer 15

infection very serious disease requiring emergency medicine. severe diarrhoea with blood and systemic toxicity

Question 16

What are symptoms of CD?

Answer 16

depend on affected region
- mouth - ulcers
- oesophagus - dysphagia
- small intestine - weight loss and abdominal pain, malabsorption
- colon - bloody diarrhoea

Question 17

How does CD progress over time?

Answer 17

inflammatory disease - strictures - penetrating disease - fistulas with other organs/ bowel

Question 18

What are malabsorptive symptoms of CD?

Answer 18

• malnutrition,
• vitamin + nutrient deficiencies,
• anorexia/weight loss

Question 19

how do you investigate CD? (7)

Answer 19

similar to UC
- bloods,
- stool,
- calprotectin (may be normal if CD limited to other part of GI),
- colonoscopy,
- MRI small bowel,
- capsule endoscopy,
- CT if acutely unwell - rule out abscesses

Question 20

Crohns vs Ulcerative colitis histology? (5)

Answer 20

• UC no granulomas, CD non-caesiating granulomas
• UC has many goblet cells affected
• both crypt abscesses but UC more
• UC blood and mucus excreted, CD not
• CD transmural, UC limited to mucosa

Question 21

What is perianal CD? treat?

Answer 21

• severe pain and inability to sit. gives pain, itching, bleeding, purulent stool and incontinence.
• give Rectal EUA and MRI. drain abscess and seton stitch. antibiotics

Question 22

What are some extra-intestinal manifestations of IBD?

Answer 22

• mouth ulcers
• skin rashes - erythema nodosum
• eye conditions - uveitis, scleritis, iritis
• PSC

Question 23

What are differential diagnoses’ of IBD?

Answer 23

• other causes of chronic diarrhoea - malabsorption, IBS, overflow diarrhoea
• ileo-caecal TB
• colitis may be IBD - but can be infective or due to ischaemic colitis

Question 24

What is a long term complication of colitis?

Answer 24

bowel cancer.
- pancolitis have 26X more chance
- left colitis 8x more chance
- proctitis minimal
screen 10 years after diagnosis and as often as indicated depending on severity and risk factors