GI Flashcards
What is IBD
Inflammatory Bowel Disease, defines Crohn’s disease and Ulcerative Colitis (UC)
What are the features of crohns
N - no mucus or blood E - entire GI tract S- skip lesions T - terminal ileum most affected T - transmural (full thickness) inflammation S - smoking is a risk factor
what are the potential risk factors for Crohns disease
- smoking
- genetic
- recurrent URTIs
- NSAIDs
Presenting symptoms for Crohns
- diarrhoea
- abdominal pain
- passing blood
- weight loss
- malaise
- anorexia
- fever
what are the extra-intestinal manifestations of crohns
- Clubbing, erythema nodosum, pyoderma gangrenosum.
- Conjunctivitis, episcleritis, iritis.
- Large joint arthritis, sacroiliitis, ankylosing spondylitis.
- Fatty liver, primary sclerosing cholangitis (rare), cholangiocarcinoma (rare).
- Granulomata may occur in the skin, epiglottis, mouth, vocal cords, liver, nodes, mesentery, peritoneum, bones, joints, muscle or kidney.
- Renal stones.
- Osteomalacia.
- Malnutrition.
- Amyloidosis
How does crohns typically present
periods of acute exasperation followed by periods or remission or less severe disease
what initial Ix would be done for Crohns
- FBC
- CRP
- U&Es
- LFTs
- stool culture and microscopy
- faecal calprotectin
what can the CRP Ix show in Crohns
useful to determine a pts risk of relapse (High CRP is indicative of active disease or bacterial complication)
what further Ix can be done to diagnose Crohns
- endoscopy with biopsy
what are the possible complications of Crohns disease
- fistulas
- strictures
- abscesses
What Ix are done to look for the complications of Crohns disease
- CT/MRI
- US
What are the differential diagnosis’ for Crohns
- Infectious gastroenteritis.
- Tuberculosis.
- Ulcerative colitis.
- Actinomycosis.
- Carcinoid.
- Amyloidosis.
- Intestinal lymphoma.
- Behçet’s disease.
- Bowel carcinoma.
- Ischaemic colitis.
- Radiation or drug-induced colitis (eg, NSAIDs).
- Diverticulitis.
- Coeliac disease.
- Irritable bowel syndrome[11].
- Acute ileitis may mimic acute appendicitis.
what staging system is used to assess the severity of Crohns
Crohn’s Disease Activity Index (CDAI)
What condition is it essential to rule out if the faecal calprotectin comes back positive in pts >50yrs
colorectal adenoma or colorectal carcinoma
when should you consider admission for a pt with crohns
- severe abdo pain
- severe diarrhoea
- bowel obstruction
- pt is systemically unwell
What is the typical tx used to induce a remission in Crohns
mono-therapy with a glucocorticosteriod
name a glucocorticosteriod
- prednisolone
- methylprednisolone
- intravenous hydrocortisone
what alternative can be given to induce remission in Crohns if glucocorticosteriods are contra-indicated
budesonide
when are glucocorticosteroid contraindicated
- hypersensitivity
- live/live-attenuated vaccines (if using immunosuppressive dosages)
- systemic fungal infection
- osteoporosis
- DM/uncontrolled hyperglycaemia
- adrenocortical atrophy
- Cushings syndrome
What is budesonide
corticosteriod
when would you consider add-on tx in Crohns
- 2 or more exacerbation’s in 12mths
- glucocorticosteriod dose can’t be tapered
what medication would you add on to tx when inducing a remission of Crohns
- azathioprine
- mercaptopurine
- methotrexate
- Infliximab
- Adalimumab
Why are Infliximab and Adalimumab used in the tx in Crohns
they block the action of the cytokine tumour necrosis factor alpha (TNF-α), which mediates inflammation in Crohn’s disease
when are Infliximab and Adalimumab recommended in the tx of Crohns
- severe active disease that has not responded to conventional therapy
- when conventional tx cannot be used due to contra-indications/intolerance
