IBD Flashcards
Feature that distinguishs Crohns and UC?
UC starts in the rectum and does not spread the ileocaecal valve. It is continuous. Crohn’s is discontinuous throughout the GI tract
Peak age of onset of UC
15-25 years, 55-65 years
Presentations of UC
bloody diarrhoea, urgency, tenesmus, abdominal pain (LLQ), extra-intestinal symptoms
Common presentations associated with UC disease process?
arthritis, erythema nodosum, episcelritis, osteoporosis
Common presentations not associated with the UC disease process
arthritis, uveitis, clubbing, primary sclerosis cholangitis
Inflammation in UC is found where?
not beyond the submucosa
Crypt abscesses - crohns or UC?
UC
Pseudopolyps - crohns or UC?
UC
what causes the formation of crypt abscesses?
neutrophils infiltrating the submucosal wall
pathology of the glandular epithelium in UC?
depletion of goblet cells and mucin production
If a barium enema was performed on a UC patient (old practice) what would be seen?
lack of haustrations, possible pseudopolyps
Tests and Investigations carried out in UC?
Bloods - FBC, U&Es, CRP, ESR, LFTs; Stool culture - to rule out microbial involvement; Colonoscopy - to assess disease extent; AXR and CXR - faecal shadowing, colon dilation, perforation
Treatment of UC to maintain remission?
5-ASAs such as mesalazine, sulfasalazine
Treatment of UC flair ups - mild to moderate disease
steroids i.e. prednisolone PO, may be used as suppositories if necessary
Treatment of severe UC flair ups?
Nil by mouth, IV hydration, steroids rectally and IV;monitor bloods, temp, HR and BP and stool frequency and character; consider blood transfusion if low Hb,
Where might surgical intervention occur in UC?
perforation, massive haemorrhage, toxic dilation, last resort due to failed medical therapy
Immunemodulation may be used when?
there is no remission of disease or there is prolonged steroid use
Examples of immune modulation therapy in UC?
azathioprine, methotrexate, infliximab
It is important to monitor ___ while using immune modulation therapies
bloods - FBCs and LFTs particularly
Crohn’s typically affects…?
the terminal ileum and colon but anywhere mouth to anus
Inflammation occurs where in crohn’s?
all the way to the serosa
Crohn’s patients are prone to…?
strictures, fistulas and adhesions
Presentation of crohn’s may include?
weight loss, lethargy, diarrhoea (bloody or non-bloody), abdominal pain, perianal disease (skin tags and ulcers)
Extra-intestinal features of crohn’s include?
arthritis, erythema nodosum, pyoderma gangrenosum, clubbing, apthous ulcers
Pathology of crohns
goblet cells and granulomas
complications associated with crohns?
small bowel obstruction, abscess formation, fistulae, colon cancer, fatty liver disease, primary sclerosing cholangitis
Tests involved in Crohn’s investigations
Bloods - FBCs, ESR, CRP, U&Es, LFTs, INR, ferritin, VitB12, Folate; Stools - exclude infection; Colonscopy and biopsy; small bowel enema - detects ileal disease; MRI - detects pelvic disease and fistulae
Treatment of mild Crohn’s?
steroids tapered over time
Treatment in severe Crohn’s flair up?
steroids, metronidazole, daily bloods and stool, consider transfusion,
Additional therapies that may or may not work in Crohn’s patients?
Azathioprine, sulfasalazine, TNFa inhibitors - infliximab, methotrexate for inducing remission, surgery
