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Gastroenterology6
| Question | Answer |
|---|---|
| What is the relationship between PSC and IBD? | Associated with both UC and Crohn's. Colectomy does not prevent PSC, does not parallel severity of disease. |
| Are constitutional symptoms common in UC? | Generally, no. |
| Do fistuals occur in UC, Crohn's or both? What is the treatment? | Fistulas are specific to Crohn's diesase. Treatment is infliximab. |
| Is CRC associated with UC, Crohn's or both? What screening recommended? | Is both (if colon involved in Crohn's), although risk is probbly higher in UC. Colonoscopy and biopsies after 8-10 years post-diganosis. If high grade dyplasia found - colectomy. If low grade - increase screening frequency. |
| What are the eye lesion associated with IBD? | Episcleritis & anterior uveitis (urgent). |
| What are the skin lesions associated with Crohn's and UC respectively? | Erythema nodosum (tender red nodules, self-limiting)- especially in Crohn's; parallels disease activity. Pyoderma gangrenosum - espeically in UC, parallels bowel disease activity in 50% of cases. |
| What is the treatment of pyoderma gangrenosum? | Systemic corticosteroids + cyclosporine. If ineffective - mycophenalate, infliximab. |
| What investigations are essential for diagnosis of IBD? | Colonoscopy = biopsy. Never scope during an acute flare! |
| What are the goals of manamagene to IBD? | 1. Treat acute attacks. 2. Prevent relapses. 3. Detect carcinoma at an early stage. 4. Select patients for surgery. |
| What is the most common extra-inestinal manifestation of IBD? | Arthritis. |
| Describe the arthritis that occurs in IBD. | Migratory monoarticular arthritis - parallels bowel disease activity (coincides with exacerbation of colitis). Ankylsoing spondylitis, sacroilliits. |
| Is Ankylosing Spondylitis more associated with Crohn's or UC? Does it correlate with disease activity or is it independent? | UC. The course if independent of the colitis. |
| Can sacroiliitis occur? Does ti parallel bowel disease activity? | Yes; No. |
| Describe two haematological abnormalities associated with IBD. | 1. Thromboembolic - hypercoagulable state - can lead to DVT, PE or CVA. 2. ITP |
| Do gallstones occur in Crohn's or in UC? | Associated with Crohn's - due to ileal involvement. |
| Treatment of Crohn's: How is mild, active disease treate? (No fistulas). | Either oral budesonide or mesalasine (orallay). |
| Management of Crohn's: How is moderately active disease (steroid refractive) managed? | Anti-TNF (infliximab), oral steroid tapers. |
| How is a severe episode of Crohn's disease treated? | IV steroids - exclude abscesses or fistulas before starting. IV hydrocortisoen sodium succinate/IV methyylpred. |
| How is extensive small bowel disease treated in Crohn's? | Steroids and early introduction of immunomodulators (azathoprine, 6-mercaptopruine). |
| How is colonic Crohn's treated? | Mildly active: 5-ASSA (Sulfasalazine, mesalazine - orally, or rectal). Can add hydroctorisone enemas or supposites. Oral corticosteroids can be given as an initial treatment but not budesonide - give prednisolone. |
| how is Crohn's per-anal or fiistulating disease treated? | Surgical: perianal or itnra-abdomainl abscess should be excluded - exclude with CT. Treat with non-cutting seton or a fistulotomy. Adjunct: Azathioprine, 6-mercapto-inflizimab - infliximab has been proven to induce closure of perianal fistulae. |
| Is surgery curative in UC? What about Crohn's? | Yes in UC; for Corhn's - surgery is often done - obstruction, fistulas, not is not curative (disease will recur). |
| In the diagnosis of Crohn's, when is capsular enteroscopy indicated? | When imaging, colonoscopy and OGD fail to establish a diagnosis. |
| What blood tests are indicated in investigation of Crohn's? | FBC, inflammatory markers, LFTs, B12, iron, red cell folate. |
| Describe the antibodies associated with UC and Crohn's: | UC: positive pANCA, negative ASCA. Crohn's: positive ASCA, negative pANCA. |
| How is Pyoderma Gangrenosum treated? | With corticosteroids - systemic, +/- ciclosporin. |
| How is erythema nodosum treated? |
Created by:
tnei5002
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