Gastro - IBD Flashcards
How do you differentiate between Crohn’s and UC?
NESTS
N- No blood or mucus
E- Entire GI tract
S- Skip lesions
T- Terminal ileum most affect and transmural inflammation
S- Smoking is a risk factor
Also associated with strictures and fistulas
How is UC differentiated from Crohn’s?
You see (UC) CLOSEUP
C- Continuous inflammation
L- Limited to colon and rectum
O- Only superficial mucosa
S- Smoking may be protective, less common in smokers
E- Excrete blood and mucus
U- Use aminosalicylates
P- Primary sclerosing cholangitis
What are the extra-intestinal manifestations of IBD?
Erythema nodosum
Pyoderma gangrenosum
Enteropathic arthritis
Primary sclerosing cholangitis
Red eye conditions (episcleritis, scleritis, anterior uveitis)
What are the general presenting features of IBD?
Diarrhoea
Abdominal pain
Rectal bleeding
Fatigue
Weight loss
What investigations are done for IBD?
Bloods
- FBC
- CRP
- U&Es
- LFTs
- TFTs
- Anti-TTG antibodies
Stool microscopy and culture
Faecal calprotectin
90% sensitive and specific for IBD, initial test before endoscopy
Endoscopy
(OGD and colonoscopy)
With multiple intestinal biopsies
CT and MRI
Fistulas, abscesses and strictures
What is the Gold standard investigation for IBD?
Endoscopy with biopsy
What are the principles of managing IBD?
Growth and pubertal development- particularly when having steroids
Patients likely need input from a dietician
Inducing remission
Maintaining remission
How is Crohn’s managed?
Inducing remission
First line
Steroids (oral prednisolone or IV hydrocortisone )
Enteral nutrition
Second line
Addition of :
- Azathioprine
- Mercaptopurine
- Methotrexate
- Infliximab
- Adalimumab
Maintaining remission
First line
Azathioprine
Mercaptopurine
Alternatives
Methotrexate
Infliximab
Adalimumab
What are the surgical managements for Crohn’s?
Resecting distal ileum
Treating strictures
Treating fistulas
How is UC managed?
Mild to moderate
First line
Oral or rectal mesalazine
Second line
Oral or rectal prednisolone
Severe
IV hydrocortisone (first line)
IV ciclosporin (second line)
Surgery
Maintaining remission
Aminosalicylate (oral or rectal mesalazine) first line
Azathioprine
Mercaptopurine
How is UC managed surgically?
Panproctocolectomy
Patient has permanent ileostomy or ileo-anal anastomosis (J-pouch)
What is a J-pouch?
Ileum folded back on itself and makes a larger pouch
Attached to anus and functions like a rectum, collecting stools before bowel opening
What is enteral nutrition?
Liquid diet given orally or by NG
- Treats nutritional deficiencies
- Improves gut microbiome
- Removes inflammatory foods
