A 22 y/o female presents to her GP with a two year history of intermittent diarrhoea and constipation. She complains of bloating and abdominal pain, which eases with defecation. Which condition is she likely to have?
A. Coeliac disease B. Ulcerative colitis C. Crohn’s disease D. Irritable bowel syndrome E. Infectious diarrhoea
B. Ulcerative colitis
A 26 y/o male presents to his GP with weight loss, abdominal pain and watery diarrhoea. On examination he looks pale and you notice ulcers in his mouth. Which condition is he likely to have?
A. Coeliac disease B. Ulcerative colitis C. Crohn’s disease D. Irritable bowel syndrome E. Infectious diarrhoea
C. Crohn’s disease
A 23 y/o female presents to her GP with a limp. On further questioning she reveals she has recently lost weight and has had bloody, mucoid diarrhoea. On examination her right knee is tender and swollen, and her eyes are red. Which condition is she likely to have?
A. Coeliac disease B. Ulcerative colitis C. Crohn’s disease D. Irritable bowel syndrome E. Infectious diarrhoea
E. Infectious diarrhoea
A 27 y/o male presents with a history of mucoid, bloody diarrhoea and weight loss. On examination you note a number of red marks on his shins. After a number of investigations his diagnosis is confirmed. Which treatment would you start him on?
A. IV corticosteroid B. Oral prednisolone C. Topical mesalazine D. Oral azathioprine E. IV cyclosporin
C. Topical mesalazine
A 31 y/o male presents with a history of diarrhoea, weight loss and RIF pain. On examination you note a number of red marks on his shins. After a number of investigations his diagnosis is confirmed. Which treatment would you start him on?
A. IV corticosteroid B. Oral prednisolone C. Oral mesalazine D. Oral azathioprine E. IV cyclosporin
B. Oral prednisolone
which is a corticosteroid
A 31 y/o male presents with a history of diarrhoea, weight loss and RIF pain. On examination you note a number of red marks on his shins. After a number of investigations his diagnosis is confirmed. Which treatment would you start him on?
After starting treatment, his symptoms improve. Which additional treatment would you start him on to maintain his remission?
A. IV corticosteroid B. Oral prednisolone C. Oral mesalazine D. Oral azathioprine E. IV cyclosporin
D. Oral azathioprine
A 55 y/o female presents to her GP with an itchy rash on her forearms. On further questioning she reveals she has recently lost weight and has had mucoid diarrhoea. Which test will best confirm her diagnosis?
A. Endoscopy with duodenal biopsy B. Serum antibodies to tissue-transglutaminase C. Serum anti-endomysial antibodies D. Colonoscopy E. Endoscopy with ileal biopsy
A. Endoscopy with duodenal biopsy
Crohn’s:
- Gut layer
- Regions most common site
- Inflammation
- Abscess/fissure
- symptoms
- Flare patterns
- surgery
- All
- mouth to anus (although terminal ileum is common)
- patchy - skip lesions
- common
- Diarrhoea +/- blood (mixed in)
- systemically unwell
- NOT curative
Ulcerative Colitis
- Gut layer
- Regions most common site
- Inflammation
- Abscess/fissure
- symptoms
- Flare patterns
- surgery
- Mucosa and submucosa
- Colon and rectum
- continuous
- uncommon
- bloody +/- mucus diarrhoea (mixed in)
- well between attacks
- curative
What are other important features of Crohn’s
- mouth ulcer
- fever
- perianal lesions
- RIF pain (from ileitis)
What are other important features of UC
- Abdominal pain
2. relapsing-remitting
What are extra-intestinal manifestations of IBD
A PILE SAC
A = aphthos
What are extra-intestinal manifestations of IBD
A PILE SAC A = aphthos (mouth) ulcers [CD>UC] P = pyoderma gangrenosum I = (eye) iritis, uveitis, episcleritis [CD>UC] E = erythema nodosum S = sclerosing cholangitis [UC] A = arthritis C = clubbing fingers [CD>UC]
What is the first line investigation for inflammatory bowel disease
Stool sample
What are the investigations used to diagnose Crohn’s
- stool sample
- Blood tests
- CT/MRI
- (colonoscopy and biopsy)
What are the investigations used to diagnose ulcerative colitis
- stool sample
- blood tests
- AXR
- colonoscopy/flexible sigmoidoscopy and biopsy
What are the radiological signs of inflammatory bowel disease
- lead pipe sign
- thumb printing
- toxic megacolon (IBD is serious enough to cause inflammatory colitis)
What drug is used to induce remission in Crohn’s
corticosteroids
What drug is used to induce remission in ulcerative colitis
Aminosalycilates
- topical
- oral (low dose)
- oral (high dose)
What drugs are used to maintain remission in Crohn’s
- Azathioprine
- methotrexate
- cyclosporin
- infliximab
What drugs are used to maintain remission in ulcerative colitis
- Azathioprine
- methotrexate
- cyclosporin
What is coeliac disease
chronic autoimmune disease of the small intestine, categorised by gluten intolerance in genetically susceptible individuals
What is the aetiology behind coeliac disease
autoimmune damage to intestinal mucosa leads to villous atrophy WBC infiltration cryptal hyperplasia = malabsorption
What are the risk factors for coeliac disease
- female
- autoimmune background
T1DM
Thyroid disease - Family history
