Ulcerative colitis vs Crohns disease MCQs
QUESTIONs: What is IBD?
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ANSWER: IBD is inflammatory bowel disease, inflammatory disease of the GI tract
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QUESTION: What are the two inflammtory bowel diseases?
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ANSWER: Crohn’s disease and ulcerative colitis
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QUESTION: What is the cause of IBD?
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ANSWER: No one knows, but probably an autoimmune process with environmental factors contributing
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QUESTION: What are the extraintestinal manifestations seen in both types of IBD?
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ANSWER:
- ankylosing spondylitis
- aphthous (oral) ulcers
- iritis
- pyoderma gangrenosum
- erythema nodosum
- clubbing of fingers
- sclerosing cholangitis
- arthritis
- kidney disease (nephrotic syndrome, amyloid deposits)
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QUESTION: In contrast to ulcerative colitis, Crohn’s disease of the colon:
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a. Is not associated with increased risk of colon cancer
b. Frequently presents as daily hematochezia
c. Is usually segmental rather than continuous
d. Has a lower incidence of perianal fistulas
e. Never develops toxic megacolon
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ANSWER: The answer is c: Crohn’s is patchy, segmental, chronic, and penetrates bowel wall to form fistulas, but seldom causes rectal bleeding. UC is mucosal ulcerating process that extends continuously from rectum proximal and has frequent rectal bleeds. Both can have toxic megacolon and both increase risk of cancer in large bowel.
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QUESTION: Match the clinical comment below to either being associated with Crohn’s disease, Ulcerative colitis, Both, or Neither.
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A. Anal involvement in 50%
B. Rectal involvement frequently seen
C. Small bowel involvement common
D. Chronic diarrhea, cramps, and fever
E. Curative surgery available
F. Toxic megacolon
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ANSWER:
A – Crohn’s disease
B – Both
C – Crohn’s disease
D – Both
E – Ulcerative colitis
F – Both
- Rectal involvement can be seen with both of these inflammatory diseases of the colon but is more common in ulcerative colitis (95% vs 50%)
- The clinical prsentations of these two entities are similar: chronic diarrhea, cramping, abdominal pain, and fever.
- a toxic megacolon can be an emergent, life threatening complication of either ulcerative colitis or Crohn’s disease, although it occurs less frequently with the latter.
ULCERATIVE COLITIS
- In ulcerative colitis, the anus is spared,
- “Backwash ileitis” a nonspecific dilatation of the terminal ileum, occurs in perhaps only 10% of patients with ulcerative colitis and has no prognostic or physiologic implications.
- Bloody stools, common with ulcerative colitis, are less common in Crohn’s disease.
- Total proctocolectomy or colectomy, rectal mucosectomy, and ileal pouch-anal anastomosis eliminate ulcerative colitis, whereas there is no curative operation for Crohn’s disease.
CROHN’S DISEASE
- In Crohn’s disease, anal or perianal disease is the first manifestation in 25-30% of cases.
- Ultimately, 50-70% of patients with Crohn’s colitis develop anal disease
- The small bowel is extensively involved in approximately 50% of patients with Crohn’s disease.
- There is no curative operation for Crohn’s disease
- Indeed even after total proctocolectomy for pancolonic invovelement with Crohn’s disease, its recurrence rate may be as high as 50%
- One third of patients require additional surgery for such recurrence
ULCERATIVE COLITIS VS CROHN’S DISEASE: REVIEW
Pathology Crohn’s Disease Ulcerative Colitis
Transmural inflammation Yes Uncommon
Granulomas 50-75% No
Fissures Common Rare
Submucosal thickening, fibrosis Common No
Submucosal inflammation Common Uncommon
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Characteristic Crohn’s Colitis Ulcerative Colitis
Location Small bowel involvement Colon only
(rare backwash ileitis)10%
Anatomic distribution Asymmetric distribution Contiguous involvement
(skip lesions) beginning distally
Rectal involvement Rectal sparing common 50% Involved 90%
Gross bleeding Absent in 25-30% Universal
Perianal disease ≤75% Rare, may be severe
Fistulization Yes No
Granulomas 50-75% No
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Endoscopic feature Crohn’s Colitis Ulcerative Colitis
Mucosal involvement Discontinuous Contiguous
Discreet ulcers (aphthous ulcers) Common Rare
Surrounding mucosa Relatively normal Abnormal
Longitudinal ulcer Common Rare
Cobblestoning In severe cases No
Rectal involvement Sparing common Involved in 90%
Mucosal friability Uncommon Common
Vascular pattern Normal Distorted
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SOURCES
ABSITE KILLER Q&A
STUDY SCHEDULE FOR FUTURE QUESTIONS
Categorised as: Crohns Disease, Ulcerative Colitis