IBD IBD Complications and Extraintestinal Manifestations 2 — Questions and Answers
Question 1: IBD-related uveitis (anterior uveitis) is potentially sight-threatening and requires which urgent management?
- Oral antihistamines and cool compresses
- Urgent ophthalmology referral and topical corticosteroid eye drops (Correct answer)
- Systemic mesalamine dose increase
- Observation for spontaneous resolution
Correct answer: Urgent ophthalmology referral and topical corticosteroid eye drops
Anterior uveitis can cause permanent vision loss if untreated; urgent ophthalmology evaluation and topical steroids (with mydriatics) are required, independent of IBD disease activity.
Question 2: Short bowel syndrome (SBS) is a major risk in Crohn's disease after repeated intestinal resections when less than how much small bowel remains?
- <300 cm
- <200 cm (Correct answer)
- <150 cm
- <100 cm
Correct answer: <200 cm
SBS typically occurs when less than 200 cm of functional small bowel remains, leading to malabsorption, electrolyte imbalances, and often dependence on parenteral nutrition.
Question 3: Which IBD complication presents with absolute right lower quadrant tenderness, fever, and CT showing a mesenteric mass with trapped bowel loops in Crohn's disease?
- Toxic megacolon
- Intra-abdominal abscess (Correct answer)
- Carcinoid tumor
- Volvulus
Correct answer: Intra-abdominal abscess
Intra-abdominal abscesses in Crohn's form from penetrating transmural inflammation creating mesenteric phlegmons or frank abscesses, requiring drainage and antibiotics before definitive surgery.
Question 4: Oxalate kidney stones in Crohn's disease result from which pathophysiological mechanism?
- Elevated uric acid from cell turnover in active IBD
- Increased intestinal oxalate absorption due to fat malabsorption binding calcium (Correct answer)
- Dehydration causing supersaturated urine
- Aminosalicylate nephrotoxicity
Correct answer: Increased intestinal oxalate absorption due to fat malabsorption binding calcium
Fat malabsorption causes luminal calcium to bind free fatty acids (saponification) rather than oxalate, leaving free oxalate available for hyperabsorption and renal deposition.
Question 5: Anemia in IBD is most commonly due to which combination of causes?
- B12 deficiency and folate deficiency exclusively
- Iron deficiency anemia (chronic blood loss, malabsorption) and anemia of chronic inflammation (Correct answer)
- Hemolytic anemia and aplastic anemia
- Vitamin K deficiency
Correct answer: Iron deficiency anemia (chronic blood loss, malabsorption) and anemia of chronic inflammation
IBD anemia most commonly results from iron deficiency (chronic GI blood loss, impaired duodenal absorption) combined with anemia of chronic inflammation (hepcidin-mediated iron sequestration).
Question 6: Which IBD-associated hepatobiliary manifestation requires liver transplant evaluation and is associated with significant risk of cholangiocarcinoma?
- Non-alcoholic fatty liver disease
- Primary sclerosing cholangitis (PSC) (Correct answer)
- Autoimmune hepatitis overlap
- Granulomatous hepatitis
Correct answer: Primary sclerosing cholangitis (PSC)
PSC is a progressive fibro-inflammatory biliary disease with no effective medical therapy; it carries a 10-20% lifetime risk of cholangiocarcinoma and frequently requires liver transplantation.
IBD IBD Complications and Extraintestinal Manifestations 2
IBD-related uveitis (anterior uveitis) is potentially sight-threatening and requires which urgent management?