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Colorectal > IBD > Flashcards

IBD Flashcards

1
Q

Crohn’s disease

A

Chronic inflammatory bowel disease of the gut with distinct disease pattern of full thickness transmural inflammation, involving any portion of the GI tract

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2
Q

Ulcerative colitis

A

Chronic inflammatory condition characterized by relapsing and remitting episodes of inflammation limited to the mucosal layer of the colon and rectum

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3
Q

Macroscopic features of Crohn’s disease

A
  • Thickened bowel wall (full thickness inflammation)
  • Creeping extension of mesenteric fat over serosa
  • Inflamed/ fibrotic/ stenotic/ fistulation
  • Patchy linear ulcers with cobblestone appearance
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4
Q

Macroscopic features of Ulcerative Colitis

A
  • Involves only colon and rectum, may have backwash ileitis if involve caecum
  • Continuous mucosa and submucosal inflammation
  • Pseudopolyp formation
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5
Q

Microscopic features of Crohn’s disease

A
  • Transmural inflammation
  • Non-caseating granuloma
  • Lymphovascular granuloma
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6
Q

Microscopic features of Ulcerative Colitis

A
  • Active cryptitis and crypt abscess formation
  • Lamina propria cellular infiltrate (plasma cells, eosinophils, lymphocytes),
  • Mucin depletion, Lymphoid aggregates, Erosion or ulceration(shallow)
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7
Q

Endoscopic appearance of Crohn’s disease

A
  • Deep ulcers
  • Aphthoid ulcers
  • Swollen mucosa
  • Skip lesions
  • Transverse fissure
  • Cobblestone appearance
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8
Q

Endoscopic appearance in UC

A
  • superficial ulcers
  • mucosa erythema
  • granularity
  • continous inflammation
  • pseudopolyps
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9
Q

Montreal classification of UC (Extent of disease)

A
  • E1: ulcerative proctitis
  • E2: left side UC / distal UC (involves colon distal to splenic flexure
  • E3: pancolitis / extensive colitis (extends proximal to SF)

E = extent

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10
Q

Truelove and Witt classification of UC (severity of disease)

A
  • Number of bloody stools / day
  • Temperature
  • Heart rate
  • Hemoglobin
  • ESR
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11
Q

Management of elective presentation of UC

A
  • Multi-disciplinary approach
  • Workup up extent and severity of disease
    • Bloods
    • Colonoscopy + biopsy x 2 in at least 5 segments including ileum
    • Imaging (CT /MRI enteroclysis +/- MRI pelvis)
  • Screen for CRC, stool culture for infective causes
  • Induce and maintain remission by medical treatment
  • Surgery in refractory cases
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12
Q

Medical management of UC

A

Aim induction and maintain remission

  • 1st line: topical ASA (rectal enema/foam/suppository of Sulfasalazine/ Mesalamine)
  • 2nd line: oral ASA
  • Oral steroids can help induce remission then tail down
  • For steroid refactory:
    • Azathioprine
    • Infliximab
    • Cyclosporin A
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13
Q

Elective surgical options for UC

A
  • Restorative proctocolectomy with IPAA 1st line
  • Total colectomy + IRA or ileostomy
  • Proctocolectomy + end- ileostomy (with or without Koch pouch)
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14
Q

Restorative proctocolectomy

A

excision of entire colon and rectum with ileal pouch anal anastomosis

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15
Q

Contraindications for IPAA in UC

A
  • Crohn’s disease
  • Prior extensive small bowel disease
  • Active perineal disease
  • Anal sphincter dysfunction
  • Low rectal cancer
  • Sclerosing cholangitis (high incidence of pouchitis)
  • Young female relative CI, affects fertility
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16
Q

Indications for emergency surgery for UC

A
  • Fulminant colitis
  • Toxic megacolon
  • Bleeding
17
Q

Management for severe UC

A
  • Bowel rest
  • Parenteral nutrition
  • Broad spectrum antibiotics
  • IV steroids +/ topical steroids
  • Biologics if steroids fail (Infliximab)
18
Q

Management of fulminant UC

A
  • Bowel rest
  • Intravenous fluids
  • Broad spectrum antibiotics
  • IV and topical steroids
  • if not responsive within 3 days → biologics (Infliximab)
  • If not responsive to biologics within 3 days → colectomy
19
Q

Definition of acute severe ulcerative colitis

A
  • Bloody stool frequency >6/day +
  • Evidence of systemic toxicity from one of the following:
    • Fever
    • Tachycardia
    • Anemia
    • Elevated inflammatory markers
20
Q

Definition of fulminant ulcerative colitis

A
  • Bloody stool frequency >10 times/ day with fecal urgency +
  • Criteria for acute severe colitis
21
Q

Indication for surgery in small bowel Crohn’s disease

A
  • Complications:
    • Stenosis leading to obstructive symptoms
    • Fistulas to other organ
    • Draining intra-abdominal abscess
    • Controlling acute / chronic bleeding
    • Free perforation
  • Limited disease to terminal ileum
22
Q

Medical management for Crohn’s disease

A
  • Induction of remission
    • mild-moderate disease: oral prednisolone
      • right colon: budesonide
      • colitis: salicyclate component
      • perianal: Metronidazole 400mg TDS or Ciprofloxacin 500mg BD
    • severe
      • IV prednisolone
      • Infliximab
  • Maintenance of remission (immunomodulatory drugs)
    • Infliximab
    • Azathioprine
    • Methotrexate
23
Q

Treatment options for small bowel fibrostenotic Crohn’s disease

A
  • Resection
  • Stricturoplasty (H-M, Finney, side-side long segment stricturoplasty)
  • Endoscopic dilation

Colorectal (8 decks)

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