IBD Flashcards
what are the two major forms of IBD ?
crohn’s disease
Ulcerative colitis
what are the areas of affection for each disease ?
CD - anywhere in the GI tract , but has a tendency to affect the terminal ileum and ascending colon
UC - only the large bowel is affected
what gene increases the susceptibility of IBD ?
HLA-B27
what are the pathological features associated with CD ?
transmural
skip lesions
cobblestone appearance
backwash ileitis is specific to which type of IBD ?
Ulcerative colitis
what is an early feature seen on endoscopy of Crohn’s disease ?
aphthoid ulcerationn
what is a late feature seen in CD ?
llarger, deeper ulcers appear in patchy distribution
what are the pathological features associated with UC ?
inflammatory polyps
superficial affection
pseudo polyps and friability
what are thee microscopic changes seen in CD vs UC ?
CD - since its transmural - lymphoid hyperplasia and granulomas are present ( langhan cells )
UC- superficial inflammation , crypt abscess and goblet cell depletion
what are the extra gastrointestinal manifestations of IBD ?
joint affection ( type 1 and 2 polyarthropathy)
eyes (uveitis )
pyoderma gangrenosum and erythema nodosum
primary sclerosing cholangitis
what does fulimant colitis refer to ?
intense form of UC
what are the clinical features of CD ?
diarrhea, abdominal pain and weight loss
diarrhea usually contains blood
constitutiional symptoms
if the small bowel is affected in CD what is the C/P of that ?
steatorrhea
what often precedes small intestine symptoms in CD ?
anal and perianal diseases as well as enteric fistula
what type of anemia is seen in CD ?
normocytic normochromic anemia
what is seen on blood test of CD ?
normocytic normochromic anemia
iron and folate deficiency
raised ESR and CRP
hypoalbuminemia
what are the serological tests performed in CD ?
Anti-ASCA is usually positive
P-ANCA is negative
when should colonoscopy be performed ?
if colonic involvement is suspected except in acute severe disease
what appears on colonoscopy before cobblestone appearance in CD ?
aphthoid ulcers
what investigation is required for patients suspected to have CD ?
small bowel imagine whether CT oral contrast or MRI enteroclysis
what imaging modalities can be used to asses the thickness of the bowel wall and abscesses ?
High resolution US
Spiral CT scanning
what can be used as a non invasive marker of disease activity in IBD ?
faecal calprotectin
what marker can be used to predict response and failure to treatment ?
faecal calprotectin
what is the management for CD patients with mild symptoms ?
cigarette smoking should be stopped
diarrhea - use loperamide, codeine phosphate, co-phenotrope
correct anemia according to cause
what could be the cause of diarrhea in long standing non active CD ?
may be due to bile acid malabsorption and should be treated with cholestyramine
steatorrhea is an indication off ?
involvement of the small bowel
what is used for the induction of remission ?
glucocorticoids - prednisone
azathioprine/ mercaptopurine is also added at the beginning
what is used for maintenance ?
aminosalicylates or mycophenolate mofetil
what is a common side effect of azathioprine ?
at high doses it may cause leukopenia
what is the management in CD patients who are corticosteroid or immunosuppressive therapy resistant?
methotrexate or Iv cyclosporine
what are the biological therapies and when are they indicated ?
anti-TNF - infliximab
used when conventional therapy fails
in the presence of fistulas
what are the complications of UC ?
acute severe UC
toxic megacolon
dysplasia ( indicated for colectomy )
when is an attack of UC considered severe ?
more than 6 bloody stools per day
fever
tachycardia
ESR > 30
Anemia < 10 g/dl
Albumin < 30g/L
what is the serology in UC ?
pANCA positive
pASCA negative
in moderate to severe attacks of UC what are the key investigations ?
plain abdominal x ray with an abdominal ultrasound
where is 5 ASA absorbed ?
in the small intestine
what is the management of UC with proctitis ?
oral aminosalicylate plus a local rectal steroid prep
what is the mngmtn for UC patients with total colitis ?
admitted to the hospital
initially given hydrocortisone with 6 hourly aminosalicylate
full investigation and enteral nutrition
what is the association between IBD and cancer ?
patients with UC for more than 10 years are at a higher risk for developing colorectal cancer
what is the presentation of patients with microscopic inflammatory colitis ?
chronic or fluctuating watery diarrhea
normal colonoscopy
findings on biopsy
