IBD Flashcards
what is toxic megacolon?
a total colitis that presents acutely with toxic dilatation
in both UC + chron’s
extra-intestinal manifestations of IBD
iritis
arthritis
erythema nodosum
pyoderma gangrenosum
IBD - peak incidences
chron’s - 20s
UC - 30s
chron’s - what is it?
transmural disease in a patchy distribution with non-caseating granulomas
more likely than UC to present with weight loss, general ill health or anaemia of chronic disease
UC - what is it?
mainly confined to colon (uC)
chron’s - site of disease
patchy - skip lesions
malabsorption if terminal ileum involved
stricture (oft terminal ileum) can cause obstruction
can get total colitis with rectum spared
fistulae common - eg rectum-skin (perianal) or small bowel-skin
ulceration in chron’s
superficial - mucosa only
deep - mucosa + submucosa - fissures leading to cobblestone mucosa
transmural - full thickness, down to muscle layer; rose-thorn ulcers
chron’s - mnemonic
Clubbing + cobblestone mucosa
Aphthous ulceration - check mouth
Mass in RIF + malabsorption
Perianal disease: skin tags, abscess, fistulae
Erythema nodosum - check legs
Rose thorn ulcers - full thickness; rectal sparing in TMc
Skip lesions - patchy distribution + strictures
UC - what is it? presentation?
typ diarrhoea with prominent blood + mucus
superficial membrane ulceration (submucosa spared) with prominent inflam cells extending into lumen of colonic glands - ‘crypt abscesses’
severe - pseudopolyps - most of mucosa stripped away, leaving islands of normal mucosa
rectum nearly always involved
risk carcinoma of colon
IBD - differentials
infection
pseudomembranous colitis (abx)
ischaemic colitis
IBD - mgmt
symptomatic treatment of diarrhoea - eg loperamide
nutritional support
aminosalicylates - mesalazine - may induce remission; main role maintain remission
steroids
immunosuppressants - azathioprine
biologics eg adalimumab
UC vs chron’s on colonoscopy + hx
chron’s - skip lesions
UC - continuous
UC starts in rectum - proctitis common
UC - flares - presentation
mild - <4 stools/d ± blood, no other sx
mod - 4-6/d, minimal systemic sx
sev - >6 + bloody + systemic sx eg fever, distension, anaemia, hypoalbumninaemia - ADMIT
chron’s - commonest site of disease
terminal ileum
chron’s - management
1) stop smoking
2) induce remission
1° - steroids
and/or enteral feeding (esp kids)
(other - mesalazine, azathioprine, methotrexate)
3) maintain remission
1° - azathioprine
4) most eventually need surgery - oft ileocaecal resection
