IBD Flashcards
signs of Crohns
N-no mucus or blood (less common)
E- entire GI tract
S- skip lesions on endoscopy
T-terminal ileum most affected and transmural full thickness
S-smoking is a risk factor
(strictures, weight loss, and fistulas)
Signs of UC?
C-continuous inflammation
L-imited to colon and rectum
O- only superficial mucosa
s-smoking is protective
e- excrete blood and mucus
u- use aminosalicylates
p- primary sclerosing cholangitis
presentation of IBD?
diarrhoea, abdominal pain, passing blood weight loss
what test is specific to IBD?
faecal calprotectin
how to diagnose IBD?
endoscopy with biopsy
inducing remission for Crohns?
steroids oral prednisolone or IV hydrocortisone
if they dont work alone add maami- methotrexate azathioprine andalimumab mercaptopurine and infliximab
maintaining remission for crohns?
mecaptopurine and azathioprine,
alternative methotrexate infliximab and andalimumab
when to undergo surgery in crohns?
if only distal ileum affected or strictures, fistulas
inducing remission in UC?
first line- aminosalicylate (mesalazine)
second- corticosteroids (prednisolone)
if severe: IV corticosteroids
then IV ciclosporin
maintaining remission for UC?
aminosalicylate
azathioprine
mercaptopurine
what surgery can someone with IBD get?
panproctoclectomy- j pouch or permanent ileostomy
peak incidence of UC?
15-25 and 55-65
features of UC?
bloody diarrhoea, urgency, tenesmus, abdominal pain in lower left quadrant and extra intestinal features
when should you opt for flexible sigmoidoscopy?
if severe colitis and risk of perforation
typical findings of UC?
red raw mucosa that bleeds easily
pseudopolyps
inflammatory cell infiltrate in lamina propria
neutrophils migrate through walls of glands to form crypt abscesses
depletion of goblet cells and mucin from gland epithelium,
infrequent granulomas
What will barium enema show for UC?
loss of haustrations, superficial ulceration (pseudopolyps), if longstanding colon becomes narrow and short- drainpipe colon
extraintestinal features of IBD
arthritis (PAUCIARTICULAR AND ASSYMETRICAL)- both
erythema nodosum
episcleritis (crohns)
osteoporosis
unrelated to disease activity:
clubbing
uveitis (UC)
primary sclerosing cholangitis
pyoderma gangrenosum
arthritis polyarticular and symmetrical
what can cause UC flares?
NSAIDs antibiotics, stress and stopping smoking
Flares of UC classification?
Mild- less than 4 with/out blood. no systemic disturbance. normal ESR and CRP
Moderate- 4-6 with minimal systemic disturbance
Severe- more than 6 containing blood- systemic disturbance: fever, tachycardia, abdominal tenderness, distension or reduced bowel sounds anaemia, hypoalbuminaemia
what is treatment for severe colitis?
iv steroids first line. if contraindicated then iv ciclosporin
after severe relapse or more than 2 exacerbations in past year then you should give?
oral azathioprine and oral mercaptopurine
when does crohns present?
late adolescence or early adulthood
presentation of Crohns?
weight loss, lethargy, diarrhoea, abdominal pain, perianal disease (skin tags or ulcers
investigations of crohns
raised inflammatory markers, increased faecal calprotectin, anaemia, low vit b12 and d
what is investigation of choice for crohns?
colonoscopy
histology of crohns?
inflammation in all layers, goblet cells and granulomas
what would a small bowel enema show for crohns?
strictures: kantor’s string sign
proximal bowel dilation
rose thorn ulcers, fistulae
Cobblestone
Rose thorn ulcers
Obstruction of bowel
Hyperplasia of mesenteric lymph nodes
Narrowing of intestinal lumen
Skip lesion
when is infliximab used?
refractory disease and fistulating Crohns
what is given for perianal fistulae which are symptomatic?
metronidazole
what is used for complex fistulae?
draining seton
what are effective in maintaining closure of fistulae?
infliximab
complications of crohns
small bowel cancer, colorectal cancer, osteoporosis
