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9. GI system > IBD (2): Ulcerative collitis and Crohn's > Flashcards

IBD (2): Ulcerative collitis and Crohn's Flashcards

1
Q

What is IBD?

A

Inflammatory bowel disease is the umbrella term for 2 main diseases causing inflammation of the GI tract:
Ulcerative Colitis and Crohn’s disease.

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2
Q

What are the 2 major forms of inflammatory bowel disease?

A
  1. Crohn’s
  2. Ulcerative collitis

= Both chronic autoimmune conditions

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3
Q

What is ulcerative collitis?

A

Relapsing and remitting inflammatory disorder of the COLONIC MUCOSA

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4
Q

Describe the spread of UC.

A

Inflammation starts from rectum.
Continuous mucosal inflammation.
Stops at ileum.
Affects only the colon up to the ileocaecal valve.

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5
Q

Describe the distribution of inflammation seen in ulcerative colitis.

A

Continuous inflammation affecting only the mucosa.

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6
Q

Give 3 risk factors for ulcerative collitis.

A
  1. NSAIDs
  2. Chronic stress and Depression = trigger flares
  3. Fx - Genetics: HLA-B27
  4. Caucasian ethnicity
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7
Q

What part of the bowel is commonly affected by ulcerative colitis?

A

It only affects the rectum. It spreads proximally but only affects the colon.

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8
Q

Histologically, what part of the bowel wall is affected in ulcerative colitis?

A

Just the mucosa.

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9
Q

Give 3 key signs related to UC.

A
  1. Abdominal pain, usually in left lower quadrant
  2. Blood + mucous in chronic diarrhoea
  3. Weight loss
  4. Cramps
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10
Q

Give 3 extra-intestinal signs for UC.

A
  1. Clubbing
  2. Aphthous oral ulcers
  3. Erythema nodusum (red round lumps below skin surface)
  4. Amyloidosis
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11
Q

State one histological feature that will be seen in ulcerative colitis.

A
  1. Crypt abscess.
  2. Increase in plasma cells in the lamina propria.
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12
Q

Give 3 liver-related complications of UC.

A
  1. Fatty change
  2. Chronic pericholangitis
  3. Sclerosing cholangitis
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13
Q

Give 4 colon-related complications of UC.

A
  1. Blood loss
  2. Perforation
  3. Toxic dilatation
  4. Colorectal cancer
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14
Q

Give 2 skin-related complications of UC.

A
  1. Erythema nodusum - a type of skin rash
  2. Pyoderma gangrenosum (painful ulcers on skin)
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15
Q

Give 2 joints-related complications of UC.

A
  1. Ankylosing spondylitis
  2. Arthritis
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16
Q

Give 3 eye-related complications of UC.

A
  1. Iritis (iris inflammation)
  2. Uveitis (inflammation of middle layer of eye - uvea)
  3. Episcleritis
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17
Q

What factor decreases the risk of UC?

A

Smoking!

18
Q

Investigations for UC.

A

Looking for inflammation, malabsorption and specific markers of IBD/UC:

  1. Inflammation - bloods - FBC - anaemia
    - CRP/ESR
    - WCC
  2. Malabsorption

-Iron / Vit B / Folate deficiency anaemias

  1. Markers of IBD / UC
    - Faecal calprotectin stool test (aka FIT test) - for infective causes
    - pANCA (anti-neutrophilic cytoplasmic antibodies)
  2. Colonoscopy with mucosal biopsy = GOLD
    - Colon affected only, ulcers
19
Q

Treatment for mild ulcerative collitis.

A

Mild:

  1. Amniosalicylate aka 5-ASA (mesalazine)
  2. Oral steroids (prednisolone)
20
Q

Treatment for severe ulcerative collitis.

A

Severe:

  1. Fluid resus (if necessary)
  2. IV steroid (hydrocortisone)
  3. TNF-α inhibitor (infliximab or aziathioprine)
21
Q

How to maintain remission for ulcerative collitis?

A
  1. 5-ASA - most patients require maintenance treatment
  2. Azathioprine - for patients who relapse despite 5-ASA treatment or are ASA intolerant
22
Q

What to do if severe colitis fails to respond to treatment?

A

SURGERY!!

  1. Colectomy (colon removed) with ileoanal anastomosis
  2. Panproctocolectomy with ileostomy
23
Q

How to remember the key points of UC? Mnemonic?

A

Ulcerative Colitis (remember U – C – CLOSEUP)

C – Continuous inflammation

L – Limited to colon and rectum

O – Only superficial mucosa affected

S – Smoking is protective

E – Excrete blood and mucus

U – Use aminosalicylates

P – Primary Sclerosing Cholangitis

24
Q

Give 5 complications of ulcerative colitis.

A
  1. Colon: blood loss and colorectal cancer.
  2. Arthritis.
  3. Iritis and episcleritis.
  4. Fatty liver and primary sclerosing cholangitis.
  5. Erythema nodosum.
25
Q

Define Crohn’s disease.

