IBD Flashcards
What are the two diseases that encompasses IBD?
Ulcerative Colitis and Crohns disease
What does IBD stand for?
Inflammatory bowel disease
Recommended diet for IBD patients
High fibre diet
Describe the macroscopic features of UC
Superficial mucosal ulcerations–>loss of the epithelial lining
Pseudopolyp formation
Red mucosa- easy bleeding
Describe the microscopic features of UC
Mucosal inflammation
Crypts containing lymphocytes
Gland/goblet cell depletion
What are the clinical features of UC?
Episodic or chronic diarrhoea with blood and mucus
Cramp-like abdominal discomfort
What tests would you order for suspected UC?
Bloods- FBC, ESR, CRP, LFTs, U&Es, blood culture
Stool- Microbiology, culture and sensitivity (M,C and S), C.diff toxin
Faecal Calprotectin- test for GI inflammation, highly sensitive
Abdo X-ray- dilated colon, mucosal thickening
Flexi-sigmoidoscopy- establish diagnosis and biopsy samples
Colonoscopy- assess exact extent and severity
What variable are involved in assessing the severity of UC?
Motions/day Rectal bleeding Temperature Pulse (at rest) Hb ESR and CRP Serum albumin
What are the complications of UC?
Toxic megacolon with risk of perforation
Dysplasia
Malignancy (adenocarcinoma- malignant neoplasm of glandular tissue)
Briefly outline how you would treat UC
Conservatively: stop smoking, high fibre diet
Medically:
Mild- oral Mesalazine (5-ASA)
Moderate- oral Mesalazine (5-ASA) and oral prednisolone
Severe- hydration and electrolyte replacement, IV steroids e.g. hydrocortisone and thromboembolism prophylaxis
Immunomodulation- thiopurines e.g. azathioprine and monoclonal antibodies e.g. infliximab
Surgically: subtotal colectomy and terminal ileostomy
What is Crohn’s Disease?
Crohn’s disease is chronic inflammation characterised by transmural granulomatous inflammation affecting any part of the GI tract (mouth to anus)
What is Ulcerative Colitis (UC)?
Ulcerative colitis is a relapsing and remitting disease of the colon involving an abnormal Th2 immune response
NB it affects the colon continuously rather than being patchy
What are the signs and symptoms of Crohn’s Disease?
Diarrhoea
Weight loss/failure to thrive
Abdo pain and tenderness
Systemic symptoms- fatigue, fever, malaise, anorexia
Anal strictures
Clubbing and skin, eye and joint problems
What are the complications of Crohn’s Disease?
Fistula formation Abscess formation Small bowel obstruction Malignancy Malnutrition
What are the macroscopic features of Crohn’s disease?
Deep ulceration- transmural inflammation Bowel wall thickening-->narrowed lumen Congestion and exudate Abnormal serosa Patchy involvement (skip lesions)
What are the microscopic features of Crohn’s disease?
Transmural inflammation Granulomas Patchy inflammation Fissuring ulceration Neuronal hyperplasia
What tests would you order in suspected Crohn’s?
Blood- FBC, ESR, CRP, U&Es, LFTs, INR, TIBC, Ferratin, B12, folate
Stool- microscopy, culture and sensitivity
Faecal calprotectin
Colonoscopy and biopsy
Capsule endoscopy
How would you treat Crohn’s Disease?
Medically:
Steroids- 40mg/d Prednisolone for 1wk then taper dose
Azathioprine 2-2.5mg/kg/d
Anti TNF alpha- infliximab and other monoclonal antibodies
Surgical:
Aims to reset affected areas, control perianal or fistulising disease and definition/rest distal disease with a temporary ileostomy
which of the following is most common? (UC or Crohn’s)
UC
which of the following is more common in smokers? (UC or Crohn’s)
Crohns
which of the following is predominantly driven by Th1 immune response? (UC or Crohn’s)
Crohns
which of the following is predominantly driven by Th2 immune response? (UC or Crohn’s)
UC
describe the radiological features of Crohn’s? (AXR)
String sign of Kantor rose thorn appearance stricture common fistulae common segmental regions affected --> cobblestone appearance
what are some radiological features of UC? (AXR)
continuous distribution
lead-pipe colon (loss of haustrations)
toxic megacolon
giant cell granulomas on histology…UC or Crohn’s?
Crohns
which has a higher risk of malignancy UC or Crohn’s?
UC
which is characterised by bloody diarrhoea? (UC or Crohn’s?)
UC
which has a risk of small bowel obstruction UC or Crohn’s?
Crohns
how does crohns present?
abdo pain and diarrhoea, wt loss, malabsorption and malnutrition
what is a major complication of UC?
toxic megacolon with risk of perforation
indications for surgery in UC
severe attacks unresponsive to medical therapy
toxic megacolon, pyoderma gangrenous, colorectal cancer
chronically affecting QOL
what are the surgical options in UC
total or subtotal colectomy with an end ileostomy +/- a mucus fistula
after 3 months either: completed proctectomy and ilioanal pouch or end ileostomy OR colectomy and ileorectal anastomosis
What is the criteria called to assess the severity of UC?
Truelove and Witts’ criteria
