IBD

Question 1

What’s the macroscopic difference between Chron’s and UC?

Answer 1

• Chron’s anywhere along the bowel - UC only the large bowel
• Chron’s has oral and perianal disease - UC starts at the rectum and spreads from there
• Chron’s has discontinuous involvement - UC has continuous involvement
• Chron’s deep ulcers and fissures - UC superical red mucosa, bleeds easily
• chron’s has a stronger genetic association

Question 2

What are the microscopic difference between chron’s and UC?

Answer 2

• Chron’s is transmural inflammation - UC mucosal layer inflammation
• Chron’s granuloma’s - UC none
• UC crypt abcess & goblet cell depletion - Chron’s none

Question 3

What are some macroscopic presentations of chron’s?

Answer 3

• mouth to anal disease
• skip lesions (none diseased areas)
• fistulae and abscess
• ulcers

Question 4

When does chron’s present? Typical Sx?

Answer 4

• adolescence/early adulthood.
• triad - abdo pain (colicky), weight loss, diarrhoea (may be bloody, may be fatty)
• peri-anal disease
• anal disease - fistulae

Question 5

what are the extra-intestinal manifestation?

Answer 5

• erythema nodosum
• arthritis
• anterior uveitis, scleritis, episcleritis
• osteoporosis
• clubbing

Question 6

Investigations for chron’s?

Answer 6

• bloods - FBC, folate, B12, CRP (disease activity)
• stool - faecal caprotectin
• colonoscopy + biopsy

Question 7

What lifestyle advice is important for chron’s?

Answer 7

-STOP SMOKING

Question 8

What is the stepwise ladder for inducing remission in chron’s?

Answer 8

same as usual expect mesalazine before MTX/azathio

• steroids - oral or IV (+/- parenteral feeding)
• 5-ASA - mesalazine
• azathioprine/MTX/mercaptopurine (test TMPTbefore start)
• infliximab

metronidazole in isolated peri-anal disease

Question 9

How is remission maintained in chron’s?

Answer 9

• stop smoking
• azathioprine or metacapurine
• MTX
• mesalazine (if patient had previous surgery) (test TMPT before start)

Question 10

What is the most common surgical intervention in chron’s?

Answer 10

-ileocecal resection - most common affected disease site

Question 11

4 main complications of chron’s?

Answer 11

• obstruction
• small bowel cancer
• large bowel cancer (greater risk in UC)
• osteoporosis

Question 12

What’s the anti-bodies present in UC and Chron’s?

Answer 12

Chron's = ASCA +ve (anti-saccharomyces cerevisiae)
UC = ANCA -VE

Question 13

Symptoms of UC?

Answer 13

• bloody diarrhoea
• urgency
• tenesmus (recurrent or continual feeling of needing to empty ones bowels)
• lower abdo pain
• systemic features
• extra intestinal features

Question 14

investigations for UC are the same as Chron’s BUT there is one extra test you might do in an acute flare of UC. What is it and why?

Answer 14

• abdominal Xray
• rule out bowel dilation
• toxic mega colon is a complication of UC and needs treating aggressively FAST

Question 15

What findings on a barium enema may you find for UC?

Answer 15

• loss of haustrations
• superficial ulcers
• colon is narrow and short

Question 16

What signs on abdo xray suggest toxic megacolon? what’s the intervention?

Answer 16

• dilated bowel loops >6cm
• thin walled
• mucosal islands
• urgent surgery w/in 48 hours

Question 17

mild, moderate, severe classification of UC flare?

Answer 17

• mild <4 stool, no ESR/CRP, no systemic disturbance
• moderate 4-6 stool/day, mild CRP/ESR, mild systemic distrubance
• Severe >6 stools/day, raised ESR/CRP, systemic instability.

Question 18

Induction of remission in UC differs from Chron’s. how do we do?

Answer 18

• mild rectal disease PR aminosalicylates
• then oral mesalazine
• THEN pred
• then azathiopurine or mercaptopurine

NEVER MTX in UC