IBD Flashcards
where are UC legions found in the bowel
rectum
where does UC never extend past
ileocaecal valve
what is the peak incidence for UC
15-25 and 55-65
what are common GI symptoms of UC
bloody diarrhoea // urgency // tenesmus // left lower Q pain
what extraintestinal symptoms are common in UC only (2)
primary sclerosing cholangitis!! // uveitis
what extraintestinal symptoms are common in both UC and chrons (5)
arthritis // erythema nodosum // osteoporosis // pyoderma gangreosum // clubbing
what is the most common extraintestinal symptoms in IBD
arthritis
how is UC usually diagnosed
endoscopy/ colonscopy + biopsy
when is colonscopy in UC contraindicated and what is done instead
severe colitis incase of perforation –> flexible sigmoidoscopy
what is seen on colonscopy of UC
no inflamm beyond submucosa // pseudopolyps
what is seen on biopsy of UC
crypt absecc and low goblet cells
what is seen on barium enema of UC
loss of haustrations // pseudopolys // drainpipe colon
what classifies mild UC
<4 stools/ day and small blood
what classifies moderate UC
4-6 stools/ days // some blood
what classifies severe UC
> 6 bloody stools // systemic upset eg fever
how is remission initially achieved in mild UC (proctitis)
topical 5asa
what is 1st line mx to induce remission mild UC (proctitis)
topical 5 ASA’s (mesalazine)
if 1st line mx fails in mild UC proctitis what is offered next (2)
2nd = + oral 5ASA // 3rd = + oral or topical steroid
what what is 1st line mx to induce remission in proctosidmoiditis and left sided UC
topical 5ASA
what what is 2nd line mx to induce remission in proctosidmoiditis and left sided UC
oral 5ASA + top steroid/ ASA
what what is 3rd line mx to induce remission in proctosidmoiditis and left sided UC
stop topical treatments –> oral 5ASA and steroid
what what is 1st line mx to induce remission in extensive UC
topical 5ASA and oral 5ASA
what what is 2nd line mx to induce remission in extensive UC
stop topical –> 5ASA and steroids
what is given first line for severe colitis in UC
admission and IV steroids
what 2nd line treatment for severe colitis UC
(IV steroids) + ciclopsorin // surgery
how is remission maintained in proctitis and proctosigmoiditis (UC)
topical 5ASA +/- oral 5ASA
how is remission maintained in left sided and severe (UC)
low dose daily 5ASA
following a severe UC relapse or >2 exacerbations in a year what is given
oral azathioprine or mercaptpurine
what mx is NOT recommended in UC
methotrexate
what are common triggers of UC flares
stress // NSAIDs // abx // stopping smoking!
what are common triggers of UC flares
stress // NSAIDs // abx // stopping smoking!
what is toxic megacolon
total and non-obstrucive dilation of colon
how is toxic megacolon diagnosed
AXR –> thumbprinting
when does crohns usually present
late adolescence or early adult
what are symptoms of crohns
non specific // diarrgoea // abdo pain // perianal skin tags
what extraintestinal symtpoms are common in crohns (2)
arthritis // episcleritis
what blood tests support dx of crohns
raised CRP // raised faecal calprotectin // aneamia // low B12 and vit D
what marker correlates to crohns disease activity
CRP
which part of bowel does crohns usually affect
terminal ileum and colon but can be anywhere
what is seen on endocsopy of crohns
deep ulcers and skip legions and cobble stone
what is seen on biopsy of crohns (3)
inflamm from mucosa –> serosa // goblet cells // granulomas!!!
what is seen on enema of crohns
strictures // proximal bowel dilation // rose thorn ulcers // fistulae
why are crohns patients more prone to fistulas/ strictures and adhesions
inflammation in all layers down to serosa
1st mx to induce remission in crohns
glucocorticoids eg prednisolone (some patients use budesonide)
2nd mx to induce remission in crohns
5ASA eg mesalazine
what add on therapies can be used in crohns inducing remission
- azathioprine or mercaptopurine // methotraxate if cant have 2. infliximab
what treatment can be given in isolated perianal disease
metronidazole
what is 1st line in maintaining crohns remission
azathrioprine or mercapropurine
what activity needs to be checked before starting azathrioprine or mercapropurine
TPMT
what is 2nd line in maintaining crohns remission
methotrexate
how are perianal fistulas diagnosed in crohns
MRI
how can perianal fistulas in crohns be managed medically
- oral metro 2. infliximab
how can perianal fistulas in crohns be managed surgically
draining seton
how are perianal abscess managed in crohns
incisiion, drainage, abx
what are complications of crohns
small bowel cancer // colorectal cancer!!! // osteoporosis
in UC, how is poorly controlled/ unresponsive colitis treated surgically
sub total colectomy
in UC, how is poorly controlled/ unresponsive colitis treated surgically
sub total colectomy
what does terminal ileal crohns increase risk of
gallstones
