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Inflammatory Bowel Disease Overview
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Inflammatory Bowel Disease Overview

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Questions and Answers

What is a common cause of strictures in Crohn's disease?

  • Increased bowel motility
  • Transmural inflammation (correct)
  • Dilated bowel segment
  • Tumor formation

    • Which of the following is a complication specifically associated with partial colectomy?

  • Anastamotic leak (correct)
  • Chronic diarrhea
  • Increased red blood cell count
  • Tumor metastasis

    • What type of anaemia is commonly caused by Crohn’s disease due to terminal ileum resection?

  • Iron deficiency anaemia
  • B12 deficiency anaemia (correct)
  • Hemolytic anaemia
  • Sideroblastic anaemia

    • Which complication is NOT typically associated with Crohn's disease?

    <p>Dysplasia</p> Signup and view all the answers

    What is the role of the ileocecal valve in gastrointestinal physiology?

    <p>Regulating transit time</p> Signup and view all the answers

    What type of anaemia may be present due to inadequate intake or absorption in Crohn's disease?

    <p>Macrocytic anaemia</p> Signup and view all the answers

    Which symptom is likely NOT a manifestation of intestinal complications of Crohn's disease?

    <p>Hyperplasia of lymphoid tissue</p> Signup and view all the answers

    Which extraintestinal manifestation is specifically associated with Crohn's disease?

    <p>Uveitis</p> Signup and view all the answers

    What is a characteristic microscopic feature of Crohn's disease?

    <p>Transmural inflammation with patchy lesions</p> Signup and view all the answers

    Which of the following is NOT a risk factor associated with ulcerative colitis?

    <p>Dietary fiber intake</p> Signup and view all the answers

    What is one of the cardinal symptoms of inflammatory bowel disease?

    <p>Abdominal pain</p> Signup and view all the answers

    Which is a common differential diagnosis for colitis?

    <p>Ulcerative colitis</p> Signup and view all the answers

    What microscopic feature is associated with Crohn's disease in a significant percentage of cases?

    <p>Granulomas</p> Signup and view all the answers

    Which type of inflammation is associated with antibiotic-associated colitis?

    <p>Acute</p> Signup and view all the answers

    What overarching principle is essential in the management of IBD?

    <p>Long-term pharmacotherapy management</p> Signup and view all the answers

    Which of the following reflects the pathophysiology behind the increased incidence of IBD?

    <p>Abnormal T-cell response</p> Signup and view all the answers

    Which physiological alteration is associated with the pathophysiology of idiopathic inflammatory bowel disease (IBD)?

    <p>Leaky epithelium leading to increased luminal antigens</p> Signup and view all the answers

    Which of the following is considered a cardinal symptom of ulcerative colitis?

    <p>Bloody diarrhoea</p> Signup and view all the answers

    What is a key characteristic of Crohn's disease compared to ulcerative colitis?

    <p>It has patchy inflammation</p> Signup and view all the answers

    What factor is NOT a significant risk factor for developing IBD?

    <p>Living in a rural area</p> Signup and view all the answers

    Which symptom is more commonly associated with Crohn's disease than ulcerative colitis?

    <p>Fistulae</p> Signup and view all the answers

    What is the primary pathophysiological consequence of a leaky epithelium in IBD?

    <p>More luminal antigens enter the bloodstream</p> Signup and view all the answers

    Which sign may indicate iron deficiency anemia in IBD patients?

    <p>Koilynchia</p> Signup and view all the answers

    In Crohn's disease, which section of the gastrointestinal tract is most commonly affected?

    <p>Terminal ileum</p> Signup and view all the answers

    What is a common extraintestinal feature of IBD?

    <p>Delayed puberty</p> Signup and view all the answers

    What mechanism is associated with the symptom of abdominal pain in Crohn’s disease?

    <p>Distension due to obstruction</p> Signup and view all the answers

    Which of the following is a common complication of ulcerative colitis?

    <p>Primary sclerosing cholangitis</p> Signup and view all the answers

    What is one of the differential diagnoses for colitis?

    <p>Idiopathic inflammatory bowel disease</p> Signup and view all the answers

    Which feature distinguishes Crohn's disease from ulcerative colitis regarding inflammation?

    <p>Inflammation affects the full thickness of the bowel wall</p> Signup and view all the answers

    What is a common presentation of ischaemic colitis?

