GI - Inflammatory Bowel Disease

Question 1

Definition

Answer 1

Umbrella term for two main diseases which cause inflammation of the GI tract
- ulcerative colitis
- Crohn’s disease
Both involve inflammation of the walls of the GI tract and are associated with periods of remission and exacerbation

Question 2

Crohns features

Answer 2

N - no blood or mucus
E - entire GI tract
S - skip lesions on endoscopy
T - terminal ileum most affected and Transmural inflammation
S - smoking = risk factor

Crohns is also associates with weight loss, strictures and fistulas

Question 3

UC features

Answer 3

C - continuous inflammation
L - limited to colon and rectum
O - only superficial mucosa affected
S - smoking is protective
E - excrete blood and mucus
U - use aminosalicylates
P - primary sclerosing cholangitis

Question 4

Signs and symptoms

Answer 4

Profuse diarrhoea
Abdominal pain
Bleeding
Weight loss
Anaemia

May be systemically unwell during flares with:
- fever
- malaise
- dehydration

Question 5

Extra intestinal manifestations

Answer 5

Finger clubbing
Erythema nodosum
Pyoderma gangrenosum
Episcleritis and iritis
Inflammatory arthritis
Primary sclerosing cholangitis (UC)

Question 6

Diagnosis

Answer 6

FIRST LINE = Faecal caprotectin (90% sensitive + specific to IBD in adults)
FBC - anaemia, infection, thyroid + liver function
CRP + ESR
GOLD STANDARD = Endoscopy + biopsy
Imaging = USS, CT, MRI can be used to visualise fistulas, abscesses and strictures

Question 7

Management Crohns

Answer 7

Inducing remission
FIRST LINE: steroids e.g. oral prednisolone or IV hydrocortisone
Consider immunosuppressant medication:
- Azathioprine or Mercaptopurine if 2+ exacerbations in 12 month period or glucocorticoids cannot be tapered
- Infliximab = SEVEREA
- Adalimumab

Maintaining remission
- FIRST LINE = AZATHIOPRINE
- Mercatopurine
- Second line = Methotrexate. Infliximab
- Adalimumab

When the disease only affects the distal ileum, it is possible to surgically resect this area to prevent further flares.
Surgery can also be used to treat strictures and fistulas secondary to Crohn’s disease

Question 8

Management of UC

Answer 8

Mild/Moderate:
- FIRST LINE = AMINOSALICYLATE = MESALAZINE
- Second line = Corticosteroids = prednisolone
Severe disease:
- FIRST LINE = IV corticosteroids = hydrocortisone
- second line = IV ciclosporin

Maintaining remission:
- AMINOSALICYLATE e.g. mesalazine oral or rectal
- Azathioprine
- Mercaptopurine

Surgery
- UC usually only affects the colon and rectum therefore removing them (panprotocolectomy) will remove the disease. Patient left with permenant ileostomy or ileo-anal anastomosis (J-pouch)