IBD

Question 1

What are the three types of IBD?

Answer 1

• UC
• Crohn’s
• Indeterminate Colitis

Question 2

What are the features of Crohn’s Disease?

Answer 2

NESTS (Crows Nests)

No blood or mucus
Entire GI tract
Skip lesions
Transmural inflammation 
Smoking is a RF

Question 3

What other features are seen in Crohn’s?

Answer 3

• WL
• Strictures
• Fistulae

Question 4

Where does Crohn’s usually affect?

Answer 4

Terminal Ileum

Question 5

What are the features of UC?

Answer 5

CLOSE-UP

Continuous inflammation
Limited to colon and rectum
Only superficial
Smoking protects
Excrete blood and mucus
Use aminoalicylates
PSC association

Question 6

How does IBD present?

Answer 6

• Diarrhoea
• Abdominal pain
• Passing blood
• Weight loss

Question 7

What bloods should be done in IBD?

Answer 7

• FBC (anaemia, white cells)
• Thyroid function
• UsEs (Kidney function, bleeds)
• LFTs
• CRP (active disease/inflammation)

Question 8

What orifice tests should be done for IBD?

Answer 8

• Faecal calprotectin

- Colonoscopy with biopsy

Question 9

What is faecal calprotectin?

Answer 9

• Measure of inflammation anywhere in the GI tract

Question 10

How specific and sensitive is faecal calprotectin for IBD?

Answer 10

90%

Question 11

What can also raise faecal calprotectin?

Answer 11

• Diverticulitis
• Colorectal Ca
• RTI

Question 12

What imaging is useful for IBD?

Answer 12

CT (for complications)

• Fistulae
• Abscesses
• Strictures

Question 13

How is remission induced in CROHN’S?

Answer 13

Steroids (PO Pred/IV Hydro)

Question 14

If steroids alone don’t induce remission in CROHN’S, what can you do?

Answer 14

Add an immunosuppressant

Question 15

What drugs are first line for maintaining remission in CROHN’S?

Answer 15

• Azathioprine

- Mercaptopurine

Question 16

How does azathioprine work?

Answer 16

Inhibits purine synthesis (cannot produce DNA/RNA)

Question 17

How does mercaptopurine work?

Answer 17

Inhibits PRPP amidotransferase in PURINE SYNTHESIS

Question 18

What alternatives are there for IBD?

Answer 18

• Methotrexate
• Infliximab
• Adalimumab

Question 19

What surgery is used in CROHN’S?

Answer 19

Treat complications e.g. strictures, fistulae

Question 20

How is remission induced in mild/moderate UC?

Answer 20

1st- Aminosalicylate (Mesalazine PO)

2nd- Corticosteroids (PO Pred)

Question 21

How is remission induced in severe UC?

Answer 21

1st- IV Corticost. (Pred)

2nd- IV Ciclosporin

Question 22

How is remission maintained in UC?

Answer 22

1st- Aminosalicylate (Mesalazine PO/PR)

2nd- Azathioprine/mercaptopurine

Question 23

How is UC surgically treated?

Answer 23

Colon resection is curative

Question 24

What surgery may be used to resect the colon for UC?

Answer 24

• Panproproctocolectomy (colon and rectum)

Question 25

What may be used following panproctocolectomy?

Answer 25

- Ileostomy | - Ileo-anal anastamosis ('J-Pouch')

Question 26

What is a J-pouch?

Answer 26

Ileum folded back on itself to make a storage pouch for faeces