Wk 11: IBD

Question 1

What is crohn’s disease?

Answer 1

• In distal ileum/colon but can affect entire tract
• Inflammatory lesion -> ulceration of mucosa -> deeper layers
• Skip lesions - cobbled appearance

Question 2

What is ulcerative colitis?

Answer 2

• Most common
• Affects colon (colonic mucosa)
• Characterised by diffuse inflammation + crypt abscesses
• 20% suffer from pancolitis

Question 3

What are the signs and symptoms of CD + UC?

Answer 3

• Abdominal pain/cramping
• Diarrhoea
• Fever
• Fatigue
• Weight loss
• Mouth sores

Question 4

What is the difference between abdominal pain in UC vs CD?

Answer 4

• UC: lower abdomen (colicky type pain)
• CD: RLQ + more prevalent

Question 5

Why do patients with UC + CD get abdominal pain/cramping?

Answer 5

Inflammation/ulceration affect normal movement of intestines/colon, results in pain

Question 6

What type of diarrhoea do patients with UC tend to present with?

Answer 6

Bloody, mucoid diarrhoea due to inflammation of mucosa

Question 7

What is fatigue caused by in patients with UC + CD?

Answer 7

Development of anaemia

Question 8

What is weight loss caused by in patients with UC + CD?

Answer 8

• Red ability to digest/absorb food
• Malasb
• Results in reduced BMI

Question 9

Give examples of extra-intestinal manifestations that patients with UC + CD may experience

Answer 9

• Ankylosing spondylitis (spine/hip joint)
• Arthritis
• Erythema nodosum (skin flushing/tenderness)
• Uveitis (inflammation of eye)
• Aphthous ulcers (painful open ulcers)
• Failure to have children

Question 10

What are the potential complications of both UC and CD?

Answer 10

• Inc risk of colon cancer
• Malnutrition - excess di + malabs
• Anaemia - bleeding from GI tract
• Meds
• Blood clots - pro-coaguable state during flare
• Primary sclerosing cholangitis

Question 11

What are the risks associated with medication?

Answer 11

• Cancer (biological agents)
• Hypertension
• Osteoporosis - steroids w/ low BMI + malabs

Question 12

What are the potential complications of crohn’s disease?

Answer 12

Bowel wall narrowing:
- Obstruction: strictures caused by spasms, scarring + oedema
- Fistulas: abnormal connection btw 2 areas of intestine

• Ulcers
• Anal fissures + perianal lesions (skin tags + abscesses)

Question 13

What are the potential complications of UC?

Answer 13

Toxic megacolon
- Dilation of colon causing severe abdominal pain + tenderness
- High risk of bowel perforation

• Perforated colon

Question 14

What are the risk factors of UC + CD?

Answer 14

• Age (UC 20-40, CD 15-40)
• Fx
• Infection
• Smoking
• Meds (NSAIDs)

Question 15

What are the causes of UC + CD?

Answer 15

• Genetics
• Env
• Autoimmune (esp CD)

Question 16

Outline how smoking has an effect on developing UC + CD

Answer 16

• Smoker: CD
• Non-smoker: UC

Question 17

Which food have an affect on the already damaged mucosal lining?

Answer 17

• Caffeine
• Spicy
• Fatty

Question 18

How is UC + CD diagnosed?

Answer 18

• Examination + history: abdomen tender + distended, blood
• Colonoscopy/sigmoidoscopy: 2 biopsies from 5 diff. sites
• Stool cultures: during flare
• Blood test
• Abdominal x-ray: rule out toxic megacolon
• Endoscopy: if inflammation high up in GI tract

Question 19

What will be found in a normal blood test of a patient with UC + CD?

Answer 19

• Anaemia: FBC for iron/B12 deficiency
• Inflammation: inc WCC, platelet, ESR + CRP
• LFTs: red albumin, raised ALP, AST, ALP + bilirubin
• U+Es: dehydration
• Faecal calprotectin

Question 20

Why are LFTs abnormal in a patient with UC or CD?

Answer 20

• Red albumin: malabs
• Raised ALP, AST, ALP + bilirubin: primary sclerosing cholangitis

Question 21

What is calprotectin?

Answer 21

Protein released into faeces when neutrophils gather at inflammation site

Question 22

Give examples of differential diagnosis that may be similar to UC + CD

Answer 22

• Colorectal cancer
• Infection
• Diverticular disease
• Irritable bowel syndrome
• Appendicitis
• Ectopic pregnancy
• Pelvic inflammatory disease