IBD Flashcards
In tayside there are 2500 patients with IBD. Do more have UC or crohn’s disease?
More have UC
What are the risk factors for IBD?
Vitamin D deficiency (Vit D suppresses pro inflammatory mediators)
Low fibre diet (Fibre prevents release of proinflamatory cytokines)
Western diet and residual starch around the gut lining => inflammatory response
What are the clinical features of Crohn’s disease?
Abdominal pain Diarrhoea Anorexia and weight loss Malaise and fever Fistulas and strictures are deeper in the mucosa and can effect anywhere from mouth to anus
What are the clinical features of Ulcerative colitis?
Bloody diarrhoea, colicky abdominal pain
Urgency
Effects the lining of the gut and from the rectum upwards
Why do most IBD patients have a protein energy malnutrition?
Catabollic effect increases protein and calorie requirements
Increased nutritional losses via symptoms eg vomiting
Poor absorption due to active disease and section of bowel affected
Often eat poorl to aviod symptoms and do not get adequate intake
Crohn’s disease often effects the small bowel. What nutritional contents should you monitor?
Fat soluble vitamins, vitamin B12,
Iron
(VItamins D and B12 are only absorbed in the small bowel.
Folic acid
UC affects the large bowel. What nutritional contents should be monitored?
Electrolytes and fluid status.
Iron deficiency
Is there a therapeutic diet for IDB?
No the dietary advice is no different from the general population but patients can get an open appointment and its good to get in contact sooner rather than later
What are the common high risk deficiencies in Crohn’s disease?
Anaemia- IV not oral replacement.
Osteoporosis (calcium and Vit D)
Fat soluble vitamins, zinc, iron and B12.
Patients with crohn’s disease get a annual B 12 injection. T or F?
True
Crohn’s disease: steroid therapy is more effective than Entral nutrition from inducing long term remission but when would EN be chosen over steroids?
Steroid intolerance
Patient refusal of steroids
EN with steroids for malnourished patients
Inflammatory stenosis of the small intestine
Paediatrics- first line
Would EN be used in UC?
No
Exclusive EN for 3-6 weeks can be used as an alternative to steroids in active Crohn’s disease
What is Modulen?
Nutritional supplement/replacement which contains a naturally occurring anti inflammatory factor. Used first line in children and considered in adults (poor compliance/response to medication)
Preventing malnutrition is key to maintaining remission in IDB patients. T of F?
True
When is Parentral nutrition used in IBD?
No evidence that PN helps to induce remission in CD or UC.
May be used Pre op to improve nutritional status.
PN or Home PN can be used in CD with intestinal failure due to short bowel syndrome
When would you give total parentral nutrition in CD?
Extensive active disease in the small bowel Previous multiple surgeries Short bowel syndrome <1m Fistulas, strictures or obstructions All => Intestinal failure
What is colitis?
Inflammation of the colon
Why was crohn’s disease previously confused with TB?
They are both granulomatous diseases
WHat is Crohn’s disease and where does it most commonly affect?
Chronic inflammatory ulcerating condition of the GI tract that can affect anywhere from the mouth to the anus.
Most common in the terminal ileum and colon
Who is diagnosed with crohns disease?
Most people are in 20s and 30s
Slightly more common than males
How does Crohn’’s disease present?
Ando pain Small bowel obstruction Diarrhoea Bleeding PR Anaemia Weight loss. (Similar symptoms to cancer but in a young person
What is the clinical course of Crohns?
Chronic
Relapsing and remitting with an unpredictable response to therapy
How is Crohns disease diagnosed?
Endoscopy and mucosal biopsy
What is the endoscopic pattern of Crohns disease?
Patchy and segmental disease with Skip areas or lesions anywhere in the GI tract
Deep festering producing Cobblestonning and ulceration
Pseudopolyps may be seen but are uncommon
Fat wrapping