IBD & other colitis flashcards
28 high-yield MRCP Part 1 cards from the Intellect Medicos Gastroenterology & Hepatology course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.
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Crohn's disease causes ______ inflammation with skip lesions and non-caseating granulomas; it most often involves the terminal ileum.
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transmural
Why? Full-thickness inflammation explains fistulae, strictures and abscesses; UC is confined to mucosa and submucosa.
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Crohn's disease causes transmural inflammation with skip lesions and ______; it most often involves the terminal ileum.
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non-caseating granulomas
Why? Full-thickness inflammation explains fistulae, strictures and abscesses; UC is confined to mucosa and submucosa.
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What is the gold-standard investigation to diagnose Crohn's disease?
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Ileocolonoscopy with biopsies.
Why? It shows patchy inflammation, aphthous and deep linear ulcers and cobblestoning, and histology can show granulomas.
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Smoking worsens Crohn's disease, but in ulcerative colitis it is ______.
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protective (UC is commoner in non-smokers and ex-smokers)
Why? Smoking cessation is one of the most effective interventions in Crohn's. The UC paradox is a favourite exam fact.
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Under NICE guidance, what is first-line to induce remission in a first presentation of Crohn's disease?
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Monotherapy with a conventional glucocorticosteroid (e.g. oral prednisolone or IV hydrocortisone).
Why? Steroids induce remission quickly but are not used for maintenance.
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Which drugs are first-line to MAINTAIN remission in Crohn's disease?
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Azathioprine or mercaptopurine (thiopurines).
Why? They are steroid-sparing. Start them after 2 or more exacerbations in 12 months needing steroids, or if steroids cannot be tapered.
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Which enzyme must be checked before starting azathioprine?
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Thiopurine methyltransferase (TPMT) activity.
Why? Low TPMT activity causes toxic metabolite build-up and life-threatening bone marrow suppression.
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Which gout drug interacts dangerously with azathioprine, and why?
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Allopurinol: it inhibits xanthine oxidase, which breaks down azathioprine, causing severe marrow toxicity.
Why? If both are needed, the azathioprine dose must be greatly reduced (to about a quarter) under specialist advice.
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What screening must be done before starting an anti-TNF drug such as infliximab?
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Screen for latent tuberculosis (and hepatitis B).
Why? TNF is needed to contain granulomas; blocking it can reactivate latent TB, often as disseminated disease.
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Vedolizumab is an anti-______ antibody; ustekinumab targets IL-12 and IL-23.
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α4β7 integrin
Why? Vedolizumab blocks lymphocyte homing to the gut only, so it is 'gut-selective' with little systemic immunosuppression.
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Vedolizumab is an anti-α4β7 integrin antibody; ustekinumab targets ______.
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IL-12 and IL-23
Why? Vedolizumab blocks lymphocyte homing to the gut only, so it is 'gut-selective' with little systemic immunosuppression.
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Which antibiotic is used first for a simple perianal fistula in Crohn's disease?
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Oral metronidazole (± ciprofloxacin).
Why? Antibiotics reduce sepsis and discharge. Complex or persistent fistulae need examination under anaesthesia, seton drainage and anti-TNF therapy (infliximab).
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Ulcerative colitis begins in the ______ and extends proximally in a continuous pattern, limited to the colon.
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rectum
Why? Histology shows crypt abscesses and no granulomas; inflammation is mucosal and submucosal only.
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Ulcerative colitis begins in the rectum and extends ______ pattern, limited to the colon.
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proximally in a continuous
Why? Histology shows crypt abscesses and no granulomas; inflammation is mucosal and submucosal only.
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Which liver disease is most strongly associated with ulcerative colitis?
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Primary sclerosing cholangitis (PSC).
Why? About 70% of people with PSC have UC. Suspect it if a UC patient has a raised ALP.
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Severe UC (Truelove & Witts) = ______ bloody stools a day plus a systemic feature (fever, tachycardia, anaemia or raised ESR/CRP).
