Case 12 SAP Flashcards
Risk factors for Crohn’s disease
Positive family history, adverse life events, stress, depression, smoking, GI infections, excessive sanitation
Protective factor for Crohn’s disease
Breastfeeding
Morphological features of Crohn’s disease
Ulceration, skip lesions (normal areas within the ulcerations), cobblestoning, pseudopolyps, scarring, strictures, fistulas, granulomas, transmural, discontinuous
What are the most common fistulas in Crohn’s disease?
Perianal fistulas
Where is Crohn’s disease located?
Anywhere in the GI tract but most commonly in the terminal ileum, often spares rectum
Complications of Crohn’s disease
Strictures, fistulas, perforation, malabsorption
Crohn’s disease statistics for patient future
50% will undergo surgery in 10 years
Only 20% will have long-term remission in 20 years
Steroid use within three months predictive of surgery
Clinical presentation of IBD
Diarrhoea, rectal bleeding with colon inflammation, abdominal pain, weight loss, fatigue, negative impact on quality of life
What to ask about in IBD history
Chronicity, bleeding, pain location, incontinence, nocturnal diarrhoea, contacts with or recent gastroenteritis, smoking, family history, appendectomy status, NSAID use
What does visible blood in the stool suggest about the location of the inflammation?
Lower down e.g. rectum or large intestine
What to look for on IBD examination?
Anaemia, mouth ulcers, angular stomatitis, swollen lips, clubbing, bloating, visible pain, slim/cachectic build, erythema nodosum, uveitis, pyoderma gangrenosum, arthritis
Definition of IBD
Aberrant inflammatory response to host microbial or environmental factors in a genetically predisposed individual. Can occur at any age. Can have many inflammatory diseases at once e.g. MS, coeliac, type 1 diabetes
Genes in IBD
Very strong genetic component, can very rarely be monogenic but this presents very early (<2 or <6) and is very severe
Risk factors for ulcerative colitis
Positive family history , adverse life events , stress, depression, GI infections, excessive sanitation
Protective factors in ulcerative colitis
breastfeeding and smoking
Morphological features of ulcerative colitis
Erosions, ulcerations, continuous so NO SKIP LESIONS, pseudopolyps crypt abscesses, confined to mucosa
Where is ulcerative colitis located?
Always in the rectum but may extend upwards to a variable length
Complications of ulcerative colitis
Double risk of colonic carcinoma, risk of severe acute colitis that can lead to toxic megacolon
Statistics for ulcerative colitis patient future
90% will have relapses
Early relapse (within 2 years) associated with worse course
Male gender, young age, and elevated inflammatory markers on diagnosis predictive for surgery
Epidemiology of IBD
Prevalence highest in Northern Europe and North America
Prevalence increasing - now 0.8%
Migrants take on prevalence of new country
