IBD IBD Surgical Management 2

Question 1

Pouchitis after IPAA surgery is most effectively treated initially with which antibiotic?

Accepted Answer

Metronidazole or ciprofloxacin

Answer

Acute pouchitis responds to a 2-week course of metronidazole or ciprofloxacin in approximately 80-90% of cases, making these the first-line treatment.

Question 2

Which finding on pouchoscopy is consistent with chronic antibiotic-refractory pouchitis?

Accepted Answer

Persistent mucosal inflammation, ulceration, and edema despite ≥4 weeks of antibiotics

Answer

Chronic antibiotic-refractory pouchitis is defined by persistent symptomatic and endoscopic inflammation despite ≥4 weeks of antibiotic therapy, requiring biologic escalation.

Question 3

Which pre-operative factor most increases the risk of complications after IPAA surgery for UC?

Accepted Answer

Chronic corticosteroid use (>20 mg/day prednisone)

Answer

Chronic high-dose corticosteroid use (>20 mg/day) significantly increases post-operative complications including anastomotic leak, infection, and poor wound healing.

Question 4

Why is IPAA surgery generally contraindicated in Crohn's disease?

Accepted Answer

High risk of pouch failure due to Crohn's recurrence in the pouch and anastomosis

Answer

Crohn's disease in the pouch leads to high rates of pouch failure (fistulas, strictures, severe pouchitis) requiring pouch excision, making IPAA generally contraindicated.

Question 5

The Rutgeerts score (i0–i4) is used post-operatively in Crohn's disease to assess which parameter?

Accepted Answer

Endoscopic recurrence at the neo-terminal ileum after ileocolonic resection

Answer

The Rutgeerts score grades endoscopic recurrence at the neo-terminal ileum at the ileo-colonic anastomosis; i2-i4 predicts clinical relapse and guides treatment escalation.

IBD - Inflammatory Bowel Disease Practice Test

IBD - Inflammatory Bowel Disease Practice Test

IBD IBD Surgical Management 2