IBD Flashcards
IBD is the umbrella term for what?
The two main diseases causing inflammation of the GI tract:
Ulcerative colitis and Crohn’s disease.
Describe the features of Crohn’s that allow you to differentiate between Crohn’s and UC?
Crohn’s Nests (like crows nests).
No blood or mucus (less common).
Entire GI tract.
Skip lesions upon endoscopy (gaps in the inflammation).
Terminal ileum most affected and Transmural (full thickness) inflammation. (This will make the complications worse).
Smoking is a risk factor (don;t set the nest on fire).
Crohn’s also associated with weight loss due to malabsorption, strictures and fistulas.
How would a patient present with IBD?
Diarrhoea. Abdominal pain. Passing blood. Weight loss. And others.
What tests are done to look investigate IBD?
Bloods: LFT’s, anemia, CRP (C-reactive protein is an indicator for inflammation of the body). thyroid and kidney function
Faecal calprotectin is released by the intestines and is more than 90% sensitive to IBD in adults.
Endoscopy with biopsy is diagnostic.
Imaging with ultrasound, CT, MRI can help to look for complications.
Describe the initial management of Crohn’s?
Aim: Induce and maintain clinical remission and to achieve mucosal healing.
First line is: Corticosteroids like oral prednisone or IV hydrocortisone.
If steroids don’t work maybe add immunosuppressents like Azathroprine.
Methotrexate.
Can you get granulomas in Crohn’s.
Yes, non-casesating granulomas as well.
What are the complications of Crohn’s disease?
Malabsorption (vitamin deficiency, anaemia…).
Fistulas - Abnormal connection between two hollow spaces with epithelialized surfaces like blood vessels, intestines, example would be a gastrocolic fistula.
Anal disease.
Bowl obstruction.
Perforation (hole in the lining of the bowl.
Which part of the bowel is usually most affected by Crohn’s Disease?
The terminal ileum and the ascending colon, but it can aslo affect the whole GI tract.
Describe how you would maintain remission of Crohn’s after the initial stages of treatment?
First line is Azathioprin and Mercaptopurine (often used with methotrzate)
^Immunosuppressents.
Why would surgery be used for treating Crohn’s?
Surgery would only be done if it was only affecting the distal ileum. It is possible to surgically respect this area to prevent further flare ups. You can also us surgery for treating strictures and fistulas secondary to Crohn’s.
How do you manage inducing remission in Ulcerative Colitis?
Mild to moderate:
First line - Aminosalicylate (oral or rectal mesalazine.
Second line - Corticosteroids (prednisolone).
Severe disease:
First line: IV corticosteroid (hydrocortisone).
Second line: IV ciclosporin.
What treatment is given to maintain remission of Ulcerative Colitis?
Aminosalicylate (mesalazine oral or anal).
Azathioprine.
Mercaptopurine.
Why is surgery more common in Ulcerative Colitis than Crohn’s disease?
UC typically only affects the colon and the rectum, whilst Crohn’s often affects the the whole GI tract. So in UC you can perform a panproctocolectomy (removing the colon and the rectom).
If someone has a Panproctocolectomy performed on them, what are there options for synthetic alternatives?
They could have a permanent ileostomy.
They can also have an ileo-anal anastomosis (J-pouch). This is where the ileum is folded back on itself and fashioned into a larger pouch that functions a bit like a rectum. This then collects stools prior to it being passed.
What are some of the complications of Ulcerative colitis?
Toxic megacolon - Colon swells up to massive size. It will rupture unless removed.
Colorectal carcinoma - Chronic inflammation leads to epithelial dysplasia and then carcinoma.
Blood loss.
