IBDs

Question 1

What is Ulcerative Colitis?

Answer 1

chronic, relapsing-remitting inflammatory disease affecting the large bowel and rectum

Question 2

UC Risk Factors

Answer 2

1. FMHx
2. Genetic predisposition: HLA-B27
3. No appendicectomy
4. Not smoking
5. NSAIDs

Question 3

UC histological findings

Answer 3

Surface inflammation with loss of goblet cells and crypt abscess (diffuse mucosal atropy, basal plasmacytosis and mucin depletion)

Question 4

UC complications

Answer 4

1. Primary sclerosing cholangitis
2. Toxic megacolon

Question 5

remission, acute flare and 3rd

UC Mx for stable patients

Answer 5

1st line: Topical ASA, if not tolerated then Oral ASA e.g. mesalazine to induce remission 4/52

2nd line: Corticosteroids e.g Oral Prednisolone for acute flare weaning off 6-8/52

3rd line: Thiopurines e.g. Azathioprine to maintain remission if 1st+2nd failed OR 2> flare ups in 12/12

Question 6

UC Mx for acute severe flare

Answer 6

1st line: IV steroid + VTE prophylaxis

2nd line: Immuno suppressant: Ciclosporin

Question 7

When to perform Emergency panproctocolectomy

Answer 7

Acute severe flare not responding to IV corticosteroids for 72h

Question 8

2

Skin manifestation in UC/Crohn’s?

Answer 8

Erythema nodosum
Pyoderma gangrenosum

often at shins

Question 9

Ocular manifestation for UC/Crohn’s

Answer 9

Ant. Uveitis
Episcleritis

Question 10

UC Sx

Answer 10

1. Bloody + mucus diarrhoea
2. LIF Abdo pain
3. Tenesmus
4. Urgency
5. Anaemia

Question 11

Crohn’s Sx

Answer 11

1. Non-bloody diarrhoea
2. Non LIF Abdo pain
3. WL
4. mouth ulcers
5. Tenesmus
6. Perianal involvement (skin tags, fistula, abscess)

Question 12

Crohn’s endoscpy features:

Answer 12

1. Patchy, skip lesions
2. Transmural
3. Cobblestone appearance, deep ulcers

Question 13

UC endoscopy features

Answer 13

1. Continuos lesions
2. Limited to the mucosa layer

Question 14

Crohn’s Mx

Answer 14

STOP SMOKING

1st Induce remission: Oral steroids OR IV hydrocortisone

2nd Maintain remission: Thiopurines (2 or more flare in 12/12)

Question 15

Crohn’s and UC Severe flare criteria

Answer 15

A severe flare is characterised by 6 or more bowel motions per day and any of:

Temperature > 37.8°C
Tachycardia > 90 bpm
Anaemia, Hb < 105 g/L
ESR > 30 mm/h, CRP > 30 mg/L