    <p>Sudden pain and bloody diarrhea</p> Signup and view all the answers

    Which of the following is a non-occlusive cause of ischaemic colitis?

    <p>Cardiac failure</p> Signup and view all the answers

    Which procedure is considered the gold standard for investigation of inflammatory bowel disease (IBD)?

    <p>Colonoscopy with biopsy</p> Signup and view all the answers

    What is a key feature observed in colonoscopy for ulcerative colitis?

    <p>Loss of vascular markings</p> Signup and view all the answers

    Which of the following medications can induce and maintain remission in ulcerative colitis?

    <p>Mesalazine</p> Signup and view all the answers

    What is a major risk associated with the use of anti-TNF therapy?

    <p>Increased risk of infections</p> Signup and view all the answers

    What is a commonly observed finding in Crohn's disease during colon biopsy?

    <p>Crypt abscesses</p> Signup and view all the answers

    Which treatment approach is typically used for high-risk patients with severe IBD?

    <p>Top down approach starting with potent therapies</p> Signup and view all the answers

    When is surgery generally considered for treating ulcerative colitis?

    <p>For serious cases non-responsive to medical treatment</p> Signup and view all the answers

    What does the presence of skip lesions indicate in Crohn’s disease?

    <p>Discontinuous areas of ulceration</p> Signup and view all the answers

    What is the role of corticosteroids in the management of inflammatory bowel disease?

    <p>Used to induce remission in moderate to severe cases</p> Signup and view all the answers

    Which laboratory test can indicate malabsorption in patients with inflammatory bowel disease?

    <p>Low albumin levels</p> Signup and view all the answers

    What is the first step in the treatment pyramid for low-risk patients with mild inflammatory bowel disease?

    <p>Less potent medications with fewer side effects</p> Signup and view all the answers

    What is a common complication of Crohn's disease that may necessitate surgical intervention?

    <p>Complex perianal fistulas</p> Signup and view all the answers

    Which of the following statements accurately describes Crohn's disease?

    A) It affects only the large intestine. B) It presents with continuous inflammation. C) It can affect any part of the gastrointestinal tract. D) It primarily affects the mucosa and submucosa.

    <p>It can affect any part of the gastrointestinal tract.</p> Signup and view all the answers

    Which of the following types of fistulae is NOT typically associated with Crohn's disease?

    <p>Gastroesophageal fistula</p> Signup and view all the answers

    Which of the following is a characteristic symptom of ulcerative colitis?

    A) Fistula formation B) Strictures C) Continuous bloody diarrhea D) Transmural inflammation

    <p>Continuous bloody diarrhea</p> Signup and view all the answers

    In comparing Crohn's disease and ulcerative colitis, which of the following cardinal symptoms is more likely to occur in Crohn's disease?

    <p>Perianal disease</p> Signup and view all the answers

    What is a key pathological feature of Crohn's disease compared to ulcerative colitis?

    <p>Full-thickness inflammation of the bowel wall</p> Signup and view all the answers

    Which symptom is commonly associated with Crohn's disease affecting the terminal ileum?

    <p>Right lower quadrant abdominal pain</p> Signup and view all the answers

    How does diarrhea in Crohn's disease differ when the small intestine is affected compared to ulcerative colitis?

    <p>Diarrhea in Crohn's disease can be non-bloody, especially when the small intestine is involved.</p> Signup and view all the answers

    What symptom is a hallmark of ulcerative colitis that may not be as pronounced in Crohn’s disease affecting the colon?

    <p>Bloody diarrhea</p> Signup and view all the answers

    Patients with Crohn's disease affecting only the colon may present with symptoms similar to ulcerative colitis. Which of the following statements about abdominal pain is correct?

    <p>Abdominal pain may occur in the right lower quadrant.</p> Signup and view all the answers

    In addition to gastrointestinal symptoms, patients with Crohn's disease may experience systemic symptoms. Which of the following is a common systemic symptom?

    <p>Fever</p> Signup and view all the answers

    Which of the following is the classical presenting symptom of ulcerative colitis?

    <p>Bloody diarrhea</p> Signup and view all the answers

    What symptom is often associated with inflammation affecting the rectum and sigmoid colon in ulcerative colitis?

