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BDS2 BAMS > Crohn’s Disease and Ulcerative Colitis > Flashcards

Crohn’s Disease and Ulcerative Colitis Flashcards

1
Q

significant diseases of GI

A

Oesophagus and upper GI

Malabsorption

  • Pernicious anaemia
  • Coeliac disease
  • Crohn’s disease

Large bowel

  • Inflammatory bowel disease (IBD)
  • Cohn’s disease
  • Ulcerative Colitis

Colonic Ca

Infections

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2
Q

incidence of inflammatory bowel disease

A

20 times more in Western Societies
- Increasing

White > Black

age: 15-25, 50-80

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3
Q

gender ratio for Crohn’s

A

male > female

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4
Q

gender ratio for Ulcerative Colitis

A

female > male

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5
Q

aetiology of inflammatory bowel diseases

A

Immunological

Psychological
- Chronically anxious more at risk

Smoking
- Less risk but benefit lost by increase CV disease risk

Genetic

Mystery
- Complex pattern of inherited and environmental and psychological changes
- Change in gut pathology
Likely more than one cause in population
- Clinical manifestation the same but aetiology of changes in mucosa are different

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6
Q

aetiology of Crohn’s disease

A

Granulomatous inflammation – varied aetiology
- Collection of multinucleated giant cells in clump and resistant to removal by phagocytosis (surrounded by immune cells)

Tissue causes immune stimulation body is unable to deal with (alike TB) and generalised chronic inflammation

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7
Q

cause of Crohn’s disease

A

unknown

Food intolerance
- Irritation to immune system caused by something passing through the gut

Persisting viral infection/immune activation

  • Recurrent viral infection
  • Infectious agent passed to people in right susceptibility causes problems

? Infection with Mycobacteria (paratuberculosis)

  • Johne’s disease
  • -Problem in cattle which is similar to Crohn’s

Hard to find and ID agents

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8
Q

M.paratuberculoisis cycle

A 
Mycobacteria causes disease in cow
Happen in farm 
Dairy passed into industry 
Treated incorrectly 
Passed to humans

Incidence of both diseases increased similarly

  • Gap in time of 10 years
  • Zoonotic infection from cow to people

Pasteurisation of milk
- Good at getting rid of pathogens
But not M.paratubercolosis
- Only way is by UHT milk

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9
Q

Crohn’s disease impact on bowel surface

A

Lumps (should be smooth)

  • areas of oedema, caused by granulomas washed into lymphatics carried away into tissue fluid, preventing draining of lymphatics
  • Cobble stoning of mucosa
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10
Q

how are the lumps formed in Crohn’s disease

A

Block lymphatics cause oedema and lump

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11
Q

crohn’s disease sites

A

can be ID anywhere
- can be in certain sections and skip lesions

(colitis in colon)

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12
Q

3 common Crohn’s disease sites

A

Mouth

Ileocecal region - small to large

rectal

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13
Q

ulcerative colitis sites

A

only colonic disease
- Ascending, sigmoid, descending
Starts at rectum and works way up
- Continuous inflammation up the way

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14
Q

what is ulcerative colitis

A

Ulcers in colon
- Like mouth ulcers

Change in bowel activity

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15
Q

features of ulcerative colitis

A

Disease continuous

Rectum always involved (bottom up)

Anal fissures 25%

Ileum involved 10%
- Small bowel involved in small number

Mucosa granulomas & Ulcers

Vascular

Serosa normal

  • Superficial inflammation
  • Only areas affected are top layers
  • a featureless colon with complete loss of haustration, total blurring of the normal vascular pattern, and agranular-likemucosadevelops.

ulcerative colitis thereisa continuous, diffuse granular mucosal pattern, with or without superadded ulceration; i

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16
Q

features of Crohn’s disease

A

Discontinuous

Rectum involved 50%

Anal fissures 75%

Ileum involved 30%

Mucosa cobbled and fissures
- Due to lymphatic blockage

Non-vascular

Serosa inflamed
- Entire thickness of bowel wall inflamed

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17
Q

microscopic features of ulcerative colitis

A

Granular Mucosal

Vascular more blood vessels

Mucosal abscesses

18
Q

microscopic features of Crohn’s disease

A

Transmural
- full thickness effected

Oedematous
- blocking lymphatics

granulomas
- Drainage is deep
Biopsy to show it is a challenge

19
Q

Clinical features and signs of Crohn’s disease

A

Oedema

Perioral erythema

  • red inflammatory changed
  • Swollen lips (can just be one or both)

Inflammation
Swelling
Oedema of bowel wall
- narrower lumen so problem with passing bowel contents

All though bowel wall so abscesses can form
Outside or inside
End up with inflammation causing a fistula
- hole between two loops of bowel, connection,
- bacteria spread

full thickness inflammation, granuloma formation and oedema

Crohn’s colitis is characterised by discrete ulcers with intervening normal mucosa.

20
Q

ulcerative colitis effect on mucosa

A

Normal tissue
– Secretory mucosa
– Thin layer of serosa tissue

In UC distorted picture but not extended to outside

  • Bottom area largely normal
  • superficial

ulcerative colitis there is a continuous, diffuse granular mucosal pattern, with or without superadded ulceration

a featureless colon with complete loss of haustration, total blurring of the normal vascular pattern, and agranular-likemucosadevelops.

