IBD Flashcards
What are the extraintestinal manifestations of ulcerative colitis?
Erythema nodosum
Episcleritis
Uveitis
Primary sclerosing cholangitis
What are the extraintestinal manifestations of Crohn’s disease?
Fat wrapping of mesenteric fat around the intestine
Fatty liver
Gallstones
Renal stones
Increased risk of adenocarcinoma fo distal ileum
Mouth and vagina ulcers are more common
What investigation confirms Crohn;s?
Endoscopy
Which opthalmolgoical patholgoies are associated with IBD?
Episclerritis
IBD
When is mesasalazine given first line?
For ulcerative colitis in initial presentation first line
What is given to induce remission in ulcerative colitis?
Steroids
What is given to maintain remission?
Azathriopine if mesasalazine has failed
What is first line in Crohn’s?
Oral mesasalazine
What is second line in Crohn’s?
Mesasalazine with corticosteroid
What is 3rd line in Crohn’s
immune modifying drugs like azathriopine then progreessing to methotrexate. Before adminstering, thiopurinemethyltransferase activity should be assessed, which is an indicator of bone marrow activity. CXR and PPD test to assess for latent tuberculosis
What can predict fistula trajectory?
Goodsall rule:
Posterior to transverse anal linemen as it will follow a curved course to the posterior midline
Anterior to transverse anal line: fistula will have a straight radial course to the dentate line
What is the Trulove and Witt severity index?
The Truelove and Witts severity index is used to assess the severity of a flare-up of ulcerative colitis, which then guides management decisions.
What are the features of TruLove and Witt?
The presence of bloody diarrhoea 6 or more times a day is a key diagnostic feature for severe disease, alongside one of:
temperature >37.8 degrees
pulse >90bpm
ESR >30mm/hour
anaemia.
What should be done if a patient meets the criteria for Trulove and Witt’s?
If a patient meets the criteria for severe disease they should be admitted to hospital and typically are treated with intravenous steroids (with proton pump inhibitor cover) first-line and broad-spectrum antibiotic cover if infection is suspected
