IBD Flashcards
What is it
Relapsing and remitting inflammatory disorder of the colonic mucosa
Where does UC affect
rectum and may extend part of the colon (L sided) or entire colon (pan colitis)
never spreads beyond ileocaecal valve
What is peak incidence of UC
15-25
55-65
What is a RF of UC ?
non-smoker
What are the symptoms of UC
episodic or chronic diarrhoea +/- blood + mucus (prominent)
Crampy abdo pain
Urgency/ tenesmus
Systemic sx in attacks: fever, malaise, anorexia, WL
What would you find endoscopically in US
continuous inflamed mucosa from rectum proximally
What would you find histologically in UC
Mucosal and submucosal inflammation
Crypt abscesses
Reduced goblet cells
What is the treatment of UC?
Fluids
Oral/IV steroids if a flare
Mild-moderate UC – oral/rectal mesalazine (aminosalicylate)
Immunosuppressants – mercaptopurines, anti-TNF – be aware of infection!
What tests would yo carry out in UC?
- Raised WCC and CRP
- Faecal calprotectin
- Stool cultures to rule out bacterial cause
- AXR, CT/MRI
- Sigmoidoscopy, colonoscopy
What are the complications of UC? Give acute and chronic
Acute: toxic megacolon -> perforation
VTE - give proph
hypokalaemia
Chronic: colon cancer - monitor!
When is surgery indicated in US?
failure of medical therapy
fulminant colitis w toxic dilation or perforation
What are the sx of crohns?
Diarrhoea
Abdo pain
Weight loss prominent
What is the GI involvement in Crohns?
Anywhere along GI tract
most commonly terminal ileum
What is peak age of crohns?
20-40
What is crohns associated w ?
smoking
NSAIDs may exacerbate
What is seen endoscopically in Crohns?
inflamed thickened mucosa
aphthous ulcers
skip lesions
What is seen histologically in Crohns?
inflammation extending beyond the submucosa
granulomas present
What are the complications of Crohns?
SBO Toxic megacolon Abscesses Fistulae Colon cancer + small bowel cancer Malnutrition Primary sclerosing cholangitis
what tests would u do in crohns?
same as UC
Small bowel enema - strictures - Kantors string sign
proximal bowel dilatation
‘rose thorn’ ulcers
What is the management of inducing remission in Crohns?
- Glucocorticoids - pred, methylpred IV hydrocortisone
- Mesalazine
- +/- azathioprine or mercaptopurine
What is given to maintain remission in Crohns?
Azathioprine or mercaptopurine
Methotrexate is second lin
What is the most common surgery to have in Crogns?
ileocaecal resection
What is the treatment of perianal disease in Crohns?
§oral abx
immunosuppressant therapy +/- anti-TNF + local surgery