    <p>Tenesmus</p> Signup and view all the answers

    Which of the following systemic symptoms can occur in patients with ulcerative colitis? (Select all that apply)

    <p>Fever</p> Signup and view all the answers

    In ulcerative colitis, abdominal pain is typically described as:

    A) Constant and severe B) Cramping and relieved by defecation C) Only occurring in the right lower quadrant D) Non-existent

    <p>Cramping and relieved by defecation</p> Signup and view all the answers

    Patients with ulcerative colitis may experience changes in bowel habits. Which of the following is a common change?

    <p>Urgency to defecate</p> Signup and view all the answers

    What is the primary reason for low BMI in patients with inflammatory bowel disease?

    <p>Malabsorption due to small bowel involvement</p> Signup and view all the answers

    Koilynchia, or spoon-shaped nails, is often associated with which condition in inflammatory bowel disease?

    <p>Iron deficiency anemia</p> Signup and view all the answers

    Which of the following ocular complications is less common but more severe in patients with inflammatory bowel disease?

    <p>Uveitis</p> Signup and view all the answers

    Mouth ulcers in inflammatory bowel disease can be attributed to which of the following mechanisms?

    <p>Inflammatory process and malnutrition</p> Signup and view all the answers

    What is the association between primary sclerosing cholangitis (PSC) and ulcerative colitis?

    A) PSC is rare and has no connection to IBD. B) PSC is a common complication of Crohn's disease. C) PSC has a strong association with ulcerative colitis. D) PSC is unrelated to gastrointestinal conditions.

    <p>PSC has a strong association with ulcerative colitis.</p> Signup and view all the answers

    Erythema nodosum in patients with IBD is characterized by which of the following?

    A) Painless, fluid-filled blisters B) Raised, tender, red or violet subcutaneous nodules C) Ulcerative lesions on the skin D) Systemic infections

    <p>Raised, tender, red or violet subcutaneous nodules</p> Signup and view all the answers

    What is the characteristic feature of sacroiliitis in patients with inflammatory bowel disease?

    <p>Prolonged stiffness in the back/buttocks in the morning</p> Signup and view all the answers

    Primary sclerosing cholangitis (PSC) has a strong association with which of the following conditions?

    <p>Ulcerative colitis</p> Signup and view all the answers

    Which of the following clinical features is commonly observed in patients with primary sclerosing cholangitis?

    <p>Jaundice</p> Signup and view all the answers

    What is the primary pathological process involved in primary sclerosing cholangitis?

    A) Necrosis of hepatocytes B) Inflammation, fibrosis, and stricturing of biliary ducts C) Autoimmune destruction of pancreatic tissue D) Thrombosis of hepatic veins

    <p>Inflammation, fibrosis, and stricturing of biliary ducts</p> Signup and view all the answers

    Which of the following extrahepatic features may be evident in patients with primary sclerosing cholangitis? (Select all that apply)

    <p>Both A and C</p> Signup and view all the answers

    Which of the following conditions is NOT typically included in the differential diagnosis of colitis?

    A) Ulcerative colitis B) Crohn's disease C) Appendicitis D) Diverticulitis

    <p>Appendicitis</p> Signup and view all the answers

    Which infectious agent is most commonly associated with infectious colitis? A) Clostridium difficile B) Escherichia coli C) Salmonella D) All of the above

    <p>All of the above</p> Signup and view all the answers

    Ischemic colitis primarily results from which of the following conditions?

    <p>Reduced blood flow to the colon</p> Signup and view all the answers

    Which of the following diseases is characterized by immune-mediated colitis?

    <p>Ulcerative colitis</p> Signup and view all the answers

    Which of the following is considered an irritant that can cause colitis?

    <p>All of the above</p> Signup and view all the answers

    What is meant by 'idiopathic' in the context of colitis?

    <p>The cause cannot be identified despite thorough investigation</p> Signup and view all the answers

    Which of the following symptoms is commonly associated with colitis? (Select all that apply)

    <p>All of the above</p> Signup and view all the answers

    What is the primary diagnostic tool used to evaluate suspected colitis?

    <p>Colonoscopy</p> Signup and view all the answers

    Which of the following is classified as an idiopathic inflammatory bowel disease?

    <p>Crohn's disease</p> Signup and view all the answers

    Which of the following bacteria is NOT commonly associated with infectious colitis? (Select one)

    <p>Clostridium perfringens</p> Signup and view all the answers

    Which virus is a common cause of infectious colitis, especially in children?

