Crohn's & UC Flashcards
What is the cytokine profile of Crohn’s?
Th-1, IFN-gamma
What is the cytokine profile of ulcerative colitis?
Th-2, IL5 IL13
In which disease might you find a right iliac fossa mass?
Crohn’s
What is the definition of Crohn’s?
Chronic inflammatory and ulcerating condition of the GI tract that can affect anywhere from the mouth to the anus
Where does Crohn’s most commonly affect?
Most common in the terminal ileum and colon
What might Crohn’s disease present with?
Abdominal pain Small bowel obstruction Diarrhoea Bleeding PR Anaemia Weight loss
Which disease is characterised by chronic transmural inflammation?
Crohn’s
How is the diagnosis of inflammatory bowel disease made?
Endoscopy and mucosal biopsy
Which disease IBD is characterised by skip legions?
Crohn’s
Which IBD is characterised by granulomatous inflammation?
Crohn’s
What do the ulcers of Crohn’s disease typically look like?
Knife-life, fissuring ulcers
What are some of the complications of Crohn’s disease?
Perforation Stricture Malabsorption Fistula Anal disease Bowel obstruction Malignancy
What is the characteristic appearance of the mucosal remodelling due to fissuring ulcers?
Cobblestoning
Where in the colon does ulcerative colitis affect?
The rectum, extends proximally
What are some of the symptoms of ulcerative colitis?
Diarrhoea + bleeding Increased bowel frequency Urgency Tenesmus Incontinence Night rising Lower abdo pain (esp. LIF)
What is the Truelove and Witt criteria for severe ulcerative colitis?
>6 bloody stools/24 hour \+ 1 or more of Fever (>37.8°C) Tachycardia (>90/min) Anaemia (Haemoglobin 30mm/hr)
Other than the abdomen and anus, where might other signs of IBD manifest?
Skin, joints, eyes
What is the definition of toxic megacolon when assessing on a plain AXR?
Dilatation of colon:
Transverse > 5.5cm
Caecum > 9cm
What changes occur in the intestinal mucosa in ulcerative colitis?
Crypt distortion and abscess formation
Absence of goblet cells
What is the aberrant immune response in Crohn’s?
Persistent activation of T-cells and macrophages (failure to switch off)
Excess proinflammatory cytokine production
Which two layers is ulcerative colitis confined to?
Mucosa and submucosa
Which IBD is primary sclerosing cholangitis associated with?
UC > Crohn’s
What are some examples of peri-anal disease associated with Crohn’s?
Recurrent abscess formation
Pain
Can lead to fistula with persistent leakage
Damaged sphincters
What do the ulcers of ulcerative colitis look like?
Limited to submucosa
Wide/broad based
Superficial horizontal undermining ulcer
Which IBD is development of colorectal cancer associated with and why?
UC
Chronic inflammation leads to epithelial dysplasia and then carcinoma
What are some of the complications of UC?
Blood loss
Electrolyte disturbance (hypokalaemia)
Colorectal cancer
Anal fissure
Which disease might treatment with 5ASA (mesalazine) be useful in?
Ulcerative colitis
What is the mechanism of action of 5ASA?
Topical effect
Anti-inflammatory properties
Reduces risk of colon cancer
What are some of the side effects of 5ASA?
Diarrhoea
Idiosyncratic nephritis
Which steroids might be used to treat IBD?
Prednisolone
Budesonide
What are some of the side effects of steroid use?
Weight gain Diabetes Hypertension Neuropsychiatric Cataracts Growth failure Osteoporosis Acne Thinning of skin
When is immunosuppression therapy considered?
When more potent suppression of inflammation required
What are some of the side effects of immunosuppression with azothiaprine?
Pancreatitis
Leucopaenia
Hepatitis
Small risk of lymphoma, skin cancer
How long does azothiaprine take to have effect?
16 weeks
What is the mechanism of anti-TNF therapy?
Promotes apoptosis of activated T lymphocytes
When, according to NICE guidelines, is anti-TNF therapy indicated in Crohn’s disease?
As part of long term strategy, including immune suppression, surgery, supportive therapy
In fistulating disease
What is the danger in resection of small bowel to treat Crohn’s?
It is not curative
May result in “short-gut” syndrome which requires life long parenteral nutrition
What surgical options are there for ulcerative colitis?
Permanent ileostomy
or
Restorative proctocoloectomy and pouch
