IBD IBD Complications and Extraintestinal Manifestations 1 — Questions and Answers
Question 1: Which extraintestinal manifestation of IBD runs a course parallel to (mirrors) intestinal disease activity?
- Primary sclerosing cholangitis (PSC)
- Ankylosing spondylitis
- Peripheral arthropathy (type 1, pauciarticular) (Correct answer)
- Uveitis
Correct answer: Peripheral arthropathy (type 1, pauciarticular)
Type 1 peripheral arthropathy (pauciarticular, <5 large joints) directly mirrors IBD activity, typically resolving with treatment of the underlying bowel disease.
Question 2: Primary sclerosing cholangitis (PSC) is most strongly associated with which IBD condition?
- Crohn's disease of the small bowel
- Ulcerative colitis (particularly pancolitis) (Correct answer)
- Gastroduodenal Crohn's disease
- Microscopic colitis
Correct answer: Ulcerative colitis (particularly pancolitis)
PSC is found in approximately 5% of UC patients, with the converse being true (approximately 75-80% of PSC patients have IBD, predominantly UC with pancolitis).
Question 3: Erythema nodosum in IBD presents as which type of skin lesion?
- Painless, raised violet plaques on the shins
- Painful, tender, raised red/purple nodules typically on the anterior shins (Correct answer)
- Vesicular eruption following dermatomes
- Flat, hyperpigmented macules on the trunk
Correct answer: Painful, tender, raised red/purple nodules typically on the anterior shins
Erythema nodosum presents as painful, erythematous, raised nodules on the anterior shins and typically correlates with IBD activity, resolving with bowel disease treatment.
Question 4: Pyoderma gangrenosum (PG) in IBD differs from erythema nodosum because PG characteristically:
- Correlates directly with IBD disease activity
- May occur independently of IBD activity and requires specific wound care plus immunosuppression (Correct answer)
- Heals without scarring after treating the underlying IBD
- Only occurs on the anterior shins
Correct answer: May occur independently of IBD activity and requires specific wound care plus immunosuppression
Unlike erythema nodosum, PG often does not mirror IBD activity, requires specific wound care (wet dressings, avoid aggressive debridement), and needs immunosuppressive therapy.
Question 5: Venous thromboembolism (VTE) risk in IBD patients is elevated primarily because of which mechanism?
- Anticoagulant protein deficiency only
- Hypercoagulable state from chronic inflammation, elevated factor VIII, fibrinogen, and reduced protein C/S (Correct answer)
- Immobility alone
- Steroid-induced platelet destruction
Correct answer: Hypercoagulable state from chronic inflammation, elevated factor VIII, fibrinogen, and reduced protein C/S
IBD patients have a 2-3x elevated VTE risk due to chronic inflammation-driven hypercoagulability, elevated acute phase reactants, endothelial dysfunction, and often immobility during flares.
Question 6: Gallstones (cholelithiasis) are more common in Crohn's disease affecting the terminal ileum due to which mechanism?
- Increased cholesterol absorption from inflamed ileum
- Impaired bile acid reabsorption leading to supersaturated bile with cholesterol stone formation (Correct answer)
- Elevated bilirubin from hemolytic anemia
- Antibiotic-induced biliary microbiome changes
Correct answer: Impaired bile acid reabsorption leading to supersaturated bile with cholesterol stone formation
Terminal ileal disease or resection impairs enterohepatic recycling of bile acids, depleting the bile acid pool and leading to cholesterol-supersaturated bile and pigment gallstone formation.
IBD IBD Complications and Extraintestinal Manifestations 1
Which extraintestinal manifestation of IBD runs a course parallel to (mirrors) intestinal disease activity?