IBD Flashcards

1
Q

Where is ulcerative colitis most commonly found and how does it spread?

A

UC mainly presents with inflammation of the rectal and sigmoid colon (40-50% = proctitis)

The inflammation can spread proximally from the recto-sigmoid colon to the descending colon. This spread occurs in 30-40% of cases and is called left-sided colitis.

If the inflammation continues to spread proximally to the transverse colon. This spread occurs in 20% of cases and is called extensive colitis

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2
Q

What are the key features of Ulcerative colitis?

A

Ulcerative colitis is a relapsing remitting condition. When the disease is active it causes ulceration and inflammation. When the disease is inactive the cells are atrophying following an inflammatory condition.

Pseudopolpys are a unique characteristic feature of ulcerative colitis. They arise because the atrophic cells are trying to regenerate. The regeneration is abnormal and causes pseudopolyps.

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3
Q

Compare UC and Crohn’s disease

  • Association with smoking
A

UC = Smoking and appendectomy protects

Crohn’s = Smoking aggravates

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4
Q

Compare UC and Crohn’s disease

  • Age of onset?
A

UC= 15-40 years

Crohn’s = 15-40years

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5
Q

Compare UC and Crohn’s disease

  • Location affected?
A

UC= distal colon, rectum and sigmoid area

Crohn’s = Distal ileum caecum, small bowel

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6
Q

Compare UC and Crohn’s disease

  • Pathology?
A

UC = Continuous inflammatory lesions that progress from the distal colon to the proximal colon

Crohn’s = Discontinous patchy gut inflammation with skip lesions

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7
Q

Compare UC and Crohn’s disease

  • Histology?
A

UC= superficial inflammation

Crohn’s = Transmural inflammation (full depth of the colon)

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8
Q

Compare UC and Crohn’s disease

  • Complications?
A

UC= severe bleeding, toxic megacolon, rupture of bowel, colon cancers

Crohn’s = bowel stenosis, abscess formation, fistulas, colon cancer

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9
Q

Compare UC and Crohn’s disease

  • Gender?
A

UC= 50:50

Crohn’s: female>male

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10
Q

Where does crohn’s disease most commonly affect and how does is progress?

A

40% present with inflammation of the ileocecal area

30-40% present with inflammation of the small intestines and the inflammation is segmental. This segmental pattern is known as skip lesions.

20% can have skip lesions present in the colon. This is known as crohn’s colitis.

<10% have perianal inflammation

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11
Q

What are the important characteristics of crohn’s disease?

A

Skip lesions

Crohn’s disease is a transmural condition that affects the entire depth of the colon and therefore the side effects are more severe.

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12
Q

What are the symptoms and signs of UC?

A

Symptoms: episodic or chronic diarrhoea (+/- blood &mucus), cramping abdominal pain, urgency/tenesmus. In attacks: fever, malaise, anorexia, weight loss

Signs: May be none. In acute, severe Uc there may be a fever, tachycardia and a tender distended abdomen.

Extra-intestinal signs: clubbing, oral ulcers, erythema nodosum, conjunctivitis, large joint arthritis, ankylosing spondylitis, fatty liver, cholangiocarcinoma, nutritional deficits, amyloidosis

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13
Q

What investigations are done in UC?

A

Blood – FC< ESR, CRP, U&E, LFT, blood cultures

Stool culture – to exclude campylobacter, C. difficile, salmonella, shigella, E. coli,

Colonoscopy – Disease extent shown and biopsy

Faecal calprotectin – to rule out IBS

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14
Q

How is the severity of UC assessed?

A

Truelove and Witts criteria

Mild UC
Motions/day: < 4
Rectal bleeding: Small
Temperature: Apyrexial
Resting pulse: <70bpm
Haemoglobin: <110g/L
ESR	<30
Moderate UC
Motions/day: 4-6
Rectal bleeding: Moderate
Temperature: 37.1-37.8oC
Resting pulse: 70-90bpm
Haemoglobin: 105-110g/L
Severe UC
Motions/day: > 6
Rectal bleeding: Large
Temperature: >37.8 oC
Resting pulse: >90bpm
Haemoglobin: <105g/L
ESR: >30
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15
Q

How is UC treated?

A
  • 5-ASA e.g. Sulfasalazine, Mesalazine, Olsalazine
  • Steroids e.g. Prednisolone, steroid enemas, hydrocortisone (if unwell)
  • IV hydration

•Surgery - proctocolectomy, terminal ileostomy, total colectomy with ileo-anal pouch
Indications: perforation, massive haemorrhage, toxic dilatation, failed medical therapy

•Immunomodulation e.g. azathioprine, methotrexate, infliximab, adalimumab
Indications: no remission with steroids or if prolonged use is required.

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16
Q

What are the symptoms and signs of crohn’s disease?

A

Symptoms: Diarrhoea/urgency, abdominal pain, weight loss/failure to thrive. Fever, malaise, anorexia, vomiting

Signs: aphthough ulcerations, abdominal tenderness/mass, perinanal abscess/fistulae, skin tags, anal strictures

Extra-intestinal signs: clubbing, skin joint and eye problems

17
Q

How is crohn’s disease investigated?

A
  • Bloods- FS, ESR, CRP, U&E, LFT, INR, Ferritin, B12, Folate, TIBC
  • Stool culture: to exclude c. Difficile, Campylobacter, E.Coli
  • Colonoscopy +rectal biopsy
  • Capsule endoscopy
  • MRI scan
18
Q

How is crohn’s disease treated?

A
  • Steroids e.g. Prednisolone, IV hydrocortisone
  • Metronidazole
  • Monitor regularly
  • Consider need for blood transfusion if blood loss is significant
  • Immunomodulators: infliximab, adalimumab
  • Additional: Azathioprine, sulfasalazine, TNF-alpha inhibitors, methotrexate, nutrition, antibiotics, IV immunoglobulin, surgery,