IBD Flashcards
What affects only the colon, UC or CD
UC
What develops in patches, UC or Crohn’s disease
Crohns
For patients who have features of both, what are they classed as x
IBD-U
What is microscopic colitis
Inflammation that can only be seen under microscope
What are the two forms of microscopic colitis
Collagenous: thickening of subepithelial collegen band
Lymphocytic colitis
How does microscopic colitis present
Chronic, non bloody, watery diarrhoea with no macroscopic abnormalities
What is associated with microscopic colitis
Autoimmune disease, rheumatoid, thyroid, coeliac
What are risk factors for IBD
Smoking Stoping smoking in UC Young Asian men coming west Genetics: snp (nod2) Heritiary
Describe the microbial communities in IBD
Dysbiosis
Increase in actionbacteria, proteobscteria and decrease in bacteroides species
Describe clinical profile of someone with UC
Peak 20-40
Makes = females
Bloody diarrhoea, abdominal pain, Weight loss and fatigue
In UC where does Procitis Procitisigmoidtisi Left side colitis Extensive Pancolitis Effect
Procolitis effects rectum only Rectum to sigmoid Left sided up to splenic flexure Extensive up to hepatic flexure Pancolitis whole colon
For proctitis what has to be check to make sure it is IBD
STI, Chlymydia and ghonorea
In someone suffering from UC procolitis what symptoms may they experience
Frequency and urgency to go
Small volume mucous and blood
Constipation
Responds to topical therapy
How is UC severity, what score is used
True love and witts
What are the categories in true love and witts criteria
Mi,d
Moderate
Sever
Fulminant
If I have 10 stools a day +bleeding , toxicity is this sever or fulminant
Fuliminant
In UC what investigations are conducted
Bloods - CRP increase, albumin decrease
Stool culture to rule out infection
Faecal calprotectin
Colonoscopy
What is considered a normal level of faecal calprotectin in the stool
0-50 normal
59-200 equivocal
>200 elevates
What is faecal calprotectin a measure of
Any inflammation in the gut, not just UC or Cd
What is the name of the poo chart
Bristol
In acute sever colitis, how is it treated in first 24 hours
4 stools for C diff Blood tests Stool chart Avoid specific drugs, NSAIDs, opiates,anti-diarrhoea’s IV conticosterioids, methyl pred twice daly IV hydration Lmwh Axr for toxic diliation
What are complications of crohns
Inflammation
Stricture
Fistula
In symptoms with Crohn’s disease what do symptoms depend on
Where in GI is it occurring
What are the investigations for cd
Same as UC
+ small bowel mri
Only occasionally do you do CT to rule out abscess
Histologically what is the diff betweeen CD and UC
Cd causes granulomatous, transmural
UC limited to muscosa, globet cells lost, crypt abscesses
What are the complications of CD
Inflammation
Stricture
Fistula
Abscess
What symptoms does perianal CD cause
Pain in anus
Inability to sit
Plus
What is the investigations used for someone with perianal Crohn’s disease
MRI of pelvis
Examination under anasthetic
What treatment is given to someone with perianal Crohn’s disease
Surgery to drain abbesses and seton stitch
Medical antibiotics and biological therapy
What are the extra intestinal manifestations of IBD
Mouth ulcers Skin rashes Musculoskeletal Eyes Primary sclerosing cholangitis
What factors determine risk to carinoma from IBD
Extent
Duration.
When is someone first colitis survaliienced
10 years
What is 1 st line treatment for both during and induction of remission
5-ASA
ONLY in UC mile - moderat
No more than 3 g per day orally or suppository in rectal disease
What is second line of tresatment
Prednisolone (40mg per day) tapering it down with calcium and vit D to reduce side effect of bone density
Budesonide which though less effective, less side effects
INDUCE REMISION IN BOH UC AND CROHNS
What is the 3rd line of treatment
Immunomodulation in both UC and crohns
Azathioptine/ 6 MP: requires monitoring of blood due to hepatoxicity, pancreatitis, lymphoma risk and skin cancer, 28% intolerant
Methotrexate : crohns only, is teratogenic
What is the 4th line of treatment
Monoclonal antibodies
See slide
What has been found to be equally effective as steroids
Elemental feeding
Though hard to comply, for children
In someone acutely I’ll, what is the surgery called
Subtotal colectomy, leaving only recital remaining
After someone who has had subtotal colectmy what are their two options regarding the rectum
Pouch
Removal
Can someone with CD get a pouch
No only UC
