Bowel diseases

Question 1

IBD

Answer 1

Chrons- affects any part of GI
Ulcerative colitis- only affects large intestine
Some overlap may exist

Question 2

Chron’s Disease

Answer 2

Type of inflammatory bowel disease that causes inflammation of tissues in GI tract

Question 3

Chron’s Disease Epidemiology

Answer 3

M:F 1:1.2
White people 20 - 30
Family Hx
Smoking
NSAIDs

Question 4

Chron’s Disease Patho

Answer 4

• Thought to be caused by an abnormal mucosal immune response to luminal bacteria in genetically susceptible individuals.
• Mutations in the gene CARD15
  Dysfunctional immune system leads to unregulated inflammation which causes destruction of healthy tissue.

Differences from UC:
Ulcers + damage extends beyond the submucosa layer, through the depth of the GI wall.
Inflammation is scattered creating cobblestone affect.
Most commonly affects ileum and colon but can affect anywhere in GI tract

Question 5

Chron’s Disease S&S

Answer 5

Diarrhoea
Abdominal P
Weight loss
Lack of energy- nutrients not being digested properly
Mouth sores
May present as emergency- massive flare up, e.g., vomiting

Question 6

Chron’s Disease Investigations

Answer 6

Blood tests- anaemia, raised ESR
Imaging- colonoscopy, ultrasound, spiral CT

Question 7

Chron’s Disease Management

Answer 7

No cure in removal as unlike UC as can happen anywhere along GI tract
Treatment and lifestyle changes can help keep disease in remission
Changing diet
Anti-inflammatory meds
Surgical- 80% will need it, ileostomy

Question 8

Ulcerative colitis

Answer 8

Ulcers form in lumen of large intestine including both colon and rectum
An idiopathic inflammatory bowel disease characterised by inflammation restricted to the large bowel mucosa, which always involves the rectum and extends proximally in a continuous fashion for a variable distance.

Question 9

UC Epidemiology

Answer 9

Females slightly more affected
Adults before 30
White people
Family Hx- first degree relative

Question 10

UC Patho

Answer 10

Ulcers = Spots in the mucosa where tissue has errored away and left open sores/breaks in the membrane.
Character of inflammation:
- Consists of flares - new damage and periods of remission - tissues start to heal.
- Circumferential (inflam goes around whole lumen) + continuous (starts in rectum and continuous along rectum with no breaks in affective tissue)

Auto immune cause although still relatively unknown.
Thought to be a mix of environmental stimuli + genetic predisposition with Diet and stress making symptoms worse

Question 11

UC S&S

Answer 11

Bloody diarrhoea
Tenesmus - feeling that you need to pass stools, even though your bowels are already empty
Abdominal cramps
Severe P in rectum/lower left quadrant
Anaemia
Fatigue
Fever
Weight loss

Question 12

UC Investigations

Answer 12

Blood tests- ESR and CRP raised, anaemia, raised WBC
Imaging- colonoscopy, CT, MRI, X-RAY

Question 13

UC Management

Answer 13

Corticosteroids
Immunosuppressants
Biologics- targets proteins made by immune system. Infliximab- neutralise protein produced by immune system
Colectomy - removal of the colon generally cures the disease.