GI flashcards
describe the changes in the gut wall in crohn’s
transmural granulamatous inflamm
PATCHY BUT ALL THE WAY THROUGH THE WALL
GRANULOMATOUS (non-caseating)
skip lesions
where can crohn’s changes be found?
and where in particular..
anywhere in the gut (mouth to anus)
esp terminal ileum + prox colon
describe typical presenting Sx of Crohn’s
- diarrhoea urgency (get up at 5am - go 5/6 times in the next 40mins) abdo pain wt loss failure to thrive 'fine one minute - deathly the next' fever / malaise / anorexia
describe some complications of crohn’s
Bowel: SBO / perforation / malabsorption (esp terminal ileum - b12). / abcess formation / fistulae / colon Ca
Anal - fissures / fistulae
Systemic - fatty liver / osteomalacia
what blood tests would you request in a suspected crohn’s pt?
FBC - anaemia (could be anaemia of chronic disease / iron def / folate def..) - raised WCC/ raised platelets
Raised ESR
Raised CRP
negative pANCA
name 1 eye, 1 joint, 1 skin and 1 hepatic manifestation of IBD
eye - uveitis / episcleritis
joint - enteropathic athritis / spondyloarthropathies
describe the features of IBD-associated enteropathic arthritis and it’s management
10-15% of patients with IBD ASx arthritis predominantly affecting lower limb joints HLA-B27 spondyltiis often also occurs JOINT SX MAYBE PREDATE BOWEL SX Mx: sulfasalazine ?steroids? TNF-a Infliximab
describe where UC can be found in the gut
Ulcerative colitis can affect the rectum alone (proctitis), can extend proximally to involve the sigmoid and descending colon (left-sided colitis), or may involve the whole colon (extensive colitis)
descibe the microscopic changes in crohn’s
transmural inflammation
increase in chronic inflamm cells
lymphoid hyperplasia
granulomas
decribe the microscopic changes in UC
inflammation in lamina propria
crypt abcesses
goblet cell depletion
describe the macroscopic chnages in Crohn’s
involved bowel thickened + narrowed
cobblestone appearance - deep fissures
apthoid ulceration - early stage
describe the macroscopic changes seen in UC
reddened inflamed mucosa bleeds easily (friable..)
what tests other than bloods would you request in suspected Crohn’s?
Stool (ESSENTIAL IF DIARRHOEA) - culture including C diff assay
Faecal calprotectin will be raised in active colonic disease (released from intestine whenever there’s inflammation..)
**Ileocolonscopy + biopsy
Small bowel imaging - eg barium follow through
how might you monitor disease activity in Crohns?
- faecal calprotectin
2. Hb / WCC / inflamm markers (CRAP / ESR / platelet count
outline medical management of crohn’s (think of the principles….)
- INDUCE REMISSION
- if 1st pres / single exac in 12/12 - glucocorticoid eg. IV hydrocortison / Oral Pred
- If 2nd in 12/12 - add Azathioprine. BUT FIRST - ASSESS TMPT levels
- enteral nutrition
- infliximab (anti-tnf a) - MAINTENANCE
- azathioprine / MTX / infliximab
- stop smoking
- monitor for osteopenia / porosis
PERIANAL DISEASE
- MRI + EUA
- oral Abx (cipro)
- Infliximab
when does crohn’s present..
bimodal distribution
first peak 20-30
second peak 60-70
how to distinguish between CD + UC on:
- macrocytically
- microcytically
- on barium
macro:
- CD - skip lesions / rectal sparing
- UC - continuous / non-rectal sparing
micro:
- CD - increased goblet cells, transmural inflammation
- UC - decreased goblet cells, inflammation limited to lamina propria (only mucosal disease)
on barium:
- CD - rose thorn ulcers (deep linear ulcers)
- UC - loss of haustrations / lead pipe colon
describe the primary Sx of UC
** bloody diarrheoa** episodic / chronic diarrhoea +/- blood / mucus crampy abdo discomfort bowel frequency relates to severity.. TOBUM tenesmus ooh (colicky pain) bloody diarrhoea urgency mucus
give some differential diagnoses of IBD..
GE / TB / IBS / coeliac / diverticulitis
outline the Truelove-Willis criteria for the severity of UC
Severe (>6 bowel motions / day, + large amounts of rectal bleeding + increased ESR)
Moderate (4-6 bowel motions /day - moderate amounths of blood)
Mild (<4 motions /day - low amounts of blood)
describe some RFs for UC
Fam Hx IBD / recent NSAID use
outline some complications of UC
double risk of colon Ca
Steroid Tx - osteoporosis
Opiates / antispasmodics (eg. loperamide) toxic megacolon (diameter >6cm)
venous thrombosis
Investigations for UC?
investigations: FBC - anaemia of Chronic disease U&Es LFTs - associated with PSC Faecal calprotectin (raised NB - not raised in IBD) **colonoscopy with multiple biopsies** malabsorption..?
Management of UC?
think of principles!!
INDUCING REMISSION
Mild-moderate
1. Oral mesalazine (topical if procto/sigmoiditis)
2. if no improvement in 4/52 - add oral pred
3. if no improvement in 4/52 - add oral tacrolimus
SEVERE:
1. admit + IV hydrocortisone + IV fluids
2. add IV ciclosporin
COLECTOMY IS CURATIVE - consider if toxic megacolon / > 8 stools per day