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6 or more
Why? Severe disease needs admission and IV steroids, not outpatient treatment.
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What is the first-line treatment to induce remission in mild-to-moderate ulcerative proctitis?
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Topical (rectal) aminosalicylate, e.g. mesalazine suppository.
Why? Topical 5-ASA delivers a high local dose to the inflamed rectum. If no remission by about 4 weeks, add oral 5-ASA, then a topical or oral steroid.
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What is first-line induction treatment for mild-to-moderate EXTENSIVE ulcerative colitis?
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Topical 5-ASA plus high-dose oral 5-ASA.
Why? Oral 5-ASA reaches the proximal colon. If no remission by about 4 weeks, stop topical 5-ASA and give high-dose oral 5-ASA with an oral corticosteroid.
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What is the first-line treatment of acute severe ulcerative colitis?
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Hospital admission and IV corticosteroids (e.g. IV hydrocortisone).
Why? Severe colitis risks toxic megacolon and perforation, so it is managed jointly by physicians and surgeons.
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In acute severe UC with little or no response to IV steroids after about 72 hours, what is the next step?
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Add IV ciclosporin ('rescue therapy') or proceed to surgery (colectomy); infliximab is used if ciclosporin is contraindicated or unsuitable.
Why? Failure of rescue therapy means urgent surgical referral; delay increases mortality.
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When should azathioprine or mercaptopurine be started to maintain remission in UC?
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After 2 or more exacerbations in 12 months needing systemic steroids, or if remission is not maintained by 5-ASA.
Why? Thiopurines are steroid-sparing and reduce relapse.
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Which renal adverse effect of mesalazine means renal function must be monitored?
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Interstitial nephritis (nephrotoxicity).
Why? 5-ASA drugs can cause interstitial nephritis, so check U&Es before and during treatment.
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Which reversible adverse effect of sulfasalazine is relevant to men planning a family?
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Oligospermia (reduced sperm count), which reverses after stopping.
Why? It is caused by the sulfapyridine part of the molecule. Mesalazine does not have this effect.
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What is the first-line drug treatment for microscopic colitis?
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Oral budesonide.
Why? Microscopic colitis causes chronic watery diarrhoea with a normal-looking colon; budesonide induces remission in most cases. First stop any trigger drug.
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Name three drugs that can trigger microscopic colitis.
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Any three of: PPIs (e.g. lansoprazole), NSAIDs, SSRIs, statins, beta-blockers.
Why? Stopping the culprit drug can be enough to settle the diarrhoea.
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Ischaemic colitis most often affects the ______ (Griffith's point), a watershed between the SMA and IMA territories.
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splenic flexure
Why? Watershed zones get the lowest-pressure blood from terminal branches, so they become ischaemic first in hypotension. The rectosigmoid (Sudeck's point) is the other watershed.
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A 78-year-old with atrial fibrillation develops sudden left-sided crampy abdominal pain followed within 24 hours by bloody diarrhoea. Lactate is raised. What is the investigation of choice?
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CT abdomen with IV contrast.
Why? It shows segmental colonic wall thickening, submucosal oedema ('thumbprinting') and fat stranding, and excludes perforation.
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Name two drugs that can precipitate ischaemic colitis.
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Any two of: cocaine, triptans, digoxin, the combined oral contraceptive pill.
Why? They cause vasoconstriction or thrombosis in the mesenteric circulation.
More Gastroenterology & Hepatology topics
- Oesophagus & dysphagia
- Stomach, H. pylori & GI hormones
- Malabsorption & IBS
- GI bleeding & diverticular disease
- Viral hepatitis
- Alcohol, fatty & autoimmune liver disease
- Inherited & metabolic liver disease
- Cirrhosis & its complications
- Pancreas & biliary tree
- GI cancer, polyposis & NETs
- Infection, nutrition & pregnancy