Case 11 Flashcards
What is the main difference between Chron’s and ulcerative colitis?
Ukcerative colitis inflammation is limited to the colon and inflammation is mucosal. By contrast, Chron’s pattern of inflammation is patchy and is also transmural
- So just remember that Chron’s pattern of inflammation is transmural, and UC is not!
Where is the most common distribution for Chron’s disease?
1) Small bowel alone (ileitis)
2) Colon only (Colitis)
3) Large and Small bowel (Ileocolitis)
What are the types of non specific of colitis?
- Diverticular colitis
- microscopic colitis
Apart from the disease processes ulcerative colitis and Chron’s, what else causes GI inflammation?
- Radiation Injury
- Mesenteric Iscaemia
- Infections
- Infestations
- Antibiotic effects
- NSAID toxicity
- Diversion of the faecal stream
- Massed diverticulosis
What are the two categories of inflammatory bowel disease?
Ulcerative colitis and Chron’s disease
What is the most common distribution of ulcerative colitis?
- 50% limited to the rectum (proctitis) or rectosigmoid (proctosigmoiditis)
- 10% Large bowel
Distribution is usually intermediate or extensive. Intermediate distribution involves the descending colon not beyond the splenic flexure. Extensive distribution is proximal to the splenic flexure
What are the symptoms of ulcerative colitis?
1) Bleeding
2) Diarrhoea (not in proctitis)
3) Urgency
4) Abdo pain (only marked in severe disease)
What are the complications of ulcerative colitis?
1) Rectal bleeding - most frequent due to mucosal ulceration
2) Toxic mega colon - most dangerous
3) Perforation - most lethal, clinical signs can be subtle or even absent
4) benign and Malignant strictures - benign strictures occur due to muscle hypertrophy and spasm
5) Colorectal cancer
What is toxic mega colon and what are the radiological features of toxic mega colon?
Occurs when ulcerating, inflammatory process dissects deeply through the wall of the colon, producing serous iris and paralytic ileus.
Can be seen on plain films as an accumulation of gas over a long segment of colon.
- Abnormal haustra
What are the differences between IBD and IBS?
Clinical and lab signs found in IBD are absent in IBS are there is rarely a need for differential diagnosis
IBS is not so much a disease but more of a functional disorder. Whereas IBD is a pathological disease involving inflammation either mucosal (UC) or transmural (Chrohns)
What are the extra intestinal manifestations of IBD?
- Peripheral Arthiritis
- Skin Lesions
- Mouth
- Eye Lesions
- Central (axial) Arthiritis
With peripheral Arthiritis, how does this differ from rheumatoid Arthiritis as an extracolonic manifesto on of IBD ?
- asymmetric (e.g. Would affect one ankle side)
- non-erosive
- few joints affected
- rheumatoid factor negative
What are the skin lesions associated with IBD?
- Erythema Nodosum (esp. In chrohn’s)
- Pyoderma gangrenosum (esp. In UC)
What occurs in the moth in relation to IBD?
These are more common in Chron’s
- Aphthous Ulceration
- Angular Cheilitis
- Lip Swelling
- In teenagers, pro facial involvement can occur years before the manifestations of Chron’s
What eye lesions are involved with IBD?
- Epsiscleritis
- anterior Uveitis (painful)
- spondylitis
- sacro-ilitis
