3. Inflammatory bowel disease

Question 1

name 4 ulcerative colitis symptoms

Answer 1

• bloody diarrhoea,
• (mild) abdominal pain during diarrhoeal attacks
• tenesmus
• malaise/fever

Question 2

name 3 crohn’s disease symptoms

Answer 2

• non-bloody diarrhoea,
• severe abdominal pain
• malaise/fever/anorexia

Question 3

name 3 crohn’s disease signs

Answer 3

• weight loss and malnutrition
• abdominal mass (relatively common)
• anal and perianal lesions

Question 4

is UC and CD inflammation acute or chronic

Answer 4

UC = recurrent acute inflammation with intervening quiescent phases

CD = chronic relapsing inflammation

Question 5

which parts of the GI tract are affected by UC and CD

Answer 5

UC = only colon (always with rectal involvement) but not anus

CD = any part of GI system inc. anus but not rectum

Question 6

is inflammation of affected region continuous/discontinuous in UC and CD

Answer 6

UC = continuous

CD = skip lesions

Question 7

is inflammation in UC and CD superficial or deep

Answer 7

UC = superficial, limited to mucosa and submucosa

CD = deep - transmural, inc. serosa

Question 8

what are the microscopic differences between UC and CD

Answer 8

UC

• widespread irregular superficial ulceration (sloughing off of mucosal layer)
• abnormal crypt architecture
• no granulomas
• normal wall thickness, minimal fibrosis

CD

• fissured ulceration causing ‘cobblestone’ appearance
• normal crypt architecture
• granulomas
• wall thickened, marked wall fibrosis

Question 9

should colectomy be performed in UC or CD and why

Answer 9

in UC due to significantly increased risk of colon cancer

Question 10

name 3 possible complications of CD

Answer 10

1- strictures - obstruction
2- fistulae, eg bowel to bowel, bowel to bladder or vagina
3- iron, folate and vit B12 deficiency… anaemia