Discuss the causes, symptoms and dietary management of inflammatory bowel disease.

1. 1 · Open in two lines. IBD is chronic relapsing inflammation of the gut. Its two forms are ulcerative colitis and Crohn's disease.
2. 2 · Draw the sites. [Sketch: gut outline; UC shaded continuously from rectum up the colon; Crohn's as patches along the ileum and colon]
3. 3 · UC vs Crohn's. Site, pattern, depth, stools and complications.
4. 4 · Causes and symptoms.
   • Genes, immune response, environment, smoking.
   • Diarrhoea, pain, fever, weight loss, anaemia.
5. 5 · Diet in a flare. Enough energy, high protein, low residue, low fat if steatorrhoea, limit lactose, fluids, iron, B12, calcium, vitamin D, zinc.
6. 6 · Diet in remission and a menu. Normal balanced diet with fibre added slowly; give a one-day flare menu.
7. 7 · Close in one line. Good nutrition shortens flares and protects growth and strength.

Scoring tip: Split diet into 'flare' and 'remission'; it shows the examiner you know the diet changes with the disease.