    <p>Rotavirus</p> Signup and view all the answers

    Which patient demographic is most commonly affected by ischemic colitis?

    <p>Older adults with a cardiac history</p> Signup and view all the answers

    What is the most common cause of ischemic colitis?

    <p>Thrombus or embolus in the mesenteric artery</p> Signup and view all the answers

    Diverticular disease is most commonly seen in which of the following age groups? A) <30 years B) 30-50 years C) >50 years D) All age groups equally

    <blockquote> <p>50 years</p> </blockquote> Signup and view all the answers

    Which type of cancer can mimic colitis symptoms due to stricturing?

    <p>Colorectal cancer</p> Signup and view all the answers

    Which class of drugs is known to potentially cause drug-induced colitis?

    A) Antihistamines B) Nonsteroidal anti-inflammatory drugs (NSAIDs) C) Antihypertensives D) Antidepressants

    <p>Nonsteroidal anti-inflammatory drugs (NSAIDs)</p> Signup and view all the answers

    What does the term 'idiopathic' signify in the context of colitis?

    <p>The cause cannot be determined</p> Signup and view all the answers

    Which of the following blood tests is primarily used as an inflammatory marker in suspected IBD?

    <p>CRP</p> Signup and view all the answers

    Which vitamin deficiencies are commonly checked in patients with suspected malabsorption in IBD?

    <p>Folate and Vitamin B12</p> Signup and view all the answers

    Which stool test is particularly useful for assessing inflammation in the intestines?

    <p>Faecal calprotectin</p> Signup and view all the answers

    What is the gold standard investigation for diagnosing inflammatory bowel disease?

    <p>Colonoscopy</p> Signup and view all the answers

    Which of the following findings is characteristic of ulcerative colitis during colonoscopy?

    <p>Continuous loss of vascular markings</p> Signup and view all the answers

    Which imaging technique is particularly useful for assessing small bowel involvement in Crohn’s disease?

    <p>Small Bowel Barium Follow Through (SBFT)</p> Signup and view all the answers

    What histological finding is specifically associated with Crohn's disease?

    <p>All of the above</p> Signup and view all the answers

    What is a key principle in managing inflammatory bowel disease?

    <p>Tailor therapy based on disease severity and location</p> Signup and view all the answers

    In which of the following situations is surgical intervention most likely indicated in IBD? (Select one)

    <p>Uncontrolled disease despite medical therapy</p> Signup and view all the answers

    Which of the following findings is characteristic of ulcerative colitis during colonoscopy?

    <p>Loss of vascular markings and erythema</p> Signup and view all the answers

    Which of the following may be observed in severe cases of ulcerative colitis?

    A) Normal appearing rectal mucosa B) Continuous inflammation C) Skip lesions D) Cobblestone mucosa

    <p>Continuous inflammation</p> Signup and view all the answers

    What is a characteristic endoscopic finding in ischemic colitis?

    <p>Dark or dusky mucosa</p> Signup and view all the answers

    Which of the following findings is associated with Crohn's disease during colonoscopy?

    <p>Cobblestone mucosa</p> Signup and view all the answers

    What is a defining feature of Crohn's disease during colonoscopy?

    <p>Presence of skip lesions</p> Signup and view all the answers

    In Crohn's disease, which area can be affected in the absence of colonic inflammation?

    <p>Terminal ileum</p> Signup and view all the answers

    Which endoscopic feature is NOT typically associated with ulcerative colitis?

    <p>Aphthous ulcers</p> Signup and view all the answers

    Which histological feature is commonly observed in Crohn's disease?

    <p>Crypt abscesses</p> Signup and view all the answers

    Which of the following complications is commonly associated with Crohn's disease?

    A) Toxic megacolon B) Strictures C) Pseudomembranous colitis D) Colon cancer at diagnosis

    <p>Strictures</p> Signup and view all the answers

    Which of the following is an extraintestinal manifestation associated with ulcerative colitis?

    <p>Erythema nodosum</p> Signup and view all the answers

    Which inflammatory bowel disease is associated with a higher risk of developing colorectal cancer?

    <p>Ulcerative Colitis</p> Signup and view all the answers

    In which scenario would a colonoscopy be indicated for a patient with suspected inflammatory bowel disease?

