Inflammatory Bowel Disease (IBD)

Answer Explanation:

• The statement “Colorectal cancer develops more commonly in Crohn’s disease than in ulcerative colitis” is untrue. In fact, the risk of colorectal cancer is higher in patients with ulcerative colitis than in those with Crohn’s disease.
• Barium enema is indeed contraindicated in toxic megacolon due to the risk of perforation.
• A biopsy is often necessary to differentiate between Crohn’s disease and ulcerative colitis as the histological findings can help distinguish between the two conditions.
• Toxic megacolon can be diagnosed with the help of a plain abdominal film, which may show dilatation of the colon.
• Colonoscopy is contraindicated in severe acute ulcerative colitis due to the risk of perforation and worsening of the inflammation.

Overview of Inflammatory Bowel Disease:

• Definition: Inflammatory bowel disease (IBD) is a group of inflammatory conditions of the colon and small intestine. The major types of IBD are Crohn’s disease and ulcerative colitis.
• Etiology: The exact cause of IBD is unknown, but it’s thought to result from an immune reaction to an environmental trigger in genetically susceptible individuals.
• Clinical Features: Common symptoms include abdominal pain, diarrhea, rectal bleeding, weight loss, and fatigue. The severity of the symptoms varies depending on the extent of the inflammation and where it occurs.
• Diagnosis: Diagnosis is based on clinical evaluation, imaging studies, endoscopy with biopsy, and laboratory tests.
• Management: Treatment aims to reduce inflammation, manage symptoms, and achieve long-term remission. This may involve medication, lifestyle changes, and sometimes surgery.
• Complications: Both Crohn’s disease and ulcerative colitis can increase the risk of colorectal cancer. Other potential complications include bowel obstruction, fistulas, abscesses, malnutrition, and toxic megacolon.

Answer Explanation:

• The correct answer is “The bowel inflammation in Crohn’s disease is deeper than in ulcerative colitis”. This is because Crohn’s disease is a transmural disease, meaning it affects the entire thickness of the bowel wall, from the mucosa through to the serosa. In contrast, ulcerative colitis only involves the mucosa and submucosa.

Incorrect Options Explanation:

• Skip lesions are not present in ulcerative colitis. They are a characteristic feature of Crohn’s disease, where inflammation can occur in different sections of the gastrointestinal tract with normal areas in between.
• Granulomas are a feature of Crohn’s disease, not ulcerative colitis. They are clusters of immune cells that form in response to chronic inflammation.
• Most new cases of Crohn’s disease do not present over the age of 70. It typically presents in younger individuals, often between the ages of 15 and 30.
• Smoking is a risk factor for Crohn’s disease but it is actually protective against ulcerative colitis. The exact mechanisms for this are not fully understood.

Overview of Inflammatory Bowel Disease:

• Definition: Inflammatory bowel disease (IBD) is a term primarily used to describe two conditions: ulcerative colitis and Crohn’s disease. These are chronic inflammatory conditions of the gastrointestinal tract.
• Etiology: The exact cause of IBD is unknown, but it is thought to involve a combination of genetic susceptibility, immune system dysregulation, and environmental factors.
• Clinical Features: Symptoms can include abdominal pain, diarrhoea, weight loss, and fatigue. The pattern of symptoms can help differentiate between the two conditions.
• Diagnosis: Diagnosis is usually made based on a combination of clinical history, examination, blood tests, stool tests, endoscopy, and imaging studies.
• Treatment: Treatment aims to control inflammation, relieve symptoms, and prevent complications. This can involve a combination of medication, lifestyle changes, and sometimes surgery.

Answer Explanation:

• The correct answer is “Infliximab may be indicated in fistulating disease”. Infliximab is a type of medication known as a biologic, which is used in the treatment of inflammatory bowel disease (IBD). It is particularly effective in managing fistulating disease, which is a complication of IBD.

Incorrect Options Explanation:

• “Long-term steroid therapy is usually recommended for maintaining remission” – This is incorrect. Steroids are used for acute flares of IBD, not for long-term maintenance of remission. Long-term steroid use can lead to significant side effects.
• “Proctitis is best treated with arachis oil enemas” – This is incorrect. Proctitis is inflammation of the rectum and can be a symptom of IBD. However, arachis oil enemas are not the first-line treatment for proctitis in IBD.
• “Azathioprine is used for acute flares of ulcerative colitis” – This is incorrect. Azathioprine is an immunosuppressive drug used in the maintenance of remission in IBD, not for acute flares.
• “Aminosalicylates are not useful in the maintenance of remission in ulcerative colitis” – This is incorrect. Aminosalicylates are a type of medication used in the treatment of IBD and are useful in both inducing and maintaining remission in ulcerative colitis.

Overview of Inflammatory Bowel Disease:

• Inflammatory bowel disease (IBD) is a term mainly used to describe two conditions, ulcerative colitis and Crohn’s disease.
• Both ulcerative colitis and Crohn’s disease are long-term (chronic) conditions that involve inflammation of the gut (gastrointestinal tract).
• Ulcerative colitis only affects the colon (large intestine), while Crohn’s disease can affect any part of the digestive system, from the mouth to the anus.
• Common symptoms include: diarrhoea, abdominal pain, fatigue, unintended weight loss and blood and mucus in the stools.
• IBD is a complex condition that is thought to occur as a result of the immune system malfunctioning.
• Treatment for IBD aims to relieve symptoms and prevent them from returning. This typically involves a combination of lifestyle changes, medication and sometimes surgery.