Inflammatory Bowel Disease (IBD)
1. What are the two main types of IBD?
Answer: The two main types of IBD are Crohn's disease and ulcerative colitis.
Crohn's disease can affect any part of the GI tract from mouth to anus and
involves transmural inflammation, while ulcerative colitis is limited to the colon
and rectum with mucosal and submucosal inflammation.
2. What is the key pathological difference between Crohn's disease and
ulcerative colitis?
Answer: Crohn's disease involves transmural (full-thickness) inflammation and can
occur anywhere in the GI tract with skip lesions, while ulcerative colitis involves
only mucosal and submucosal layers and occurs continuously from the rectum
proximally.
3. What are the classic symptoms of Crohn's disease?
Answer: Classic symptoms include abdominal pain (often right lower quadrant),
diarrhea (may or may not contain blood), weight loss, fatigue, fever, and perianal
complications such as fistulas or abscesses.
4. What are the typical symptoms of ulcerative colitis?
Answer: Symptoms include bloody diarrhea, urgency, tenesmus, left-sided
abdominal cramping, and systemic symptoms like fatigue and weight loss during
flares.
5. What diagnostic tests are used to confirm IBD?
Answer: Diagnostic tests include colonoscopy with biopsy, CT or MRI
enterography, blood tests (CBC, ESR, CRP, calprotectin), and stool studies to rule
out infectious causes.
6. What is the significance of fecal calprotectin in IBD?
,Answer: Fecal calprotectin is a neutrophil-derived protein that indicates intestinal
inflammation. Elevated levels (>250 μg/g) suggest active IBD and can be used to
monitor disease activity and treatment response.
7. What are the first-line medications for mild to moderate Crohn's disease?
Answer: First-line treatments include aminosalicylates (sulfasalazine,
mesalamine), corticosteroids for acute flares, and immunomodulators
(azathioprine, methotrexate) for maintenance therapy.
8. What are the complications of Crohn's disease?
Answer: Complications include intestinal obstruction, perforation, fistulas
(enterocutaneous, enterovesical, enterovaginal), abscesses, perianal disease, and
increased risk of colorectal cancer with colonic involvement.
9. What extraintestinal manifestations are associated with IBD?
Answer: Common manifestations include arthritis, uveitis, erythema nodosum,
pyoderma gangrenosum, primary sclerosing cholangitis, and ankylosing
spondylitis.
10. When is surgical intervention considered in IBD?
Answer: Surgery is considered for complications (obstruction, perforation, severe
bleeding), failed medical therapy, growth retardation in children, or malignancy. In
ulcerative colitis, total colectomy is curative.
11. What is the role of biologics in IBD treatment?
Answer: Biologics (anti-TNF agents like infliximab, adalimumab; anti-integrin
agents like vedolizumab; anti-IL-12/23 agents like ustekinumab) are used for
moderate to severe IBD, especially when conventional therapy fails.
12. What dietary modifications are recommended for IBD patients?
Answer: During flares: low-residue diet, adequate hydration, vitamin
supplementation (B12, folate, vitamin D). During remission: balanced diet with
adequate fiber, avoiding only foods that trigger symptoms.
,Irritable Bowel Syndrome (IBS)
13. What are the Rome IV criteria for IBS diagnosis?
Answer: Recurrent abdominal pain ≥1 day per week in the last 3 months,
associated with ≥2 of: related to defecation, associated with change in stool
frequency, or associated with change in stool form/appearance.
14. What are the subtypes of IBS?
Answer: IBS-D (diarrhea-predominant), IBS-C (constipation-predominant), IBS-M
(mixed), and IBS-U (unclassified). Classification is based on predominant stool
pattern using Bristol Stool Chart.
15. What is the pathophysiology of IBS?
Answer: Multifactorial including visceral hypersensitivity, altered gut-brain axis,
dysregulated gut motility, intestinal dysbiosis, increased intestinal permeability,
and psychological factors.
16. What red flag symptoms rule out IBS and suggest organic disease?
Answer: Weight loss, rectal bleeding, family history of colorectal cancer or IBD,
onset after age 50, severe diarrhea, nocturnal symptoms, and laboratory
abnormalities.