    A) Routine screening in asymptomatic patients B) To assess the severity of symptoms and obtain biopsy C) Only after failure of medical therapy D) When the patient reports no abdominal symptoms

    <p>To assess the severity of symptoms and obtain biopsy</p> Signup and view all the answers

    What is a common cause of pseudomembranous colitis?

    <p>Antibiotic therapy leading to Clostridium difficile overgrowth</p> Signup and view all the answers

    Which of the following is NOT a cardinal symptom of inflammatory bowel disease?

    A) Diarrhea B) Weight gain C) Abdominal pain D) Bloody stools

    <p>Weight gain</p> Signup and view all the answers

    What is a primary goal of treatment for inflammatory bowel disease?

    A) Cure the disease B) Induce and maintain remission C) Prevent all dietary restrictions D) Eliminate all symptoms immediately

    <p>Induce and maintain remission</p> Signup and view all the answers

    Which of the following findings is typically seen in a colon biopsy of a patient with Crohn's disease?

    <p>Crypt abscesses and granulomas</p> Signup and view all the answers

    What is the role of 5-ASA (Aminosalicylic Acids) in the management of IBD?

    <p>Inducing and maintaining remission in ulcerative colitis</p> Signup and view all the answers

    Which of the following is an indication for surgical intervention in a patient with ulcerative colitis? A) Mild disease without complications B) Unresponsive medical treatment with severe life-threatening complications C) Routine management of chronic disease D) Absence of symptoms

    <p>Unresponsive medical treatment with severe life-threatening complications</p> Signup and view all the answers

    Which of the following types of fistulae is commonly associated with Crohn's disease?

    <p>All of the above</p> Signup and view all the answers

    Which of the following conditions is NOT typically included in the differential diagnosis of colitis? A) Ischemic colitis B) Ulcerative colitis C) Crohn’s disease D) Irritable bowel syndrome (IBS)

    <p>Irritable bowel syndrome (IBS)</p> Signup and view all the answers

    Which of the following medications is primarily used for inducing and maintaining remission in patients with ulcerative colitis?

    <p>Mesalazine</p> Signup and view all the answers

    What is the primary mechanism of action of azathioprine in the management of inflammatory bowel disease?

    <p>Immunosuppression</p> Signup and view all the answers

    Which of the following statements is true regarding corticosteroids in the treatment of IBD?

    A) They are used for long-term management. B) They can cause adverse effects such as hyperglycemia and increased infection risk. C) They are the first-line treatment for all patients with Crohn's disease. D) They have no role in acute severe ulcerative colitis.

    <p>They can cause adverse effects such as hyperglycemia and increased infection risk.</p> Signup and view all the answers

    Which of the following is a common side effect of methotrexate used in the treatment of Crohn's disease?

    <p>Skin rash</p> Signup and view all the answers

    What is the primary goal of the step-up approach in managing inflammatory bowel disease?

    <p>To minimize side effects and start with less potent medications</p> Signup and view all the answers

    Which of the following is considered a medical rescue therapy for acute severe ulcerative colitis?

    <p>Intravenous steroids</p> Signup and view all the answers

    In patients with Crohn's disease who are experiencing a severe exacerbation and have not responded to corticosteroids, which of the following treatments may be considered? (Select one)

    <p>Monoclonal antibodies (e.g., Infliximab)</p> Signup and view all the answers

    Which of the following complications would indicate the need for surgical intervention in a patient with ulcerative colitis?

    <p>Acute perforation</p> Signup and view all the answers

    In the management of inflammatory bowel disease, which of the following dietary considerations is recommended?

    A) High-fiber diet B) Low-residue diet during flare-ups C) Gluten-free diet D) High-sugar diet

    <p>Low-residue diet during flare-ups</p> Signup and view all the answers

    What is the role of biologic therapies in the management of IBD?

    <p>They target specific pathways in the inflammatory process.</p> Signup and view all the answers

    What is the first-line treatment step for a patient diagnosed with mild ulcerative colitis?

    <p>Prescribe mesalazine</p> Signup and view all the answers

    In a patient with moderate to severe Crohn's disease who has not responded to conventional therapy, which of the following would be the next step in management?

    <p>Introduce anti-TNF therapy</p> Signup and view all the answers

    After initiation of immunosuppressive therapy (e.g., azathioprine) in a patient with Crohn's disease, what is a crucial step in the management plan?

