IBD Flashcards
What can patients do whilst waiting for the dietitian?
Look online at the diet and orientate yourself around what you will and won’t be able to have
What is the name of the skin rash that comes with Crohns flare up?
What does it look like/characteristics?
How many people get it?
Erythema nodosum
1 in 20 people
Tender, red, circular, nodule
What are some skin manifestations commonly seen in IBD?
Erythema nodusum
Pyodermal gangrenosum
Stomatitis
Vesiculopustula eruption
What is the epidemiology of IBD?
1-2 in 1000
1 in 50 in Ashkenazi Jews
What is Ulcerative Colitis?
A relapsing and remitting inflammation of the colonic mucosa
Where does UC occur?
Proctitis (rectum) 30%
Left sided colitis 40%
Pancolitis (whole colon) 30%
What causes UC?
Inappropriate immune response to ab/normal flora of the gut (genetically susceptible individuals)
In which layer is the inflammation in UC?
Mucosa - this differentiates it from Crohn’s disease
How do you end up with blood in your stool in UC?
Polyps can form from the inflammation and these can become haemorrhagic
How does smoking relate to UC?
The incidence is 3x in non-smokers and stopping smoking can actually cause relapse of symptoms
What are the symptoms of chronic UC?
Episodic or chronic diarrhoea Abdominal crampy discomfort Blood/mucus in stool Frequency Urgency Tenesmus (proctitis)
Systemic during attacks - fever, weight loss, malaise, anorexia
What are the symptoms of an acute episode of UC?
Fever Weight loss Malaise Anorexia Tender abdomen
What are the extraintestinal manifestations/signs of IBD?
SKIN Clubbing Erythema nodosum Pyoderma gangrenosum FACE Conjunctivits Episcleritis Irits Oral ulcer JOINTS Large joint arthritis Sacroilitis Ankylosing spondylitis OTHER Primary Sclerosing Cholangitis
How common is UC?
1-2/1000
100-200 in 100,000
When does IBD typically present?
20-40year olds
What blood tests would you do in UC?
FBC - anaemia, leukocytosis, thrombocytosis
LFTs - signs of PSC
UEs - signs of PCS elevated Na urea
ESR/CRP - raised
Blood sample
Stool sample - C.diff, WBC, faecal calprotectin
AXR - air fluid level, thumb printing
Colonoscopy
What are the risk factors for UC?
Family history
Infection in those who have previous history of UC
What is faecal calprotectin?
This is a marker that is raised in inflammatory bowel disease. This is important in distinguishing between IBD and IBS
What are the criteria for the severity of UC?
SEE PHOTO
What are the complications of UC?
Toxic megacolon
Colonic cancer (more in pancolitis)
Polyps
Perforation
Venous thromboembolism
Hypokalaemia
How do we treat mild UC?
5-aminosalicylic acid (5-ACA)
Mesalazine
Can give PR as suppository or foam 1g OD for proctitis.
Up to 2.4g split per day (800mg tablets) PO for more extensive disease
These doses are combined if needed.
Loperamide to treat the diarrhoea
Hydrocortisone (1 unit) PR or prednisolone PO (20-40mg) or 1 unit PR can be added if no better in 2-4 weeks
How do we treat moderate UC?
Give prednisolone 40mg PO for 1 week then taper down 5g/week for 7 weeks.
Give up to 4.8g of mesalazine OD (800mg tablets)
Can add tacrolimus (unlicensed) if not better in 2-4 weeks
If mesalazine doesn’t work, can add budenaside multimatrix
Maintain on mesalazine 1.2-2.4g split over day PO
What are some side effects of 5-ASAs?
Rash Haemolysis Hepatitis Pancreatitis Worsening of UC
Rare - pericarditis/nephritis
What monitoring is required for mesalazine?
At prescription
Post 3 months
Yearly
UEs
FBC
How do we treat severe UC?
Give IV fluids, IV hydrocortisone 100mg/6hours, thromboembolism prophylaxis
Rescue therapy can be used: IV ciclosporin OR IV inflixumab
Monitor twice daily
What if the severe UC doesn’t get better after 3-5 days?
Urgent action is needed - i.e. rescue therapy
What happens if the severe UC gets better after 3-5 days?
Switch to prednisolone oral 40mg/day then treat as moderate UC
What is rescue therapy?
Ciclosporin
or
Infliximab
What if nothing is helping the UC attack?
Urgent colectomy if not better by day 7-10
What is immunomodulation?
Using drugs to modulate the immune system