17. What is the first-line dietary intervention for IBS?
Answer: Low FODMAP diet (Fermentable Oligosaccharides, Disaccharides,
Monosaccharides, and Polyols) under dietitian guidance, typically implemented in
three phases: elimination, reintroduction, and personalization.
18. What medications are used for IBS-D?
Answer: Loperamide for diarrhea, eluxadoline (mixed opioid receptor modulator),
rifaximin (antibiotic), alosetron (5-HT3 antagonist for severe cases), and tricyclic
antidepressants for pain.
19. What treatments are available for IBS-C?
, Answer: Fiber supplements, osmotic laxatives (polyethylene glycol), lubiprostone
(chloride channel activator), linaclotide and plecanatide (guanylate cyclase-C
agonists), and tegaserod (5-HT4 agonist).
20. What role do probiotics play in IBS management?
Answer: Certain probiotics may improve symptoms, particularly Bifidobacterium
infantis and multi-strain preparations. However, evidence is mixed, and specific
strains and dosing need further research.
21. How effective is psychological therapy for IBS?
Answer: Cognitive behavioral therapy, gut-directed hypnotherapy, and
mindfulness-based interventions have shown significant benefit for IBS symptoms,
particularly for patients with psychological comorbidities.
22. What is post-infectious IBS?
Answer: IBS symptoms developing after an episode of acute gastroenteritis,
occurring in 10-15% of patients. Risk factors include female sex, younger age,
severe initial illness, and psychological stress.
Diverticular Disease
23. What is the difference between diverticulosis and diverticulitis?
Answer: Diverticulosis refers to the presence of diverticula (outpouchings) in the
colon wall, while diverticulitis is the inflammation of these diverticula, which may
lead to complications.
24. What are the risk factors for diverticular disease?
Answer: Advanced age, low-fiber diet, obesity, smoking, physical inactivity, certain
medications (NSAIDs, opioids), and genetic predisposition.
25. What are the symptoms of acute diverticulitis?
1. What are the two main types of IBD?
Answer: The two main types of IBD are Crohn's disease and ulcerative colitis.
Crohn's disease can affect any part of the GI tract from mouth to anus and
involves transmural inflammation, while ulcerative colitis is limited to the colon
and rectum with mucosal and submucosal inflammation.
2. What is the key pathological difference between Crohn's disease and
ulcerative colitis?
Answer: Crohn's disease involves transmural (full-thickness) inflammation and can
occur anywhere in the GI tract with skip lesions, while ulcerative colitis involves
only mucosal and submucosal layers and occurs continuously from the rectum
proximally.
3. What are the classic symptoms of Crohn's disease?
Answer: Classic symptoms include abdominal pain (often right lower quadrant),
diarrhea (may or may not contain blood), weight loss, fatigue, fever, and perianal
complications such as fistulas or abscesses.
4. What are the typical symptoms of ulcerative colitis?
Answer: Symptoms include bloody diarrhea, urgency, tenesmus, left-sided
abdominal cramping, and systemic symptoms like fatigue and weight loss during
flares.
5. What diagnostic tests are used to confirm IBD?
Answer: Diagnostic tests include colonoscopy with biopsy, CT or MRI
enterography, blood tests (CBC, ESR, CRP, calprotectin), and stool studies to rule
out infectious causes.
6. What is the significance of fecal calprotectin in IBD?
,Answer: Fecal calprotectin is a neutrophil-derived protein that indicates intestinal
inflammation. Elevated levels (>250 μg/g) suggest active IBD and can be used to
monitor disease activity and treatment response.
7. What are the first-line medications for mild to moderate Crohn's disease?
Answer: First-line treatments include aminosalicylates (sulfasalazine,
mesalamine), corticosteroids for acute flares, and immunomodulators
(azathioprine, methotrexate) for maintenance therapy.
8. What are the complications of Crohn's disease?
Answer: Complications include intestinal obstruction, perforation, fistulas
(enterocutaneous, enterovesical, enterovaginal), abscesses, perianal disease, and
increased risk of colorectal cancer with colonic involvement.
