IBD Flashcards
Features of Crohn’s?
Crows NESTS:
N - no blood or mucus (possible, less commong)
E - entire GI tract
S - skip lesions
T - transmural inflammation + terminal ileum most affected
S - smoking = risk factor
Features of UC?
U-C-CLOSE UP C - continuous inflammation L - limited to colon + rectum O - only superficial mucosa affected S - smoking = protective E - excrete blood and mucus U - use aminosalicylates P - primary sclerosing cholangitis
What is IBD?
An umbrella term that refers to chronic, relapsing-remitting inflammation of the GI tract (Crohns entire, UC limited)
Presentation?
- Diarrrhoea
- Abdo pain
- Passing blood/mucus
- weight loss
Clinical features specific to Crohn’s
Aphthous ulcers
Clubbing
Possible RIF mass/tender
Perianal tags, fistula, abscess
2 dermatological features of Crohn’s and UC?
(1) Erythema nodosum (shins)
2) Pyoderma gangrenosum (well-defined ulcer, purple edge
Ocular manifestations of Crohns and UC?
(1) anterior uveitis (painful, red eye w/ blurred vision + photophobia)
(2) episcleritis (painful, red eye)
Are gallstones more common in Crohn’s or UC?
Crohns
Useful screening test?
Faecal calprotectin
Diagnostic test?
Endoscopy (OGD + colonoscopy) w/ biopsy
What is shown on biopsy if Crohns?
(1) Skip lesions (inflammation) / cobblestone mucosa (ulceration)
(2) Transmural inflammation (rose-thorn ulcer)
(3) Granuloma (non-caesating)
First line management to induce remission for Crohn’s?
Steroids = oral prednisolone OR IV hydrocortisone
If steroids don’t enter Crohn’s patient into remission, what else can be offered?
Immunosuppression:
- Azathioprine (first)
- Mercaptopurine
- Methotrexate
Biologics (if dont respond):
- Infliximab
- Adalimumab
First line management to maintain remission for Crohns?
Either:
(1) Azathioprine
(2) Mercaptopurine
Alternatives for remission (Crohns)?
(1) Methotrexate
(2) Infliximab
(3) Adalimumab
When might you consider surgery for Crohn’s?
If only affecting terminal ileum (unlikely, non-curative)
Management of peri-anal abscess?
(1) IV antibiotics (ceftriazone + metronidazole)
(2) Incision + drainage under anaesthesia
Management of a high peri-anal fistula (trans-sphincteric)?
Drainage seton
Management of a low peri-anal fistula (submucosal)?
Fistulotomy
Symptoms suggestive of UC?
Diarrhoea containing blood/mucus
Tenesmus, urgency
Pain in LIF
Bloods for Crohns and UC?
Routine + CRP:
FBC - anaemia, raised WCC
ESR/CRP - raised
LFTs - low albumin
Biopsy result of UC?
(1) Loss of goblet cells,
(2) crypt abscess
(3) inflammatory cells (lymphocytes)
First line management to induce remission for UC:
a) mild-moderate disease
b) severe disease
a) aminosalicylate (mesalazine) - offer topical then oral if no improvement after 4 weeks
b) IV hydrocortisone
2nd line management to induce remission for UC:
a) mild-moderate disease
b) severe
a) add oral prednisolone
b) add IV cyclosporin (after 72hrs)
Medications to maintain remission in UC?
(1) Aminosalicylate (mesalazine)
(2) azathioprine
(3) mercaptopurine
Long-term complications of UC?
(1) colorectal cancer –> colonscopy surveillance
(2) PSC –> monitor LFTs yearly
(3) strictures + pseudopolyps
Most common site affected by UC?
rectum
Indications of severe UC (Truelove-Witt index)?
- stools >6x day
- tachycardiac HR>90
- febrile T>37.5
- anaemic Hb<105 w/ raised CRP >30
If a patient comes in with an acute flare-up, what investigation might you perform?
Abdo X-Ray –> toxic megacolon (passmed)
If mild-moderate UC flare, what would you give if UC extends past left-side colon?
Oral AND rectal mesalazine
When would you give a UC patient oral azathioprine or mercaptopurine for maintenance?
If 2 or more exacerbations in the past year
Appropriate management step of Crohn’s patient taking azathioprine presents with a sore throat? (OR for RA, recent chemotherapy, acute leukaemia)?
Urgent FBC - neutropenia?
