MRCP Part-1 | IBD (Inflammatory Bowel Disease) - Key Differences

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MRCP Part-1 | IBD (Inflammatory Bowel Disease) - Key Differences
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Inflammatory bowel disease: key differences- .06
The two main types of inflammatory bowel disease are Crohn's disease and Ulcerative colitis. They have many similarities in terms of presenting symptoms, investigation findings and management options. There are however some key differences which are highlighted in table below:
Crohn's disease (CD) Ulcerative colitis (UC)
Features Diarrhoea usually non-bloody
Weight loss more prominent
Upper gastrointestinal symptoms, mouth ulcers, perianal disease
Abdominal mass palpable in the right iliac fossa Bloody diarrhoea more common
Abdominal pain in the left lower quadrant
Tenesmus
Extra-intestinal Gallstones are more common secondary to reduced bile acid reabsorption
Oxalate renal stones* Primary sclerosing cholangitis more common
Complications Obstruction, fistula, colorectal cancer Risk of colorectal cancer high in UC than CD
Pathology Lesions may be seen anywhere from the mouth to anus
Skip lesions may be present Inflammation always starts at rectum and never spreads beyond ileocaecal valve
Continuous disease
Histology Inflammation in all layers from mucosa to serosa
• increased goblet cells
• granulomas No inflammation beyond submucosa (unless fulminant disease) - inflammatory cell infiltrate in lamina propria
• neutrophils migrate through the walls of glands to form crypt abscesses
• depletion of goblet cells and mucin from gland epithelium
• granulomas are infrequent
Endoscopy Deep ulcers, skip lesions - 'cobble-stone' appearance Widespread ulceration with preservation of adjacent mucosa which has the appearance of polyps ('pseudopolyps')
Radiology Small bowel enema
• high sensitivity and specificity for examination of the terminal ileum
• strictures: 'Kantor's string sign'
• proximal bowel dilation
• 'rose thorn' ulcers
• fistulae Barium enema
• loss of haustrations
• superficial ulceration, 'pseudopolyps'
• long standing disease: colon is narrow and short -'drainpipe colon'
Impaired bile acid rebsorption increases the loss calcium in the bile. Calcium normally binds oxalate.
Ulcerative colitis-22.57
Ulcerative colitis (UC) is a form of inflammatory bowel disease. Inflammation always starts at rectum (hence it is the most common site for UC), never spreads beyond ileocaecal valve and is continuous. The peak incidence of ulcerative colitis is in people aged 15-25 years and in those aged 55-65 years.
The initial presentation is usually following insidious and intermittent symptoms. Features include:
• bloody diarrhoea
• urgency
• tenesmus
• abdominal pain, particularly in the left lower quadrant
• extra-intestinal features (see below)
Questions regarding the 'extra-intestinal' features of inflammatory bowel disease are common:
Common to both Crohn's disease (CD) and Ulcerative colitis (UC) Notes
Related to disease activity Arthritis: pauciarticular, asymmetric
Erythema nodosum
Episcleritis
Osteoporosis Arthritis is the most common extra-intestinal feature in both CD and UC
Episcleritis is more common in CD
Unrelated to disease activity Arthritis: polyarticular, symmetric
Uveitis
Pyoderma gangrenosum
Clubbing
Primary sclerosing cholangitis Primary sclerosing cholangitis is much more common in UC
Uveitis is more common in UC
Pathology
• red, raw mucosa, bleeds easily
• no inflammation beyond submucosa (unless fulminant disease)
• widespread ulceration with preservation of adjacent mucosa which has the appearance of polyps ('pseudopolyps')
• inflammatory cell infiltrate in lamina propria
• neutrophils migrate through the walls of glands to form crypt abscesses
• depletion of goblet cells and mucin from gland epithelium
• granulomas are infrequent
Barium enema
• loss of haustrations
• superficial ulceration, 'pseudopolyps'
• long standing disease: colon is narrow and short -'drainpipe colon'
Ulcerative colitis: colorectal cancer- 29.35
Overview
• risk of colorectal cancer is 10-20 times that of general population
• the increased risk is mainly related to chronic inflammation
• worse prognosis than patients without ulcerative colitis (partly due to delayed diagnosis)
• lesions may be multifocal
Factors increasing risk of cancer
• disease duration > 10 years
• patients with pancolitis
• onset before 15 years old
• unremitting disease
• poor compliance to treatment

[@ranitabhattacharya441]

Sir I have done my MD ..So do I need any extra recommendations to sit for paces.please guide

[@SsAcademy]

Dear Doctor,
After a year internship you are eligible to sit for Part-1 Exam, To sit for the MRCP-2 Written, you just need to pass the Part-1 then you will be eligible for the Part 2 exam.
To sit before the PACES exam, you need a recommendation letter for one year that you were supervised under any MRCP holder. Apart from that you dont need any other experience to sit for the PACES exam.
Please note that Candidates must need a clinical attachment to pass the PACES exam.
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[@drsandeepyadav4865]

Hello sir I am from India, I have completed my MBBS here, now pursuing MD - community and Family Medicine from India, can I clear MRCP-UK simultaneously?? And plz tell me what is road map for that..

[@SsAcademy]

Dear Doctor,
Greetings from SsAcademy.Yes, You are eligible for MRCP. After a year internship you are eligible to sit for the Part-1 Exam, To sit for the MRCP-2 Written, you just need to pass the Part-1 then you will be eligible for the Part 2 exam.
To sit before the PACES exam, you need a recommendation letter for one year that you were supervised under any MRCP holder. Apart from that, you don't need any other experience to sit for the PACES exam.
Please note that Candidates must need a clinical attachment to pass the PACES exam.
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[@SumantaKumerSaha]

Thank you very much dear dr; stay connected and subscribe the channel and click the bell button to get the updates; and for more lectures, you should enroll the full course in www.essmrcpuk.com

[@ritupornachanda1677]

Hello sir,
I am from India , completed my MBBS here. Now, pursuing MD internal medicine in India itself. Can I clear the MRCPUK simultaneously? And what's the roadmap after MRCP? If will b very kind of you if you can guide me.
Regards,
Rituporna

[@SsAcademy]

Dear Doctor,
Yes, you can do the MRCP simultaneously, No worries about that. We are running MRCP UK | A complete online course where you don’t have to sit for a specific time to watch the video, you have a preferable time to watch it. You can do the course anytime, anywhere in the world.
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[@SumantaKumerSaha]

Dear Dr, you just start to prepare your course here at SsAcademy (www.essmrcpuk.com) course for MRCP-Part-1 and prepare yourself the best possible way like 6 months simultaneuously with your MD course together at home; you dont need to go anywhere except to follow to the course and study at home; and after that you will pursue then the same way for the MRCP-2 WRITTEN preparation, ,the same way online course will be highly recommended for you and the LAST PART, PACES exam preparation, I will guide you then what to do; you will be glad to know that huge doctors all over the world now a days prepare at home simultaneously with their home degrees's courses with their jobs as well; so i hope that you got the right answer and happy to answer any doubts further;

[@storagehouse5290]

I am intereated for mrcp part1 online course but confused about your teaching system and experience..now days every where mrcp online class available.but i think you has great experience towards it.. But can you give a demo video .just wanna watch way of teaching ....

[@SumantaKumerSaha]

Thank you very much dear dr; stay connected and subscribe the channel and click the bell button to get the updates; and for more lectures, you should enroll the full course in www.essmrcpuk.com