IBD Flashcards
What is IBD?
A term for two conditions that are characterised by chronic inflammation of the GI
bowels/ tract.
- The two conditions are Crohn’s disease and ulcerative colitis
What is Crohn’s disease?
An inflammatory bowel disease that causes chronic inflammation of the GI tract. Most inflammation is common in the distal ileum and proximal part of the colon.
What is Crohn’s disease characterised by?
Transmural – all layers of the bowel wall be inflamed including oesophagus all the way to the anus
- Focal
- Asymmetrical
- Occasional granulomatous inflammation – inflammation of macrophages called granulomas
Outline the epidemiology of Crohn’s disease including the risk factors, age of onset, and
ratio in females: males.
Risk factors
- smoking
- family history
- appendectomy
- NSAIDs
Age of onset
- 15-30
- 60-80
More common in females 2:1 and reverse in children
When are you more likely to develop Crohn’s disease?
Around ones 30s
What are the symptoms of Crohn’s disease?
Diarrohea but not bloody diarrohea as that is associat with UC
Abdominal pain, cramping,
Anaemia
Fever
Gastrointestinal bleeding
Joint pain
Vomiting
Stomach ulcers
Weight loss
Malabsorption which leads to nutrient deficiency
What investigations can we carry out for Crohn’s disease? what markers indicate Crohn’s
disease? and what marker indicates UC?
Blood test
- FBC, LFT, Urea and Electrolytes, CRP
Stool cultures, biopsies, and microscopy
Faecal calprotectin
MARKERS: ASCA for CD and p-ANCA for UC
ASCA and p-ANCA are produced because of the disease. ASCA prevents breakdown of yeast.
Imagining : X-ray of abdomen and colonoscopy
Upper GI symptoms: upper GI endoscopy
Lower GI symptoms: flexible sigmoidoscopy
What are the complications of Crohn’s disease?
Inflammatory cytokines that are steroid resistant which go on to cause stenosis and fistulas.
Stenosis causes narrowing of the ileum of the gut.
Scar tissue can lead to the narrowing of the ileum of the bowel. it will be harder for food to pass the blockage which will cause severe pain for the patient. Surgery will therefore be needed.
Fistula – is an abnormal connection or passageway that connects two organs or vessels that do not usually connect. They can develop anywhere between an intestine and the skin, between the vagina and the rectum, and other places. The most common location for a fistula is around the anus.
Does surgery prevent the recurrence of Crohn’s disease?
No 90% of patients have recurrence within 6 years of surgery
Patients become steroid dependent
What is ulcerative colitis (UC)?
An inflammatory bowel disease that only affects the large intestine and the rectum is always involved
What are the three classifications of UC?
Proctitis – just the lining of the rectum
Left sided colitis – Inflammation extends from the rectum up through the distal colon
Pancolitis - inflammation of the entire colon
Outline the epidemiology of UC including the risk factors, age of onset, and ratio in females: males
risk of UC is decreased in smokers
causes are idiopathic but often said to be triggered by colonic bacteria
common in 15-25 years old
What are the symptoms of UC?
bloody diarrhoea
tenesmus
fever
weight loss
abdominal pain
What is tenesmus?
Tenesmus is the feeling that you need to pass stools, even though your bowels are already empty. It
may involve straining, pain, and cramping
What are the signs and symptoms of toxic megacolon? And why is toxic megacolon a major
concern?
pale, dehydrated
abdominal pain + tenderness+ distension = toxic megacolon
worrying signs include
anaemia, fever, tachycardia
A toxic megacolon is rare, but life-threatening. It is a complication of severe colon disease or infection. Toxic megacolon can be deadly because it puts you at risk for infection throughout the body, shock, and dehydration.
How do we investigate UC disease?
Blood test
- FBC, LFT, Urea and Electrolytes, CRP
Stool cultures, biopsies, and microscopy
Faecal calprotectin
MARKERS: ASCA for CD and p-ANCA for UC
ASCA and p-ANCA are produced because of the disease. ASCA prevents breakdown of yeast.
Imagining : X-ray of abdomen and colonoscopy
Upper GI symptoms: upper GI endoscopy
Lower GI symptoms: flexible sigmoidoscopy
What are the triggers for IBD?
infections
-diet
-antibiotics
-smoking
-stress
-NSAIDS
What are the causes of IBD?
The exact cause of IBD is unknown, but IBD is the result of a weakened immune system and genetics (although the how is unknown). Possible causes are:
The immune system responds incorrectly to environmental triggers, such as a virus or bacteria, which causes inflammation of the gastrointestinal tract .
A lack of anti-inflammatory mediators and an over production of pro-inflammatory cytokines.
What are the aims of treatment for UC?
Reduce inflammation
Suppress inflammatory response
Keep patients in remission to avoid surgery
A patient has been appointed a step-up approach for UC. What would be the first line of treatment? What would be the first option if it was a step-down approach?
Step-up
- Aminosalicylate
- Corticosteroid
-Surgery
STEP DOWN
- surgery
then drugs
What are the drug treatments for UC?
Amino salicylates – sulfazaline, mesalazine, olsalazine
As sulfasalazine has side effects 5-ASA can be taken on its own as mesalazine. However, mesalazine cannot be taken orally.
Corticosteroids – prednisolone and budesonide
Immunosuppressants – Methotrexate, ciclosporin, Azathioprine, Mercaptopurine
What is the role of corticosteroids in IBD and what side effects can this cause?
Induce remission in IBD patients
Osteoporosis
occular
metabolic (diabetes)
immunogenic
failure to thrive
muscoskeletal
Prolonged steroid use can cause symptoms such as Cushing syndrome.
What are the drug properties of each amino salicylate?
What are the side effects of Amino salicylates?
GI discomfort, cough, dizziness, diarrhoea, skin reactions, leukopenia (low white blood cells)
What is the role of immunosuppressant drug?
Steroid sparing drugs
inducers or remission,
used to maintain remission
good side effect profile
What patients cannot receive azathioprine and why?
Patients with Thiopurine S-methyltransferase (TPMT) deficiency - condition characterized by significantly reduced activity of an enzyme that helps the body process drugs called thiopurines. This can result in 6-MP toxicity if given.
Azathioprine can be broken down to 6 mercaptopurine which can then go on to form 6 thioguanine nucleotides which is an inactive state that can cause severe side effects of myelosuppression. If you have low levels of TPMT (TPMT deficiency) then more of the drug will form into the inactive state causing myelosuppression, making the medicine useless and causing severe side effects in patients.
What other drugs help IBD?
Infliximab
What are the side effects of infliximab?
Block immune responses leaving a patient susceptible to infections
infusion reaction
hypersensitivity reaction
headaches
infections
invokes latent TB
malignancy
intestinal stenosis
How can Crohn’s disease be managed (medication steps)?
First presentation
Give corticosteroids - prednisolone, iv hydrocortisone
can use budesonide
then 5-ASA if patient is contraindicated to corticosteroid
add azathioprine if multiple inflammatory exacerbations in 12 months period
use infliximab if patient is unresponsive to above treatment
Maintain remision
azathioprine as monotherapy
immunosuppressant - methotrexate
surgery (if benefits outweigh the risk)
How can ulcerative colitis be managed (medication steps)?
Mild UC
topical aminsalycilate
add oral aminosalicylate
add corticosteroid
Moderate - left sided colitis
high dose oral amino salicylate
add topical
if contraindicated use prednisolone
Severe
IV hydrocortisone
surgery
ciclosporin
infliximab for acute exacerbations
What are the complications of IBD?
Growth defects
Osteoporosis
