8. IBD

Question 1

compare the pattern of inflammation seen in CD and UC

Answer 1

CD

• chronic
• skip lesions in any part of GI tract (exc. rectum)
• transmural

UC

• recurrent acute
• continuous lesions starting in rectum limited to colon (never anus)
• superficial (mucosa + submucosa)

Question 2

this endoscopy image show UC or CD? why?

Answer 2

UC: loss of definition, continuous superficial ulceration

Question 3

this endoscopy image shows UC or CD? why?

Answer 3

CD: cobblestone appearance, skip lesions

Question 4

this image shows UC or CD? why?

Answer 4

CD: strictures

Question 5

this image shows UC or CD? why?

Answer 5

UC: featureless lead pipe colon

Question 6

compare the effects of UC and CD on gut wall structure

Answer 6

CD

• criss-crossing deep ulceration… cobblestone appearance
• bowel wall thickening/fibrosis, lumen narrowing
• fistulae (e.g. bowel-bladder)
• granuloma formation

UC

• mucosal sloughing
• abnormal crypt architecture, inc. crypt abscesses
• loss of haustra (featureless appearance)
• chronic inflammatory infiltrate of lamina propria

Question 7

this image shows UC or CD? why?

Answer 7

UC

• sloughing of surface
• abnormal crypts with abscess

Question 8

this image shows UC or CD? why?

Answer 8

CD:

• granuloma
• normal crypts

Question 9

compare the symptoms/signs of UC and CD

Answer 9

CD:

• severe abdominal pain
• non-bloody diarrhoea
• weight loss, malnutrition
• fevere, malaise, anorexia
• abdominal mass, perianal lesions

UC:

• milder abdominal pain during diarrhoeal attacks
• attacks of blood diarrhoea
• fevere and malaise

Question 10

name 3 examples of possible extra-intestinal signs/symptoms of IBD

Answer 10

1. erythema nodosum (tender red rash over shins)
2. uveitis (inflammation of iris, ciliary body and choroid)
3. arthritis

Question 11

describe the 3 types of drug used to treat IBD

Answer 11

step-wise approach

1. AMINOSALICYLATES: flares and remission
2. CORTICOSTEROIDS (prednisolone): flares only
3. IMMUNOMODULATORS (azathioprine): refractive, aggresive cases

Question 12

describe the surgical management of IBD

Answer 12

1. CD - not curative, only performed if absolutely necessary (strictures, fistulae), as little bowel removed as possible
2. UC - curative colectomy, performed if inflammation not settling, precancerous changes, toxic megacolon

Question 13

which type of IBD more likely results in colon cancer

Answer 13

UC