GI 10 - IBD

Question 1

Name some triggers of IBD:

Answer 1

• Infection
• Diet
• Smoking
• Antibiotics

Question 2

What is the typical presentation of ulcerative colitis?

Answer 2

• Young adult
• Urgent diarrhoea
• Mucous/bloody stools

May also have problems with:

• Skin
• Liver/biliary tree
• Eye
• MSK pain

Question 3

What is the typical presentation of Crohn’s disease?

Answer 3

• Either 15-30yrs or 60+yrs

If ileum affected:

• Colicky abdominal pain
• Diarrhoea
• Malabsorption
• Weight loss

If colon affected:

• Bloody/mucous diarrhoea
• Malaise
• Anorexia
• Weight loss
• Perianal disease

Question 4

What part of the GI tract is affected by ulcerative colitis?

Answer 4

• Continuous proximally from rectum, can affect whole colon

- Mucosa only

Question 5

What part of the GI tract is affected by Crohn’s disease?

Answer 5

• Can affect any part of GI tract (with skip lesions)

- Transmural

Question 6

Is there a higher risk of strictures with UC or Crohn’s? Why?

Answer 6

Crohn’s

Transmural disease leading to thickening of wall and narrowing of the lumen, whereas UC only affects mucosa

Question 7

What skin conditions are commonly seen with IBD?

Answer 7

• Erythema nodosum
• Pyoderma gangrenosum
• Psoriasis

Question 8

Which of IBD may be managed by dietary changes?

Answer 8

Crohn’s

Question 9

What methods are commonly used to investigate IBD?

Answer 9

• Blood test
• Stool cultures
• Abdominal XRay
• CT scan
• MRI scan
• Colonoscopy
• Barium enema

Question 10

Which IBD can cause perianal disease?

Answer 10

Crohn’s disease

Question 11

What are the macroscopic changes associated with UC?

Answer 11

• Loss of haustra
• Pseudopolyps
• Loss of typical vascular pattern

Question 12

What are the microscopic changes associated with UC?

Answer 12

• Crypt abscesses/distortion
• Decreased no. goblet cells
• Inflammatory infiltrate into lamina propria

Question 13

What are the macroscopic changes associated with Crohn’s disease?

Answer 13

• Cobblestone appearance
• Fistulae of bowel + bowel/bladder/vagina/skin
• Ulcers

Question 14

What are the microscopic changes associated with Crohn’s disease?

Answer 14

Granuloma formation

Question 15

Which sign from a barium enema is associated with UC?

Answer 15

Lead pipe sign

Question 16

Which sign from a barium enema is associated with Crohn’s disease?

Answer 16

String sign of Kantour

Question 17

Name some medications which are available for IBD:

Answer 17

• Aminosalicylates ie Sulfasalazine
• Corticosteroids ie Prednisolone
• Immune system suppressors ie Azathioprine
• Antibiotics
• Anti-diarrhoea med
• Pain relief
• Iron/vit B12/Ca2+/vit D supplements

Question 18

What is the surgical option for UC? IS it curative?

Answer 18

Proctocolectomy +/- Ileoanal anastamosis

Curative

Question 19

What are the surgical options for Crohn’s disease?

Are they curative?

Answer 19

• Strictureplasty
• Resection +/- colostomy
• Abscess drain

Not curative

Question 20

What is toxic megacolon, and with which IBD does it typically appear?

Answer 20

• Dilation of colon due to inflammation extending into smooth muscle layer, causing paralysis
• Neutrophils and macrophages produce NO = dilatation

Usually seen in ulcerative colitis