IBD

Question 1

What are the extraintestinal manifestations of ulcerative colitis?

Answer 1

Erythema nodosum
Episcleritis
Uveitis
Primary sclerosing cholangitis

Question 2

What are the extraintestinal manifestations of Crohn’s disease?

Answer 2

Fat wrapping of mesenteric fat around the intestine
Fatty liver
Gallstones
Renal stones
Increased risk of adenocarcinoma fo distal ileum
Mouth and vagina ulcers are more common

Question 3

What investigation confirms Crohn;s?

Answer 3

Endoscopy

Question 4

Which opthalmolgoical patholgoies are associated with IBD?

Answer 4

Episclerritis
IBD

Question 5

When is mesasalazine given first line?

Answer 5

For ulcerative colitis in initial presentation first line

Question 6

What is given to induce remission in ulcerative colitis?

Answer 6

Steroids

Question 7

What is given to maintain remission?

Answer 7

Azathriopine if mesasalazine has failed

Question 8

What is first line in Crohn’s?

Answer 8

Oral mesasalazine

Question 9

What is second line in Crohn’s?

Answer 9

Mesasalazine with corticosteroid

Question 10

What is 3rd line in Crohn’s

Answer 10

immune modifying drugs like azathriopine then progreessing to methotrexate. Before adminstering, thiopurinemethyltransferase activity should be assessed, which is an indicator of bone marrow activity. CXR and PPD test to assess for latent tuberculosis

Question 11

What can predict fistula trajectory?

Answer 11

Goodsall rule:

Posterior to transverse anal linemen as it will follow a curved course to the posterior midline
Anterior to transverse anal line: fistula will have a straight radial course to the dentate line

Question 12

What is the Trulove and Witt severity index?

Answer 12

The Truelove and Witts severity index is used to assess the severity of a flare-up of ulcerative colitis, which then guides management decisions.

Question 13

What are the features of TruLove and Witt?

Answer 13

The presence of bloody diarrhoea 6 or more times a day is a key diagnostic feature for severe disease, alongside one of:
temperature >37.8 degrees
pulse >90bpm
ESR >30mm/hour
anaemia.

Question 14

What should be done if a patient meets the criteria for Trulove and Witt’s?

Answer 14

If a patient meets the criteria for severe disease they should be admitted to hospital and typically are treated with intravenous steroids (with proton pump inhibitor cover) first-line and broad-spectrum antibiotic cover if infection is suspected

Question 15

What is assessed in TrueLove and Witts criteria?

Answer 15

TrueLove is THE MHB
T=Temperature
H= Heart rate
E=ESR
M=Movements of stool
B=Blood

Question 16

What is severe ulcerative colitis based on Tuelove and Witts criteria?

Answer 16

Temperature over 37.8
Heart rate over 90
ESR over 30
Movement of stool as 76
HB low
Large amount of blood

Question 17

What is moderate ulcerative colitis based on Tuelove and Witts criteria?

Answer 17

Temperature 37.1-37.8
Heart rate of 70-90
ESR less than 30
Movements of 4-6 a day
Hb low
Moderate blood in stool

Question 18

What is sulphasalazine?

Answer 18

a combination of sulphapyridine (a sulphonamide) and 5-ASA

Question 19

What are side effects of sulphasalazine?

Answer 19

rashes, oligospermia, headache, Heinz body anaemia, megaloblastic anaemia, lung fibrosis

Question 20

How is 5-ASA distributed?

Answer 20

5-aminosalicyclic acid (5-ASA) is released in the colon and is not absorbed. It acts locally as an anti-inflammatory

Question 21

How does mesasalazine work?

Answer 21

a delayed release form of 5-ASA

Question 22

What is a risk with mesasalazine?

Answer 22

Pancreatitis 7x more than sulphasalazine
Agranulocytosis

Question 23

Which IBD is gallstones more common?

Answer 23

Crohn’s disease

Question 24

Which IBD has renal stones?

Answer 24

Crohn’s and these are calcium oxolate

Question 25

Which drug for IBD has a high risk of pancreatitis?

Answer 25

Mesasalazine has greater risk than sulphasalazine -> mesasalazine is also associated with agranulocytosis

Question 26

What is used to maintain remission in Crohn’s disease.

Answer 26

Azathriopine Mercaptopurine

Question 27

When should azathriopine or mercaptopurine be avoided in managing Crohn’s?

Answer 27

When TPMT levels are low

Question 28

How to maintain remission following a mild to moderate ulcerative colitis flare?

Answer 28

Oral aminosalicylate for extensive disease Rectal aminosalicylate for limited disease

Question 29

How to maintain remission following a severeulcerative colitis flare?

Answer 29

Oral azathioprine or ora mercaptopurien

Question 30

What is the criteria for immunosuppressants in UC?

Answer 30

Following a severe relapse or >=2 exacerbations in the past year oral azathioprine or oral mercaptopurine

Question 31

Which immunosuppressant should be avoided in UC comapred to Crohn’s?

Answer 31

Methotrexate

Question 32

What is knator’s string sign?

Answer 32

Strictre of the terminal ileum in Crohn’s disease

Question 33

What does faecal elastase indicate?

Answer 33

Pancreatic cancer

Question 34

What causes ongoing diarrhoea in Crohn’s following resection with normal CRP?

Answer 34

Complication of ileocecal resection, which should be treated with cholestyramine

Question 35

What Indicates moderate exacerbation of UC?

Answer 35

*4-6 stools per day *Nocturnal bowel movements *Visible blood in stools *Mild anaemia

Question 36

What indicates severe exacerbation of UC?

Answer 36

*6 or more stools per day * severe abdominal pain *fever * signs of systemic toxicity * elevated HR and low BP

Question 37

What is first-line management to maintain remission in patients with Crohn's?

Answer 37

Azathriopine

Question 38

What is second-line management to maintain remission in patients with Crohn's?

Answer 38

Corticosteroid like budesonide

Question 39

What is peutz-jeghers syndrome?

Answer 39

autosomal dominant condition characterised by numerous hamartomatous polyps in the gastrointestinal tract. It is also associated with pigmented freckles on the lips, face, palms and soles.

Question 40

Which gene is responsible for peutz-jeghers syndrome?

Answer 40

serine threonine kinase LKB1 or STK11

Question 41

what are the features of peutz-jet hers syndrome?

Answer 41

*hamartomatous polyps in the gastronintestinal tract (mainly small bowel) *small bowel obstruction is a common presenting complaint, often due to intussusception *gastrointestinal bleeding pigmented lesions on lips, oral mucosa, face, palms and soles

Question 42

How to manage peutz-jeghers syndrome?

Answer 42

Conservative unless complications develop

Question 43

What causes crypt abscesses?

Answer 43

Ulcerative colitis

Question 44

What is this sign?

Answer 44

Coffee bean sign due to sigmoid volvulus