IBD

Question 1

Crohns histology

Answer 1

Granulomas
Cobblestoning
Thick wall
increased fat

Question 2

Ulcerative colitis histology

Answer 2

Crypt access
decreased goblet cells
pseudopolyps

Question 3

UC inducing remission

Answer 3

1. aminosalicylates (topical, then oral)
2. corticosteroids (topical or oral)
3. biologics- infliximab

admit to hospital if severe

1. IV corticosteroids
2. IV ciclosporin
3. Infliximab

Question 4

UC maintenance

Answer 4

1. topical aminosalicylate

2. rectal corticosteroid

Question 5

In UC maintenance can consider oral azathioprine or oral mercaptopurine to maintain remission:

Answer 5

after 2 or more inflammatory exacerbations in 12 months that require treatment with systemic corticosteroids or

if remission is not maintained by aminosalicylates

Question 6

Crohn inducing remission

Answer 6

1. fluid resus, nutrition, prophylactic heparin
2. a. IV hydrocortisone ( if not consider budesonide or if not then aminosalicylate)
   b. azathioprine /mercaptopurine (add on therapy not mono)
   c. methotrexate as alternative to azathioprine
   Failing immunosuppressive therapy and/ or corticosteroid, d. consider infliximab and adalimumab

metronidazole is often used for isolated peri-anal disease

Question 7

Crohn maintenance

Answer 7

1. smoking cessation
2. azathioprine or mercaptopurine is used first-line to maintain remission(test TPMT before)

( if contraindicated offer methotrexate)

Question 8

Inflammation thickness in Crohn

Answer 8

Transmural

Question 9

Inflammation thickness in UC

Answer 9

Submucosa or mucosa

Question 10

UC severity score

Answer 10

Truelove and Witts

Question 11

Crohns severity score

Answer 11

Harvey - Bradshaw index

Question 12

Ulcerative colitis is classified as ‘severe’ when the patient has blood in their stool, or is passing more than 6 stools per day plus at least one of the systemic following features:

Answer 12

T - Temp > 37.8
R - Rate (heart) > 90
U - (Uh)naemia Hb < 105g/L
E - ESR >30 mm/hour

Question 13

Triggers for UC flare

Answer 13

stress
medications (NSAIDs, antibiotics)
cessation of smoking

Question 14

Key crohns symptoms

Answer 14

Diarrhoea
Abdominal Pain ( Esp RLQ due to ileocecal common location)
Weight loss

Question 15

Key UC symptoms

Answer 15

Bloody diarrhoea