IBD Flashcards
What deficiencies can arise in IBD
Iron
B12
Folate
Vitamin D
Importance of faecal calprotectin level
Distinguishes inflammatory and non inflammatory bowel disorders
Inflammatory - in 1000s
Infection - normally raised by <50 but can be in 100s
What does Truelove and Witts criteria predict
Severity of acute UC flare
Describe Truelove and Witts criteria
Number of times bowels opened in 24 hours - main classification! Temperature Rental bleeding ESR <30 Pulse Haemoglobin
Cut off scores in Truelove and Witts
<4 mild
4-6 moderate
>6 severe
Extraintestinal features of IBD
Primary biliary cirrhosis Primary sclerosing cholangitis Erythema nodusum Pyoderma granulosum Uveitis Scleritis Arthritis
Treatment to induce remission in chron’s and UC
Chron’s: oral prednisolone
UC: 5-ASA (suppository if rectum only, otherwise oral)
Treatment to maintain remission in IBD
Chron’s: azathioprine, methotrexate
UC: oral 5-ASA
Treatment for acute chron’s
1st line - IV hydrocortisone
2nd line - Oral prednisolone
3rd line - Infliximab
Treatment for acute UC
1st line - IV hydrocortisone
2nd line - IV ciclosporin
3rd line - Infliximab
Indications for surgery in IBD
Perforation Not responding to oral medication Strictures Fistulae Severe bleeding Obstruction Abscess Toxic megacolon
Surgery options for UC
End ileostomy: total colectomy, subtotal colectomy, panproctocolectomy
Pouch: ileoanal anastomosis
Complications of a pouch
Fistula Obstruction Infertility due to pelvic adhesions May need to catheterise to empty Have to open bowels ~6 times per day and during night
What needs to be done following UC surgery with end ileostomy
Remove rectum as cancer likely
Unsuitable investigations for acute IBD and why
Colonoscopy as not enough time for bowel clearance, do sigmoidoscopy with phosphate enema
Barium enema as risk of perforation
