IBD

Question 1

How has the incidence of Crohn’s disease changed in Scottish children?

Answer 1

Dramatically increased and continues to

Question 2

What are the presenting features of Crohn’s in children?

Answer 2

Main

• Weight loss
• Growth failure

Some

• Abdominal pain
• Diarrhoea
• Rectal bleeding
• Arthritis
• Mass

Rare
-Fever

Question 3

What are the presenting features of UC in children?

Answer 3

Main

• Diarrhoea
• Rectal bleeding

Some

• Abdominal pain
• Arthritis

Rare

• Fever
• Weight loss
• Growth failure

No mass

Question 4

What history and examination is required when diagnosing IBD?

Answer 4

• Intestinal symptoms
• Extra-intestinal manifestations (can include erythema nodosum)
• Exclude infection (negative stool culture with 2/52 history)
• Family History
• Growth and sexual development (growth chart plotting and Tanner staging)
• Nutritional status

Question 5

What laboratory investigations should be carried out?

Answer 5

Full blood count & ESR

• Anaemia
• Thrombocytosis
• Raised ESR

Biochemistry

• Stool calprotectin
• Raised CRP
• Low Albumin

Microbiology
-No stool pathogens

Question 6

How does Crohn’s usually present in children?

Answer 6

• Lack of specific symptoms (present with weight loss and growth failure)
• Abnormal blood tests and high calprotectin

Question 7

How does UC usually present in children?

Answer 7

• Symptomatic with bloody diarrhoea
• Do not necessarily have abnormal growth or blood tests
• High calprotectin

Question 8

What are the definitive radiological investigations for IBD?

Answer 8

• MRI (usually >5 years due to the need to keep still without a GA)
• Barium meal and follow through (younger kids)

Question 9

What types of endoscopy are used in the definitive diagnosis of IBD?

Answer 9

• Colonoscopy
• Upper GI endoscopy
• Mucosal biopsy
• Capsule endoscopy
• Enteroscopy

Question 10

What are the aims of treatment in IBD?

Answer 10

• Induce and maintain remission
• Correct nutritional deficiencies
• Maintain normal growth and development

Question 11

What are the treatment for IBD in children?

Answer 11

Medical

• Anti-inflammatory
• Immuno-suppressive
• Biologicals ( Infliximab)

Nutritional

• Immune modulation
• Nutritional supplementation
• Milkshake diet

Surgical