IBD Flashcards
Where is ulcerative colitis most commonly found and how does it spread?
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
What are the key features of Ulcerative colitis?
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.
Compare UC and Crohn’s disease
- Association with smoking
UC = Smoking and appendectomy protects
Crohn’s = Smoking aggravates
Compare UC and Crohn’s disease
- Age of onset?
UC= 15-40 years
Crohn’s = 15-40years
Compare UC and Crohn’s disease
- Location affected?
UC= distal colon, rectum and sigmoid area
Crohn’s = Distal ileum caecum, small bowel
Compare UC and Crohn’s disease
- Pathology?
UC = Continuous inflammatory lesions that progress from the distal colon to the proximal colon
Crohn’s = Discontinous patchy gut inflammation with skip lesions
Compare UC and Crohn’s disease
- Histology?
UC= superficial inflammation
Crohn’s = Transmural inflammation (full depth of the colon)
Compare UC and Crohn’s disease
- Complications?
UC= severe bleeding, toxic megacolon, rupture of bowel, colon cancers
Crohn’s = bowel stenosis, abscess formation, fistulas, colon cancer
Compare UC and Crohn’s disease
- Gender?
UC= 50:50
Crohn’s: female>male
Where does crohn’s disease most commonly affect and how does is progress?
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
What are the important characteristics of crohn’s disease?
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.
What are the symptoms and signs of UC?
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
What investigations are done in UC?
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
How is the severity of UC assessed?
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
How is UC treated?
- 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.