A

A chronic inflammatory GI disease characterised by transmural (goes deep into mucosa) granulomatous inflammation affecting ANY part of the gut from mouth to anus (especially in TERMINAL ILEUM and PROXIMAL COLON).

26
Q

What part of the bowel is commonly affected by Crohn’s disease?

A

Can affect anywhere from the mouth to anus.

27
Q

Describe the distribution of inflammation seen in Crohn’s disease.

A

Patchy, granulomatous, transmural inflammation (can affect just the mucosa or go through the bowel wall).

28
Q

Explain the pathophysiology of Crohn’s disease.

A
  1. Faulty GI epithelium → pathogens get into the wall
  2. Exaggerated inflammatory response
  3. Formation of granuloma + destruction of GI tissues
    a. Transmural ulcers → perforation
    b. + skip lesions in between ulcers
    c. + fissures (cracks) in the lining
    = Cobblestone appearance
  4. Inflammation also causes: perianal abscesses, mouth ulcers
  5. When the wall is healing:
    a. Fistulas (abnormal open connections between two body parts), e.g. anal fistulas
    b. Adhesions (scar-like tissue formed between two body parts, causing them to stick together)
29
Q

Give 3 key features of that lead to a cobblestone appearance for Crohn’s disease.

A
  1. Non-continuous -> Skip lesions
  2. Transmural ulcer -> Perforations
  3. Fissures in the lining of the mucosa
    = Cobblestone appearance
30
Q

Give 3 risk factors for Crohn’s disease.

A
  1. Stronger genetic association - NOD2 mutation
  2. Smoking - 2/3x more
  3. NSAIDs may exacerbate disease
  4. Fx
  5. Chronic stress and depression triggers flares
  6. Good hygiene
31
Q

Histologically, what part of the bowel wall is affected in crohn’s disease?

A

Can affect just the mucosa or can go all the way through to the bowel wall -> transmural inflammation.

32
Q

Give 3 key categories of the features of Crohn’s disease.

A
  1. Abdominal pain (usually in right lower quadrant)
  2. Changes in bowel habit (diarrhoea, steatorrhoea, melena)
  3. Malabsorption (weight loss, anorexia, fatigue)
33
Q

Give 3 key symptoms of Crohn’s disease.

A
  1. Diarrhoea with urgency (need to go 5-6 times in 45 mins), bleeding and pain due to deification
  2. Abdominal pain - can present as an emergency with acute right iliac fossa pain mimicking appendicitis
  3. Weight loss/anorexia
34
Q

Investigations for Crohn’s disease.

A
  1. Serum full blood count
    - Anaemia
    - Malabsorption, or malnutrition
    - Raised WCC + platelets
  2. Serum inflammatory markers
    - C-reactive protein (CRP) may be raised
    - Erythrocyte sedimentation rate (ESR) — may be raised
    = if there is active inflammation or an infectious complication.
  3. Serum urea and electrolytes — to assess for electrolyte disturbance and signs of dehydration.
  4. Serum liver function tests, including albumin — a low serum albumin may indicate protein-losing enteropathy.
  5. Serum ferritin, vitamin B12, folate, and vitamin D levels — may be nutritional deficiencies due to malabsorption or intestinal losses.
  6. Coeliac serology — to exclude coeliac disease.
  7. Stool microscopy and culture, including Clostridium difficile toxin — to exclude infective gastroenteritis or pseudomembranous colitis.
  8. Faecal calprotectin (a faecal white cell marker, for adults) — if raised may suggest active inflammation (compared with a normal result which is expected in irritable bowel syndrome).

GOLD STANDARD - Colonoscopy + biopsy
= see trademark appearance

35
Q

Treatment of Crohn’s disease.

A

Acute
1. Steroids
- Mild: Prednisolone
- Severe: IV corticosteroids e.g. Hydrocortisone
2. + 5-ASA (Azathioprine)
- 2nd line: Methotrexate
3. + Infliximab
4. Surgery (will not fully cure the patient)
- Not curative
- resection of bowel area most affected

if perianal disease -> consider giving antibiotics

36
Q

How to maintain remission for Crohn’s disease?

A
  1. Azathioprine + methotrexate
37
Q

Give 5 complications of Crohn’s disease.

A
  1. Malabsorption.
  2. Fistula.
  3. Obstruction.
  4. Perforation.
  5. Anal fissures.
  6. Neoplasia.
  7. Amyloidosis (rare).
38
Q

What disease could be caused by a non-functioning mutation in NOD2?

A

Crohn’s.

39
Q

How to remember the key points of Crohn’s disease? Mnemonic?

A

Crohn’s (crows NESTS)

N – No blood or mucus (less common)

E – Entire GI tract

S – “Skip lesions” on endoscopy

T – Terminal ileum most affected and Transmural (full thickness) inflammation

S – Smoking is a risk factor (don’t set the nest on fire)

40
Q

Compare ulcerative collitis and Crohn’s disease in terms of:
1. Involvement
2. Inflammation
3. Disease pattern
4. Mucosal appearance.
5. Occurence of strictures
6. Occurence of fissures
7. Presence of mucosal ulceration
8. Presence of granulomas

A

9. GI system (15 decks)

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