    <p>Monitor for signs of infection</p> Signup and view all the answers

    In managing inflammatory bowel disease, what should be done if a patient on long-term corticosteroids develops adverse effects like osteoporosis?

    <p>Introduce bone protection with bisphosphonates</p> Signup and view all the answers

    For patients with Crohn's disease who have localized symptomatic ileocecal disease, what is the first-line intervention?

    <p>Consider surgical resection</p> Signup and view all the answers

    When a patient with ulcerative colitis is in remission, what is the recommended approach regarding medication?

    <p>Continue maintenance therapy with mesalazine</p> Signup and view all the answers

    In a patient with severe acute ulcerative colitis who is unresponsive to medical therapy, what is the next step after medical management?

    <p>Refer for surgical evaluation</p> Signup and view all the answers

    Which of the following stool frequencies is classified as mild ulcerative colitis according to the Truelove and Witts criteria?

    <p>&lt; 4 stools per day</p> Signup and view all the answers

    A patient presents with 5 stools per day, occasional blood in the stool, and mild abdominal pain. According to the Truelove and Witts criteria, how would you classify this patient's ulcerative colitis?

    <p>Moderate</p> Signup and view all the answers

    In the Truelove and Witts criteria, which of the following is a characteristic of severe ulcerative colitis?

    <p>Stool frequency of &gt; 6 stools per day</p> Signup and view all the answers

    Which of the following is NOT included in the assessment of ulcerative colitis severity using the Truelove and Witts criteria?

    <p>Imaging results</p> Signup and view all the answers

    A patient with ulcerative colitis presents with more than 10 stools per day, profuse blood, severe abdominal pain, and weight loss of 15%. What classification does this fit according to the Truelove and Witts criteria?

    <p>Fulminant</p> Signup and view all the answers

    Which of the following would indicate a transition from moderate to severe ulcerative colitis in a patient according to the Truelove and Witts criteria?

    <p>Increase in stool frequency to 7 stools per day</p> Signup and view all the answers

    In assessing a patient with ulcerative colitis, which of the following is considered a systemic symptom?

    <p>Fever</p> Signup and view all the answers

    Which of the following medications is considered the first-line treatment for inducing and maintaining remission in Ulcerative Colitis?

    <p>Mesalazine</p> Signup and view all the answers

    The Truelove and Witt criteria are used to assess the severity of which condition?

    <p>Ulcerative Colitis</p> Signup and view all the answers

    The Truelove and Witt criteria are used to assess the severity of which condition?

    <p>Ulcerative Colitis</p> Signup and view all the answers

    Which type of anemia is commonly associated with Crohn's disease due to malabsorption?

    <p>Macrocytic anemia</p> Signup and view all the answers

    Which of the following is a common cause of intestinal strictures in Crohn's disease?

    <p>Transmural inflammation</p> Signup and view all the answers

    When evaluating a patient with suspected intestinal obstruction, which of the following would be a key differential diagnosis to consider?

    <p>Benign stricture vs. malignant neoplasm</p> Signup and view all the answers

    In Crohn's disease, strictures typically result from which of the following healing processes?

    <p>Fibrosis and scarring</p> Signup and view all the answers

    Which of the following is NOT a complication of partial colectomy in patients with Crohn's disease?

    <p>Increased risk of colorectal cancer</p> Signup and view all the answers

    Which vitamin deficiency is most likely to occur if the terminal ileum is resected during surgery for Crohn's disease?

    <p>Vitamin B12</p> Signup and view all the answers

    In the management of strictures due to Crohn's disease, which treatment option is usually considered last if conservative management fails?

    <p>Surgical resection</p> Signup and view all the answers

    Which complication of partial colectomy can lead to dehydration and electrolyte disturbances due to high output stoma?

    <p>High output stoma</p> Signup and view all the answers

    Which of the following is a common intestinal complication of Crohn's disease?

    <p>Stricture</p> Signup and view all the answers

    What is the most significant extraintestinal complication of ulcerative colitis?

    <p>Colorectal cancer</p> Signup and view all the answers

    Which of the following statements is true regarding strictures in Crohn's disease?

    <p>They are caused by transmural inflammation and fibrosis.</p> Signup and view all the answers

    Which type of anemia is most commonly associated with Crohn's disease due to malabsorption?

    <p>Macrocytic anemia</p> Signup and view all the answers

    What is a key histological feature of ulcerative colitis?