9. What extraintestinal manifestations are associated with IBD?
Answer: Common manifestations include arthritis, uveitis, erythema nodosum,
pyoderma gangrenosum, primary sclerosing cholangitis, and ankylosing
spondylitis.
10. When is surgical intervention considered in IBD?
Answer: Surgery is considered for complications (obstruction, perforation, severe
bleeding), failed medical therapy, growth retardation in children, or malignancy. In
ulcerative colitis, total colectomy is curative.
11. What is the role of biologics in IBD treatment?
Answer: Biologics (anti-TNF agents like infliximab, adalimumab; anti-integrin
agents like vedolizumab; anti-IL-12/23 agents like ustekinumab) are used for
moderate to severe IBD, especially when conventional therapy fails.
12. What dietary modifications are recommended for IBD patients?
Answer: During flares: low-residue diet, adequate hydration, vitamin
supplementation (B12, folate, vitamin D). During remission: balanced diet with
adequate fiber, avoiding only foods that trigger symptoms.
,Irritable Bowel Syndrome (IBS)
13. What are the Rome IV criteria for IBS diagnosis?
Answer: Recurrent abdominal pain ≥1 day per week in the last 3 months,
associated with ≥2 of: related to defecation, associated with change in stool
frequency, or associated with change in stool form/appearance.
14. What are the subtypes of IBS?
Answer: IBS-D (diarrhea-predominant), IBS-C (constipation-predominant), IBS-M
(mixed), and IBS-U (unclassified). Classification is based on predominant stool
pattern using Bristol Stool Chart.
15. What is the pathophysiology of IBS?
Answer: Multifactorial including visceral hypersensitivity, altered gut-brain axis,
dysregulated gut motility, intestinal dysbiosis, increased intestinal permeability,
and psychological factors.
16. What red flag symptoms rule out IBS and suggest organic disease?
Answer: Weight loss, rectal bleeding, family history of colorectal cancer or IBD,
onset after age 50, severe diarrhea, nocturnal symptoms, and laboratory
abnormalities.
17. What is the first-line dietary intervention for IBS?
Answer: Low FODMAP diet (Fermentable Oligosaccharides, Disaccharides,
Monosaccharides, and Polyols) under dietitian guidance, typically implemented in
three phases: elimination, reintroduction, and personalization.
18. What medications are used for IBS-D?
Answer: Loperamide for diarrhea, eluxadoline (mixed opioid receptor modulator),
rifaximin (antibiotic), alosetron (5-HT3 antagonist for severe cases), and tricyclic
antidepressants for pain.
19. What treatments are available for IBS-C?
, Answer: Fiber supplements, osmotic laxatives (polyethylene glycol), lubiprostone
(chloride channel activator), linaclotide and plecanatide (guanylate cyclase-C
agonists), and tegaserod (5-HT4 agonist).
20. What role do probiotics play in IBS management?
Answer: Certain probiotics may improve symptoms, particularly Bifidobacterium
infantis and multi-strain preparations. However, evidence is mixed, and specific
strains and dosing need further research.
21. How effective is psychological therapy for IBS?
Answer: Cognitive behavioral therapy, gut-directed hypnotherapy, and
mindfulness-based interventions have shown significant benefit for IBS symptoms,
particularly for patients with psychological comorbidities.
22. What is post-infectious IBS?
Answer: IBS symptoms developing after an episode of acute gastroenteritis,
occurring in 10-15% of patients. Risk factors include female sex, younger age,
severe initial illness, and psychological stress.
Diverticular Disease
23. What is the difference between diverticulosis and diverticulitis?
Answer: Diverticulosis refers to the presence of diverticula (outpouchings) in the
colon wall, while diverticulitis is the inflammation of these diverticula, which may
lead to complications.
24. What are the risk factors for diverticular disease?
Answer: Advanced age, low-fiber diet, obesity, smoking, physical inactivity, certain
medications (NSAIDs, opioids), and genetic predisposition.
25. What are the symptoms of acute diverticulitis?
