IBD Flashcards
What is Inflammatory Bowel Disease (IBD) and what are its two main types?
IBD involves recurrent inflammation of the gastrointestinal tract, with two main types:
* Ulcerative colitis
* Crohn’s disease
It is characterized by periods of exacerbation and remission.
What are the general presenting features of inflammatory bowel disease?
- Diarrhoea
- Abdominal pain
- Rectal bleeding
- Fatigue
- Weight loss
What are the key differentiating features of Crohn’s disease?
The “crows” NESTS mnemonic:
* N – No blood or mucus (PR bleeding is less common)
* E – Entire GI tract affected (from mouth to anus)
* S – “Skip lesions” on endoscopy
* T – Terminal ileum most affected and transmural (full-thickness) inflammation
* S – Smoking is a risk factor
What are the key differentiating features of ulcerative colitis?
The “you see (UC)” CLOSEUP mnemonic:
* C – Continuous inflammation
* L – Limited to the colon and rectum
* O – Only superficial mucosa affected
* S – Smoking may be protective
* E – Excrete blood and mucus
* U – Use aminosalicylates
* P – Primary sclerosing cholangitis
What conditions are commonly associated with inflammatory bowel disease?
- Erythema nodosum (tender, red nodules on the shins)
- Pyoderma gangrenosum (painful skin ulcers)
- Enteropathic arthritis (inflammatory arthritis)
- Primary sclerosing cholangitis (mainly with ulcerative colitis)
- Red eye conditions (e.g., episcleritis, scleritis, anterior uveitis)
What blood tests are used in the diagnosis of inflammatory bowel disease?
- Full blood count (to check haemoglobin and platelet count)
- C-reactive protein (CRP) (indicates inflammation)
- Urea and electrolytes (U&Es) (for kidney function and electrolyte imbalances)
- Liver function tests (LFTs) (may show low albumin in severe disease)
- Thyroid function tests (to exclude hyperthyroidism)
- Anti-Tissue Transglutaminase antibodies (for coeliac disease)
What is faecal calprotectin used for in inflammatory bowel disease?
Faecal calprotectin is a test used to help diagnose inflammatory bowel disease. It is around 90% sensitive and specific for IBD and is used before moving on to endoscopy.
What is the investigation of choice for diagnosing inflammatory bowel disease?
Colonoscopy with multiple biopsies is the investigation of choice to establish the diagnosis of IBD. Imaging techniques like ultrasound, CT, and MRI are used to look for complications such as fistulas, abscesses, and strictures.
How is mild to moderate acute ulcerative colitis managed?
- Aminosalicylates (e.g., oral or rectal mesalazine) first-line
- Corticosteroids (e.g., oral or rectal prednisolone) second-line
How is severe acute ulcerative colitis managed?
- Intravenous steroids (e.g., IV hydrocortisone) first-line
Other options for severe cases include: - Intravenous ciclosporin
- Infliximab
- Surgery (e.g., panproctocolectomy)
What is the first-line treatment for maintaining remission in ulcerative colitis?
- Aminosalicylates (oral or rectal mesalazine)
Other options include azathioprine and mercaptopurine.
What surgical options are available for ulcerative colitis?
- Panproctocolectomy (removal of the entire colon and rectum)
Following surgery, patients may have either: - Ileostomy (end of the ileum brought to the skin to drain stools)
- Ileo-anal anastomosis (J-pouch) (ileum forms a pouch attached to the anus, functioning like a rectum)
How is an exacerbation of Crohn’s disease managed?
- Steroids (oral prednisolone or IV hydrocortisone) first-line
- Enteral nutrition (a liquid diet given orally or by NG feed) as an alternative to steroids, especially for growth concerns
What additional medications can be used when steroids alone are insufficient in Crohn’s disease?
- Azathioprine
- Mercaptopurine
- Methotrexate
- Infliximab
- Adalimumab
How is remission maintained in Crohn’s disease?
First-line treatments:
* Azathioprine
* Mercaptopurine
Alternative:
* Methotrexate (if first-line treatments are unsuitable)
What surgical options are available for Crohn’s disease?
- Resection of the distal ileum when the disease is localized to this area
- Surgical treatments for strictures and fistulas