    <p>Crypt abscesses</p> Signup and view all the answers

    Which of the following describes the gross appearance of Crohn's disease?

    <p>Cobblestone appearance with skip lesions</p> Signup and view all the answers

    Which of the following extraintestinal manifestations is associated with ulcerative colitis?

    <p>Sclerosing cholangitis</p> Signup and view all the answers

    Dysplasia in ulcerative colitis (UC) is a risk factor for which of the following?

    <p>Colorectal cancer</p> Signup and view all the answers

    Study Notes

    Inflammatory Bowel Disease (IBD) Overview

    • Chronic, relapsing inflammatory conditions of the intestines; includes Crohn's disease and ulcerative colitis.
    • Rising incidence linked to genetic factors, abnormal T-cell response, intestinal flora, and possible environmental triggers.

    Pathophysiology of IBD

    • Altered bacterial flora with increased E. coli adherence in the ileum.
    • "Leaky" epithelium allows inappropriate immune responses, leading to inflammation.
    • Mucosal destruction results in loss of absorptive function and increased secretory function.

    Risk Factors for Ulcerative Colitis and Crohn's Disease

    • Family history of IBD and specific genetic loci involvement.
    • Recent smoking cessation linked to ulcerative colitis.
    • Increased prevalence in Western countries; higher incidence in Ashkenazi Jews.
    • Bimodal age distribution with two peaks around 20-30 years and 60 years.

    Cardinal Symptoms and Clinical Signs of IBD

    • Ulcerative Colitis: Bloody diarrhea, urgency, tenesmus, abdominal pain, weight loss occasionally, fever, fatigue, and extraintestinal symptoms.
    • Crohn's Disease: Abdominal pain, right lower quadrant pain, weight loss, diarrhea (often without blood), and extraintestinal manifestations like perianal disease and fistulae.

    Differential Diagnosis of Colitis

    • Includes idiopathic IBD (Ulcerative colitis, Crohn's disease), infectious colitis, ischaemic colitis, diverticular disease, malignancy, and drug-induced colitis.
    • An acute onset and short history typically suggest infectious causes.

    Microscopic Changes in Crohn's Disease

    • Transmural inflammation with patchy, skip lesions throughout the intestinal tract.
    • Presence of granulomas in a significant percentage of cases.
    • Cryptitis, crypt abscesses, fibrosis, and acute inflammation indicative of ongoing process.

    Investigation Principles for IBD

    • Use blood tests, stool samples, imaging, and endoscopy for diagnosis.
    • Look for anemia, inflammatory markers (CRP), malabsorption signs (B12, iron studies), and stool culture for pathogens.
    • Colonoscopy considered gold standard for visualization and biopsy of inflamed areas.

    Gross and Microscopic Features of Ulcerative Colitis

    • Colonoscopy reveals continuous inflammation, loss of vascular markings, ulcerations, and potential for bleeding.
    • Inflammatory changes restricted to mucosa and submucosa.

    Complications of IBD

    • Crohn's Disease: Strictures, fistulas, abscesses, perforation, intestinal obstruction.
    • Ulcerative Colitis: Risk of colorectal dysplasia and cancer, toxic megacolon, primary sclerosing cholangitis.

    Management Strategies for IBD

    • Treatment pathways include smoking cessation, nutritional support, and pharmacological therapies.
    • Utilize 5-ASA compounds, corticosteroids, biologics (Anti-TNF, Janssen agents) for inducing and maintaining remission.
    • Surgical intervention may be necessary for complications; colectomy curative for ulcerative colitis but recurrence common in Crohn’s.
    • Anemia (iron, B12, folate deficiencies) common due to malabsorption.
    • Extraintestinal symptoms include ocular conditions (uveitis, episcleritis), dermatological (erythema nodosum), and liver involvement (sclerosing cholangitis).

    Important Assessment Tools

    • Truelove and Witts Criteria: Severity assessment for acute ulcerative colitis.
    • Comprehensive symptom and complication tracking critical for effective management.

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    Description

    This quiz covers key concepts related to inflammatory bowel disease (IBD), including its pathology, pathophysiology, risk factors, symptoms, and differential diagnosis. You'll also explore the principles of investigation and management for conditions such as ulcerative colitis and Crohn's disease. Test your knowledge and understanding of these critical medical topics.

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