IBD Picture Quiz

Dr R Gooch

This Session:

• Pen and paper• 10 pictures• Write down your diagnosis• Discussions

Number 1

Number 2

Number 3

Number 4

Number 5

Number 6

Number 7

Number 8

Number 9

Number 10

Number 1 = Anal Fissure

Crack in the wall of the anal mucosa so that the circular muscle is exposed

Usually directly posterior and in the midline

Associated with IBD esp Crohn’s

Treatment focused on the primary condition

Number 2 = Clubbing

All four of the features outlined below should be present before the fingernails can be said to be clubbed:

Increased sponginess of the nail bed

Loss of the usual acute angle between the nail and the nail bed

Increased curvature of the nail

Increased mass of the soft tissues over the terminal phalanges

Number 3 =Erythema Nodosum

Characteristically the lesions are:

Painful, palpable, dusky blue nodules or plaques:

may vary from 1-10 cm in diameterpoorly demarcatedmost commonly on the shins and calvesmay spread to the thighs and extensor surfaces of the forearm and the trunktend to be symmetricalinitially the nodules are firm but becomes more fluctuant as the disease progress

Lesions resolve completely over 1-2 months

Ulceration of the nodules cannot be seen and usually heal without atrophy or scarring

Number 4 = Pyoderma Gangrenosum

Lesions begin in the dermis with secondary

Necrosis of the epidermis

The first sign is a pustule with surrounding erythema

With time an ulcer develops - the walls of the ulcer are blue and well defined

Number 5 = Venous Thromboembolism

Number 6 = Episcleritis

The episclera is the thin layer of vascular tissue overlying the sclera.

Inflammation of this layer is referred to as episcleritis.

May be accompanied by scleritis.

It is benign and self-limited.

It is a good indicator of disease activity in IBD.

Number 7 = Anterior Uveitis

PainPhotophobiaRednessLacrimation

Number 8 = Ankylosing Spondylosis

Associated especially with Crohn’s

Number 9 = Primary Sclerosing Cholangitis

75% associated with IBD – esp UC

Should be suspicious of this in a pt with IBD and abnormal LFTs – esp raised Alk Phos

Majority of patients will be asymptomatic at time of diagnosis – but will have advanced disease

Pruritus and fatigue are early symptomsNight sweats, fevers and RUQ pain.

Mean survival for patients is 7 years (biliary cirrhosis, portal hypertension & cholangitis, cholangiocarcinoma.)

Number 10 = Skin Tags

The End