IBD Flashcards
Inflammatory bowel disease is
an umbrella term for two main diseases causing inflammation of the GI tract: Ulcerative Colitis and Crohn’s disease. They both involve inflammation of the walls of the GI tract and are associated with periods of remission and exacerbation
Crohn’s disease features (NESTS)
N - No blood or mucus
E - Entire GI tract
S - Skip lesions on endoscopy
T - Terminal ileum most affected and Transmural inflammation
S - Smoking is a risk factor
Crohn’s is also associated with weight loss, strictures and fistulas.
Ulcerative Colitis (CLOSEUP)
C - Continuous inflammation
L - Limited to the colon and the rectum
O - Only the superficial mucosa is affected
S - Smoking is protective
E - Excrete blood and mucus
U- Use aminosalicylates
P - Primary Sclerosing Cholangitis (associated with)
Presentation and clinical features of IBD (FAILSAFA)
F - Fever
A - Abdominal pain
I - Involuntary weight loss
L - Loss of appetite
S - Stools are bloody and mucoid
A - Abdominal tenderness
F - Fatigue
A - Anemia
Diagnosis gold standard
Endoscopy (OGD and Colonoscopy) with biopsy is diagnostic
Routine bloods for diagnosis
anaemia, infection, kidney and liver function
Diagnosis of stool sample is called
Faecal calprotectin is related to the intestines when inflamed - useful screening test and >90% sensitive and specific to IBD in adults
What should you check for inflammation levels and active disease
CRP
What also is used in the diagnosis to look for secondary complications
Imaging with ultrasound, CT, and MRI can be used to look for fistulas, abscesses and strictures
Crohns management NICE guidelines (May 2016)
First line: Steroids (prednisolone or IV hydrocortisone)
If steroids don’t work in Crohn’s as first-line treatment, what else can you use?
Immunosuppressant medication:
Azathioprine
Mercaptopurine
Methotrexate
Infliximab
What about maintaining remission in Crohn’s
No meds are ok OR
Azathioprine
Mecatopurine
Is surgery a treatment option for Crohn’s
Only when the disease affects the distal ileum it is possible to surgically resect this area and prevent further flareups.
However, Crohn’s usually affects the Entire GI tract thus making surgery only an option to treat strictures and fistulas, secondary to Crohn’s
Management of Ulcerative Colitis NICE Guidelines (June 2013)
Inducing remission: Mild to mod
First line: aminosalicylate
Second line: corticosteroids (prednisolone)
Severe disease:
First line: IV corticosteroids (hydrocortisone)
Second line: IV ciclosporin
What about maintaining remission in Ulcerative colitis
Aminosalicylate (oral or rectal mesalazine)
Surgery options for treating ulcerative colitis
Surgery is an option for UC as it only affects the colon and the rectum, thus removing these two areas in a panproctocolectomy will remove the disease
What is the surgery called that removes the disease in UC patients
panproctocolectomy
After a panproctocolectomy the patient is left with what
either an ileostomy or a J-pouch. This is where the ileum is folded back in itself and fashioned into a larger pouch that functions like a rectum.
J pouch is attached to the anus and collects stools prior to the person passing the motion
Prevalence of IBD
1 in 123 people
Aetiology of IBD
Exact cause unknown
Genetic components
Weekend immune system
