1. IBD Picture Quiz Dr R Gooch

2. This Session: Pen and paper 10 pictures Write down your diagnosis Discussions

3. Number 1

4. Number 2

5. Number 3

6. Number 4

7. Number 5

8. Number 6

9. Number 7

10. Number 8

11. Number 9

12. Number 10

13. Number 1 = Anal Fissure Crack in the wall of the anal mucosa so that the circular muscle is exposed Usually directly posterior and in the midline Associated with IBD esp Crohn’s Treatment focused on the primary condition

14. Number 2 = Clubbing All four of the features outlined below should be present before the fingernails can be said to be clubbed: Increased sponginess of the nail bed Loss of the usual acute angle between the nail and the nail bed Increased curvature of the nail Increased mass of the soft tissues over the terminal phalanges

15. Number 3 =Erythema Nodosum Characteristically the lesions are: Painful, palpable, dusky blue nodules or plaques: may vary from 1-10 cm in diameter poorly demarcated most commonly on the shins and calves may spread to the thighs and extensor surfaces of the forearm and the trunk tend to be symmetrical initially the nodules are firm but becomes more fluctuant as the disease progress Lesions resolve completely over 1-2 months Ulceration of the nodules cannot be seen and usually heal without atrophy or scarring

16. Number 4 = Pyoderma Gangrenosum Lesions begin in the dermis with secondary Necrosis of the epidermis The first sign is a pustule with surrounding erythema With time an ulcer develops - the walls of the ulcer are blue and well defined

17. Number 5 = Venous Thromboembolism

18. Number 6 = Episcleritis The episclera is the thin layer of vascular tissue overlying the sclera. Inflammation of this layer is referred to as episcleritis. May be accompanied by scleritis. It is benign and self-limited. It is a good indicator of disease activity in IBD.

19. Number 7 = Anterior Uveitis Pain Photophobia Redness Lacrimation

20. Number 8 = Ankylosing Spondylosis Associated especially with Crohn’s

21. Number 9 = Primary Sclerosing Cholangitis 75% associated with IBD – esp UC Should be suspicious of this in a pt with IBD and abnormal LFTs – esp raised Alk Phos Majority of patients will be asymptomatic at time of diagnosis – but will have advanced disease Pruritus and fatigue are early symptoms Night sweats, fevers and RUQ pain. Mean survival for patients is 7 years (biliary cirrhosis, portal hypertension & cholangitis, cholangiocarcinoma.)

22. Number 10 = Skin Tags

23. The End