21
Q

when taking a biopsy of a UC site what can a perforation cause

A

peritonitis

22
Q

ease of management of UC

A

Straightforward to manage

  • Easy access
  • Take away colon = remove symptoms as only site effected

Bottom up (limited disease)

23
Q

ulcerative colitis symptoms (3)

A

Diarrhoea
Abdominal pain
PR Bleeding

24
Q

crohn’s disease symptoms

A

Depend on site effected
– Tend not to be painful but mouth can be

Colonic disease – same as UC

Small bowel disease

  • Pain - obstruction
  • Narrower tube so easier to block
  • Malabsorption – anal disease

Mouth

  • Change in appearance
  • Orofacial granulomatosis
  • Gingivitis
25
Q

colonic crohn’s disease symptoms

A

same as UC

Diarrhoea
Abdominal pain
PR Bleeding

26
Q

small bowel Crohn’s disease symptoms

A

Pain - obstruction

  • Narrower tube so easier to block
  • Malabsorption – anal disease
27
Q

mouth Crohn’s disease symptoms

A

Change in appearance

  • Orofacial granulomatosis
  • Gingivitis
28
Q

orofacial granulomatosis

A

Not a single condition
- Granuloma formation blocks lymphatics

Lip and oral swelling then noted from other causes increased capillary leakage

29
Q

triggers of orofacial granulomatosis

A

Food preservative and additives – benzoate/Sorbate/cinnamon
- Benefit to miss additives in some people – exclusion diet
- Responsive after 3 months then potential success
Some have no identifiable trigger

30
Q

children and orofacial granulomatosis

A

common in 6-13 year olds

can be very localised or wider issue with Crohn’s disease

  • need to investigate
  • need GA in endoscopy higher risk of perforating bowel in children

so Assess how they grow

  • normal function= grow normally
  • malabsorption will not

Younger Get OFG more likely to get Crohn’s disease

31
Q

5 clinical features of OFG

A

lip swelling

angular cheilitis
- inflamed at corners of mouth, mouth tissue sitting incorrectly

cobble stoning

ulceration

microscopic granulomas

32
Q

6 investigation for inflammatory bowel disease

A

Inflammatory process happening in body raised in Crohn’s

Blood tests
- Anaemia, CRP (c reactive protein), ESR

Faecal Calprotectin

Endoscopy

Leukocyte Scan

Barium Studies

Bullet Endoscopy

33
Q

bullet endoscopy for IBD investigations

A
  • Swallow capsule
  • Photo inside bowel
  • Send to radio by receiver
  • Picture whole bowel
    But if miss area of interest cannot retake as works its way out
34
Q

faecal calprotein for IBD investigation

A
  • Released in inflammation
  • Bowel mucosal cells released into bowel, whether bowel is inflammed or not

If small areas of disease – not a lot produced so hard to tell

Significant area – can see higher than normal

Stool sample analysed
- Bleeding into bowel then RBC in stool

35
Q

complication of ulcertaive colitis

A

developing carcinoma

  • Risk increases with time (not as big now due to awareness and screening)
  • Depends on time rather than disease activity

Judgement as to whether Colectomy is justified

  • Attitude to risk
  • Carcinoma surveillance potential
36
Q

2 treatment pathways for IBD

A

medical treatment

surgical treatment

37
Q

medical treatments for IBD

A

immunosuppressive
- Get rid of inflammation (Suppress immune system)

Systemic Steroids(Prednisolone)

Local Steroids (rectal administered – colorectal disease) 
- Work topically on surface of bowel

Anti-inflammatory drugs

  • 5-ASA based drugs – Pentasa, mesalazine, sulphasalazine
  • topical

Non Steroid immunosuppressants

  • Azathioprine
  • Methotrexate

Anti TNFα therapy
- Infliximab, adalimumab (‘biological’ drugs)

38
Q

Anti TNFα therapy
- Infliximab, adalimumab (‘biological’ drugs)

for IBD treatment

A
  • Manufactured antibodies against specific antigens e.g. TNF α
  • Immune response for disease not generated
  • Disease better controlled (inflammation where shouldn’t be) but infection response effected
39
Q

topical medical treatments for IBD

A

Local Steroids (rectal administered – colorectal disease)

Anti-inflammatory drugs
- 5-ASA based drugs – Pentasa, mesalazine, sulphasalazine

40
Q

systemic medical treatment for IBD

A

Systemic Steroids(Prednisolone)

  • Easy treatment but can cause problem in patients (children stop growing)
  • Pass straight through
41
Q

oral issues for IBD

A

Oral lesion in Crohn’s – Orofacial granulomatosis

Oral ulceration
- ulcers worse when ulcerative colitis worse
- Worse by low iron, b12 or folic acid
- Inflamed bowel traumatised by food - bleed, lower store and malabsorption in small bowel of iron or folic acid or surgical removal of part of small bowel so less able to absorb
- Not able to absorb enough nutrient to maintain life
Haematinic deficiency caused by malabsorption or intestinal bleeding
- B12 deficient - ileocecal area effected commonly in crohn’s, site of absorption so get pernicious anaemia

42
Q

what can make oral ulcers worse

A

Worse by low iron, b12 or folic acid

  • Inflamed bowel traumatised by food - bleed, lower store and malabsorption in small bowel of iron or folic acid or surgical removal of part of small bowel so less able to absorb
  • Not able to absorb enough nutrient to maintain life
  • ulcers worse when ulcerative colitis worse

BDS2 BAMS (54 decks)

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