66. Ulcerative Colitis And Crohns Flashcards
Describe ulcreative colitis?
A relapsing and remitting disease of the large intestine. Punctuate ulcers that typically don’t extend transmurally. It is caused by an inappropriate immune response. Typically travels proximally to distal
Describe the symptoms of UC?
Episodic or chronic diarrhoea, cramps abdominal discomfort. Bowel frequency relates to severity. May also have systemic symptoms- (fever, malaise, anorexia, decreased weight)
What are the extraintestinal signs of UC?
Clubbing Oral ulcers Erythema nodosum Pyoderma gangreosum Conjunctivitis Episcleritis Iritis Large joint arthritis Ankylosing spondylitis
What are the tests that are carried out for ulcerative colitis?
FBC,ESR,CRP,U&E’S,LFT,blood culture
Stools culture- rule out infection
Faecal calprotection
Lower GI endoscopy
What are the complications of ulcerative colitis?
Toxic dilation of the colon
VTE
Low potassium
Long term cancer risk (need surgery colonoscopies every 1-5 years)
What is the treatment pathway for UC?
5 ASA (mesalalsine) Topical steroids Immunomodulation (methotrexate, ciclosporin A) Biologics (infliximab) Surgery
What do you do to someone who is admitted to hospital with a flare of colitis?
IV steroids and then switch to oral after they get better
Rescue therapy with ciclosporin, or infliximab if not improving days 3-5
Speak to surgeons
What is an ileo -anal pouch?
Allow for stomach reversibitly but must watch out for pouchitis.
Give metronidazole and ciprofloxacin for 2 weeks.
What is Crohn’s disease?
An autoimmune condition that causes trans mural granulomatous inflammation of the gastrointestinal tract affecting any region from mouth to anus
What are the symptoms of Crohns?
Diarrhoea Abdominal pain Weight loss Failure to thrive Fatigue, malaise Fever, anorexia
What are the complications of Crohn’s disease?
Small bowel obstruction Toxic megacolon Abscess formation Fistulae Perforation Colon cancer Primary sclerosing cholangitis
What tests are done to investigate Crohns?
FBC,ESR,CRP,U&E,LFT,INR,FERRITIN,B12, folate Stool culture (exclude pathogens) Colonoscopy and capsule endoscopy
What treatments are available in Crohn’s disease?
Azathipurine- immunosuppressant, started if needs >2 steroids per year
Biologics- anti TNFa, very good treatment. Long term risk of lymphoma
Surgery is needed in 50-80% of cases. Beware of short gut syndrome
What treatment is given to someone who has a flare of Crohn’s and needs hospitalised?
Prednisolone Admit for IV steroids VTE prophylaxis Consider need for blood transfusion Watch out for abdominal sepsis
