Abdominal: Inflammatory bowel disease (IBD) Flashcards
what are the two major forms of IBD?
Crohn’s disease
Ulcerative Colitis
which type of IBD affects only the colon?
Ulcerative Colitis
which part of the bowel does Ulcerative Colitis affect?
only the colon
which part of the bowel does Crohn’s disease affect?
can affect any part of the bowel
NB: can affect any part of the GI tract from mouth to anus
“skip lesions” are a classical feature of which IBD?
Crohn’s disease
affected areas followed by normal areas of bowel
which IBD starts in the rectum and spreads proximally?
Ulcerative Colitis
which IBD affects only the. mucosal layer?
Ulcerative Colitis
which IBD is deep ulcers and fissures a classical feature of?
Crohn’s disease
what do Crohn’s disease and Ulcerative Colitis have in common?
They both involve inflammation of the walls of the GI tract and are associated with periods of remission + exacerbation.
what is the largest independent risk factor of IBD?
family history
CD and UC are polygenic diseases
what are risk factors of Ulcerative Colitis?
- Family history - HLA-B27 gene.
- Infection.
- NSAIDs use.
- NOT smoking
which IBD has an increased risk in non-smokers?
Ulcerative Colitis
There is an increased risk of UC in non- or ex-smokers and nicotine has been shown to be an effective treatment in one small clinical trial.
what are risk factors of Crohn’s disease?
- Genetic susceptibility/family history.
- Age; (15-40y or 60-80y) – there is a bimodal age distribution in Crohn’s.
- Smoking
- NSAID ingestion.
- Hygiene; Good domestic hygiene has been shown to be a risk factor for CD. A ‘clean’ environment may not expose the intestinal immune system to pathogenic/non-pathogenic microorganisms.
- Nutrition (high sugar, high fat).
- Chronic stress.
- Depression.
which IBD has an increased risk in smokers?
Crohn’s disease
which IBD has an increased risk in patients with good hygiene?
Crohn’s disease
Good domestic hygiene has been shown to be a risk factor for CD but not for UC. Poor and large families living in crowded conditions have a lower risk of developing CD. A ‘clean’ environment may not expose the intestinal immune system to pathogenic/non-pathogenic microorganisms such as helminths which seems to alter the balance between effector and regulatory immune responses.
what is the general presentation of IBD?
- diarrhoea
- abdominal pain
- weight loss
clinical features of ulcerative colitis?
- rectal bleeding
- diarrhoea (with or without blood)
- abdominal pain
- faecal urgency
- Tenesmus
- Fever
- Weight loss
- Constipation
- Skin rash – Patients may have erythema nodosum and pyoderma gangrenosum
- Uveitis/Episcleritis (inflammation of eyes)
- Pallor
what is Tenesmus?
persistent, painful urge to pass stool even when the rectum is empty
clinical features of Crohn’s disease?
- Chronic diarrhoea
- Right lower quadrant pain (mimicking acute appendicitis)
- Perianal lesions – Skin tags, fistulae, abscesses, scarring or sinuses
- Bowel obstruction – Bloating, distention, cramping abdominal pains, loud borborygmi (gurgling noise made by the stomach or intestines), vomiting, constipation and obstipation
- Fever
- Fatigue
- Abdominal tenderness
- Weight loss
- Oral lesions – Ulcers in the mouth and gums
- Abdominal mass – Terminal ileum inflammation may present as a tender mass in the right lower quadrant
which IBD can feature Right lower quadrant pain - mimicking acute appendicitis?
Crohn’s disease
Blood and mucus in the stool is a classical feature of which IBD?
ulcerative colitis
which other conditions can present in a similar way to IBD?
- Diverticular disease/Diverticulitis.
- Colonic Cancer.
- Gastroenteritis.
- Coeliac disease.
- Infectious Colitis.
- Irritable bowel syndrome.
- Crohn’s disease can present as an emergency with acute right iliac fossa pain mimicking appendicitis.
NB: CD and UC can present as each other.
What blood test results would you expect with a PT who has IBD?
Anaemia is common, raised ESR and CRP (iron deficiency in severe attacks).
what investigations would you do for a pt with suspected IBD?
- blood test
- stool test
- endoscopy
- colonoscopy
How do you induce remission in a patient with the first presentation Crohn’s disease?
Offer prednisolone, methylprednisolone or IV hydrocortisone to induce remission
How do you induce remission in a patient with a single inflammatory exacerbation Crohn’s disease?
Offer prednisolone, methylprednisolone or IV hydrocortisone to induce remission
How do you induce remission in a patient with a Crohn’s disease if steroids don’t work alone?
Offer prednisolone, methylprednisolone or IV hydrocortisone to induce remission and add an immunosuppressant e.g.
(Azathioprine, Mercaptopurine, Methotrexate, Infliximab, Adalimumab)
how do you maintain remission with a pt with Crohn’s disease?
Offer azathioprine or mercaptopurine to maintain remission.
how do you maintain remission with a pt with Crohn’s disease who. can not tolerate azathioprine or mercaptopurine?
Consider using methotrexate
true or false, surgery cures Crohn’s disease.
false
The benefits of surgery for Crohn’s disease are usually temporary. The disease often recurs, frequently near the reconnected tissue. The best approach is to follow surgery with medication - maintain with azathioprine and metronidazole.
How do you induce remission in a patient with ulcerative colitis?
depends on severity:
mild to moderate - First-line – Aminosalycilate (Mesalazine), Second-line – Corticosteroids (Prednisolone).
severe - First-line – IV corticosteroids (Hydrocortisone), Second-line – IV Ciclosporin
How do you induce remission in a patient with mild to moderate ulcerative colitis?
First-line – Aminosalycilate (Mesalazine), Second-line – Corticosteroids (Prednisolone).
How do you induce remission in a patient with severe ulcerative colitis?
First-line – IV corticosteroids (Hydrocortisone), Second-line – IV Ciclosporin
which surgery could be performed for a pt with ulcerative colitis?
Removing the colon + rectum (panproctocolectomy)
NB: curative
what is the down side of performing a panproctocolectomy to cure ulcerative colitis?
The patient will then be left with either a permanent ileostomy or ileo-anal anastomosis (J-pouch).
what other medications may you consider advising a pt with IBD?
- anti-diarrheal
- pain killers (paracetamol not ibuprofen/NSAIDs)
- calcium/vit D supplements (steroids used to treat it can inc risk of osteoporosis)
- iron supplements for anaemic patients
what are some complications of IBD if left untreated?
- Colon cancer.
- Primary sclerosing cholangitis.
- Increased risk of blood clots.
- Bowel obstruction.
- Malnutrition.
- Ulcers.
- Fistulas.
- Anal fissure.
- Dehydration (due to severe diarrhoea).
- Perforated colon.
- Osteopenia.
