IBD

Question 1

Definition of Crohn’s

Answer 1

1. Chronic, relapsing inflammatory bowel disease
2. Can affect any part of GI tract; patchy (“skip lesions”)
3. Transmural inflammation

Question 2

Sx of Crohn’s

Answer 2

1. Abdominal pain
2. Diarrhoea ± blood/mucus
3. Vomiting and poor appetite
4. Weight loss
5. Growth delay

Extra-intestinal: mouth ulcers, perianal disease, joint pain, skin rashes, eye involvement

Question 3

RF of Crohn’s

Answer 3

1. Genetics
2. FH
3. NSAIDs
4. Smoking

Question 4

Ix for Crohn’s and UC

Answer 4

1. Bloods - FBC, CRP, ESR, LFTs
2. Faecal calprotectin (stool)
3. Endoscopy + biopsy = GS
4. Growth & nutritional assessment
5. MRI enterography - assess for strictures, fistulae, abscesses

Results:
1. Anaemia (microcytic or chronic disease)
2. Elevated CRP + ESR
3. Low albumin
4. Elevated faecal calprotectin

Question 5

4 features on endoscopy + biopsy for Crohn’s

Answer 5

1. Cobblestone appearance
2. Skip lesions (patchy involvement)
3. Transmural inflammation
4. Granulomas (non-caseating, diagnostic if present)

Question 6

3 intestinal & 3 extra-intestinal complications of CD?

Answer 6

Intestinal - strictures, abscesses, + fistulae
Extra-intestinal:
1. Osteoporosis
2. Arthritis
3. Uveitis

Long-term: increased colorectal cancer risk

Question 7

4 features on endoscopy + biopsy for UC

Answer 7

1. Continuous inflammation starting at rectum
2. Limited to mucosa/submucosa
3. No skip lesions or granulomas
4. Pseudopolyps may be seen

Question 8

Why would an XR be used in some UC cases?

Answer 8

Suspected toxic megacolon

Question 9

Acute mx of Crohn’s (inducing remission)

Answer 9

1. Exclusive enteral nutrition for 6-8 weeks
2. If severe, oral prednisolone/IV methylprednisolone
3. Analgesia for pain
4. Vitamin and mineral supplementation

Question 10

Maintenance and relapse prevention for Crohn’s

Answer 10

1. Azathioprine or mercaptopurine
2. If intolerant/unresponsive, methotrexate

Moderate-severe/steroid-dependent cases:
1. Infliximab or adalimumab

Note: corticosteroids are not used for long-term maintenance due to growth and bone side effects.

Question 11

What is UC?

Answer 11

• Chronic IBD
• Affects colon and rectum ONLY
• Continuous mucosal inflammation

Question 12

Sx of UC

Answer 12

1. Bloody diarrhoea, frequent stools
2. Abdominal pain
3. Urgency (tenesmus)
4. Poor appetite + weight loss (less than CROHNS)

Extra-intestinal: arthritis, skin lesions, + eye involvement

Question 13

Mx of mild-moderate UC

Answer 13

Oral or rectal 5-Aminosalicylic acid (5‑ASA)

Question 14

Acute mx of moderate-severe UC

Answer 14

1. Oral Prednisolone → moderate flares
2. IV Methylprednisolone → severe / hospitalised flares
3. Then taper → switch to maintenance (immunomodulator / biologic / 5‑ASA)

Immunomodulators - azathioprine or mercaptourine

Biologics - infliximab or adalimumab

Question 15

2 complications of UC

Answer 15

1. Toxic megacolon
2. Bleeding or perforation

Growth delay can be a complication but less common than in Crohn’s