IBD Flashcards
What are the differences between ulcerative colitis crohn’s disease?
- Crohn’s affects whole of gut while UC restricted to large bowel
- Skip lesions in CD while continuous in UC
- Lesions span entire gut wall in CD vs mucosa/submucosa only in UC
- Fistula formation in CD due to above, no fistula involvement in UC
What is the aetiology of IBD?
genetic susceptibility + bacterial insult + cytokines
What is the most common symptom in CD if small bowel is affected?
abdominal pain
What is the most common symptom in CD if large bowel is affected?
bloody diarrhoea (the same symptom is observed in UC)
A patient with crohn’s disease has nutritional deficiency. Why is this?
Likely that duodenum is affected, which is the main site for absorption e.g. folate, iron
Why is it important to ask about opening bowels during the night in a GI history?
It distinguishes between functional disease e.g. IBS and organic disease e.g. IBD
Which blood markers would be deranged in IBD?
High WCC, low Hb, low albumin (absorbed from duodenum, perhaps less prominent in UC), high CRP
A patient has a month-long history of bloody diarrhoea. A sigmoidoscopy has been conducted and is found to show no pathological changes. Which diagnosis can be ruled out?
Ulcerative colitis because UC originates from the distal colon whereas CD can appear anywhere along the tract.
What is the treatment for IBD? Is the same treatment used in both UC and CD?
Same treatment strategy for both. Step-up treatment (triangle scheme). 1. First step/mild: 5-ASAs, abx 2. 2nd step/moderate: Oral corticosteroids, immunomodulators e.g. methotrexate, azathioprine, cyclosporine 3. Final step/severe: Biologics 4. Surgery (curative in UC but lifelong stoma)
A 24 year old is diagnoses with crohn’s disease. What would you be worried about given their age?
Cancer risk, therefore to avoid risk perform surgery
How can fistulas be diagnosed?
MRI
Which inflammatory marker is a useful tool in IBD?
faecal calprotectin= inflammatory marker of GI tract, raised in IBD but not IBS, and can be useful to monitor progress with treatment
Which drugs can raise faecal calprotectin levels?
NSAIDs, antidepressants, omeprazole
Fistulae is a feature of?
crohn’s
Cobblestone mucosa is a feature of?
crohn’s
Three symptoms of UC?
diarrhoea, tenesmus, abdo discomfort, blood + mucous PR
Two symptoms of crohn’s?
diarrhoea
abdo pain
weight loss
Two signs of crohn’s?
RIF mass
anal/rectal strictures
abdo tenderness
Ulcers, glossitis
Two signs of UC?
fever
tender, distended abdomen
Describe three extra-abdominal features of both UC and crohn’s
SKIN- finger clubbing, erythema nodosum, pyoderma gangrenosum
Eyes- iritis, conjunctivits, episcleritis
Joints- arthritis, ankylosing spondylitis, scaroiliitis
Two complications of UC?
toxic megacolon
bleeding
malignancy
strictures- obstruction
Two complications of crohn’s?
fistulae
strictures
abscesses
malabsorption
Investigations for UC?
bloods
stool- exclude infection
imaging- AXR, CXR, CT
ileocolonoscopy + biopsy
Describe two features of blood results in UC
FBC- low Hb, incr WCC
LFT- low albumin
CRP raised
Two drugs to treat UC?
5-ASA, prednisolon, azathioprine, infliximab
What are the investigations for crohn’s disease?
Almost identical to UC!
What is megacolon?
diameter>5.5cm or caecum >9cm
How can chronic inflammation seen in IBD be distinguished from infective colitis?
no architectural changes in infective, high plasma cell infiltration in IBD not seen in infection
What is back-wash illeitis?
severe ulcerative colitis where ileum and caecum are involved
What are the microscopic features of ulcerative colitis?
crypt architectural changes, changes restricted to mucosa and submucosa, little/no fibrosis, no granulomas
What is the treatment of ulcerative colitis?
Mesalazine/5-ASA (these are the same thing)
What is the treatment of severe relapse of ulcerative colitis?
azathiprine/6MP + steroids
What are the difference between crohn’s and UC pathology?
Broadly similar, however pattern of distribution differs. Crohn’s- patchy inflammation, transmural inflammation, and GRANULOMAS!!! (epithelioid macrophages). Distal inflammation in UC.
What is the treatment of crohn’s disease?
Azathioprine, 6-mercaptopurine, methotrexate, biologics- infliximab
Is mesalazine used in both crohn’s and UC?
only in UC!
First line treatment for inducing remission of crohns?
Glucocoticoid: IV hydrocortisone
2nd line: budesonide
3rd line: 5-ASA
First line treatment for maintaining remission of crohn’s?
azathioprine or mercaptopurine
What are three long term complications of crohn’s?
small bowel cancer
colorectal cancer
osteoporosis
