Crohn's and Ulcerative Colitis Flashcards
Inflammatory bowel disease is inflamed intestines resulting in…
malabsorption
Which group is inflammatory bowel disease most common in?
Jews
What gene is associated with IBD?
HLA B27
What age group is IBD most common?
Bimodal
15-20 and over 55s
What causes Crohn’s disease?
NOD-2 mutation and environment.
Bacteria cause immune mediated response (T cells)
Overproduction of TNF-a contributing to tissue damage and disruption to intestinal barrier. Elevated levels of IL-1 and IL-6 contribute to tissue destruction and damage by activating immune cells.
In Crohn’s disease, where is affected?
Whole GIT especially the distal ileum and proximal colon. Patches of inflammation.
Who is at risk of Crohn’s disease?
Family History, Jewish, smokers
With Crohn’s disease, the inflammation is ______, affecting which layers?
transmural, all 4 layers: mucosa, submucosa, muscularis propria, serosa
What are common symptoms of Crohn’s disease?
Pain in RLQ
Malabsorption
Deficiency in B12/folate/iron
Gall stones and kidney stones
Weight loss
Watery diarrhoea
Aphthous mouth ulcers
(May also have, but more common in UC)
Uveitis/ episcleritis
Pyoderma gangrenosum / erythema nodosum
Spondylarthritis - “spineache”
How can Crohn’s disease cause gallstones?
Bile salts are not reabsorbed well due to inflammation. Instead they react with bilirubin in the colon changing it to a form that can be reabsorbed. More absorption of bilirubin results in more incorporated in the bile forming black gallstones
What is uveitis?
Inflammation of uvea. middle layer of eye
What is episcleritis?
inflammation of the connective tissue between the conjunctiva(sufrace membrane) and sclera (white)
What is pyoderma gangrenosum
Rare skin condition that causes painful skin ulcers (not related to gangrene, is not contagious)
What is erythema nodosum?
tender red bumps, often found symmetrically on the shins
What is spondyloarthritis?
Group of diseases characterised by inflammation in the spine and joints
What investigations are carried out for Crohn’s disease?
pANCA -ve (perinuclear Anti-Neutrophil Cytoplasmic Antibodies)
Increased faecal calprotectin (result of neutrophil migration into GI due to inflammation)
Biopsy: transmural inflammation with non caseating granulomas
Endoscopy/X-ray: skip lesions, cobble stoning, “string sign” structures
What are “string sign” structures?
Narrowing of the terminal ileum due to symmetric, transmural granulomatous inflammation and fibrotic thickening of the wall.
How do you treat flares of Crohn’s disease?
Sulfasalazine given via rectal suppository therefore better in UC
Prednisolone
What is treatment for remission of Crohn’s disease?
Azathioprine
Methotrexate
What are the biologics treatment for Crohn’s?
Anti TNF-a: Infliximab
IL 12 and 23 inhibitor: Ustekenumab
True or false: Surgery is not curative for Crohn’s disease
True
As entire bowel can be affected
What are complications of Crohn’s disease?
Fistula (abnormal connection)
Strictures
Abscesses (painful collection of pus)
Small bowel obstruction
Ulcerative colitis is an a_______ colitis
autoimmune
What gene is associated with UC?
HLA B27
In UC, is the pANCA likely to be positive or negative?
Positive (is a test for autoimmune vasculitis, more likely to be negative in Crohn’s)
Which area is affected by UC?
Colon only
Starting at rectum to sigmoid to proximal colon
What are risk factor for UC?
Family history, Jewish.
However, smoking is somehow protective for UC!
In UC, the inflammation is c____ to…
confined to the mucosa
What are common symptoms of UC?
Pain in LLQ
Tenesmus (rectal defecation pain)
Bloody mucous/watery diarrhoea
Uveitis / episcleritis
Pyoderma gangrenosum / erythema nodosum
Spondylarthropathy
PSC (primary sclerosing cholangitis)
What is PSC?
Primary sclerosing cholangitis
Uncommon chronic liver disease where bile ducts get smaller due to inflammation and fibrosis, commonly linked to UC.
What are diagnostic tests for UC?
pANCA: positive
Increased faecal calprotectin
Biopsy: mucosal inflammation with crypt hyperplasia
Colonoscopy: continuous “lead pipe sign”
Why is there crypt hyperplasia?
Not fully understood, considered compensatory response to mucosal injury and inflammation to replace lost epithelial cells.
What is the “lead-pipe” sign in UC?
Uniform loss of haustral markings (pouch like structures” in the colon. Smooth appearance resembling a lead pipe!
What is used to score the severity of UC flares?
Truelove + Witts severity index
What is treatment for flares of UC?
If severe, first give Prednisolone
Sulfasalazine
What is treatment for remission of UC?
Azathioprine
Methotrexate
Ciclosporin (calcineurin inhibitor)
What are biologic treatments for UC?
Anti TNF-a: Infliximab
Surgery (total or partial colectomy)
True or false: Surgery is not curative for UC?
False
It is curative
What are complications of UC?
Toxic megacolon
