IBD + Celiac

Question 1

Peak age + RF of Crohns

Answer 1

Strong FHx, peak at 15-30 + 50-70
Common in caucasians
Smoking
NSAIDs exacerbate

Question 2

Peak age + RF of UC

Answer 2

Peak at 15-25 + 55-65
Fam hx
NSAIDs
COCP
Risk decreased in smokers

Question 3

Mechanism of Crohns

Answer 3

Transmural granulomatous inflammation affecting all GI tract
Skip lesions

Question 4

Mechanism of UC

Answer 4

Autoimmune triggered by colonic bacteria

Causes inflammation + ulcers from rectum upwards

Question 5

S+S Crohns

Answer 5

Diarrhoea (bloody)
Abdo pain 
Weight loss 
Periods of exacerbation + remission 
Mouth, skin, eyes + joint problems 
Anaemia, fever + hypotension in exacerbations

Question 6

Pathological findings of Crohns

Answer 6

Gallstones

Cobble stone appearance

Question 7

S+S UC

Answer 7

Bloody diarrhoea, colicky abdo pain, urgency, tenesmus

Joint, skin + eye problems

Question 8

Signs of IBD

Answer 8

A PIE SAC
Aphthous ulcers 
Pyoderma gangrenosum 
Iritis 
Erythema nodosum 
Sclerosing cholangitis 
Arthritis 
Clubbing

Question 9

Investigations for IBD

Answer 9

Faecal calprotectin - positive
Endoscopy
Raised CRP, low Hb, low albumin, raised WCC + ESR

Question 10

Crohns treatment

Answer 10

Monotherapy: prednisolone or budesonide 
2nd: 5-ASA (mesalazine)
Add in thiopurine 
Methotrexate next 
Infliximab if severe

Question 11

UC treatment

Answer 11

Aminosalicylates to induce remission 
Prednisolone to induce remission 
Thiopurines 2nd line 
Ciclosporin for severe, rapid onset 
Infliximab to induce remission

Question 12

Pathology of coeliac disease

Answer 12

IgA immune mediated, inflammatory systemic disorder
Provoked by gluten
HLA-DQ2
Gliadin induces epithelial cells to express IL-15 which activates CD8+ intraepithelial lymphocytes
Heightened immune response to peptides from gluten cause inflammation + villous atrophy to lining of small intestine

Question 13

RF for coeliac disease

Answer 13

T1DM
Autoimmune thyroid 
FH
Downs 
Turner's

Question 14

S+S coeliac

Answer 14

Persistent unexplained GI/ abdo S+S
Faltering growth 
Weight loss 
Apthous mouth ulcers 
Angular stomatitis 
Iron, B12 or folate deficiency 
Steatorrhoea 
Abdo pain/ cramping 
Raised LFTs
Anaemia 
Dermatitis herpetiformis

Question 15

Investigations for coeliac

Answer 15

Autoantibodies - IgA tissue transglutaminase
Anaemia
Raised LFTs
Endoscopy + biopsy shows subtotal villous atrophy + crypt hyperplasia

Question 16

Complications of coeliac disease

Answer 16

Nutrient deficiencies 
Anemia 
Splenic dysfunction 
Osteoporosis 
GI cancer risk 
Lymphoma risk 
Ulcerative jejunitis 
Neuropathies

Question 17

Histology for Crohns

Answer 17

Rose thorn ulcers
Increased goblet cells
Cobblestone appearance

Question 18

What other disorders would warrant serology testing for celiac?

Answer 18

Metabolic bone disorders eg osteomalacia 
Unexplained:
Peripheral neuropathy/ ataxia 
Recurrent miscarriage/ infertility 
Raised LFTs with unknown cause 
Dental enamel defects
Downs or Turners

Question 19

What conditions are associated with celiac disease?

Answer 19

Dermatitis herpetiformis
T1DM
Autoimmune thyroiditis

Question 20

Complications of Crohns

Answer 20

Abscesses, strictures, fistulas, anemia, malnutrition, faltering growth, bowel cancer

Question 21

Crohns primary care follow up

Answer 21

Assess impact on daily life
Assess osteoporosis risk
Assess for disease relapse