IBD Flashcards
IBS symptoms
In presceding 12m, 12 consecutive weeks of abdominal discomfort/pain, with 2/3 of…
relieved with defecation
onset associated with change in frequency of stool
onset associated with change in form of stool
Other symptoms…
Bloating
Passage of mucus
Stool passage symptoms: tenesmus, incomplete evacuation
Associated gynaecological symptoms: dysmenorrhoea/dyspareunia
Urinary symptoms: frequency, urgency, nocturia
Back pain
Crohn’s epidemiology
50/100,000
Incidence peaks at 15-30, then 60y
Risk factors: poor diet, smoking, altered immune states
Crohn’s pathology
Mouth to anus inflammation (commonly ileum and ascending colon)
One/multiple areas
Involved bowel: narrow, thickened wall, deep ulcers, involving all layers of the bowel
Fistulae + stenosis common
Cobblestone appearance on CT
Histological: transmural inflammation, lymphoid hyperplasia and granulomas
Crohn’s clinical features
Abdominal pain (varying) Steatorrhoea: ileal disease Bloody diarrhoea: colonic disease Weight loss/failure to thrive Severe apthous ulceration of the mouth (early sign) Anal complications (fissure, fistula, haemorrhoids, skin tags, abscesses) Extra GI manifestations Can present with acute RIF pain/mass
Ulcerative colitis epidemiology
100-200/100,000
Incidence peaks at 15-30, then 60y
Smoking is protective
F>M
Ulcerative colitis pathology
Inflammation beginning in rectum, extending proximally along the colon (proctitis affects rectum alone)
Inflammation of terminal ileum (backwash ileitis
Inflammation only affects mucosa: excessively ulcerated
Adjacent mucosa has appearance of inflammatory polyps
Histological: mucosal inflammation, crypt abscess and goblet cell depletion
Ulcerative colitis clinical features
Crampy lower abdominal discomfort
Gradual onset diarrhoea (often bloody)
Urgency and tenesmus (if disease confined to rectum)
Extra GI symptoms
IBD investigations
Bloods: FBC, U&E, CRP/ESR, LFT, serum iron/B12/folate if anaemia
Stool studies: stool chart, MCSxs (infective causes), calprotectin (rule out IBD in general practice)
Radiology: AXR/CXR (acute), CT in Crohn’s
Endoscopy: rigid/flexible sigmoidoscopy in UC, colonoscopy, endoscopic rectal biopsy
General IBD complications
Bowel perforation
Lower GI haemorrhage
Toxic dilatation (more common in UC)
Colonic carcinoma: crohn’s>UC
Toxic dilatation presentation
Persistent pyrexia, tachycardia, loose blood-stained stool
Falling albumin/K+
AXR: dilated >6cm colon with mucosal islands
Perforation imminent
Crohn’s disease complications
Small bowel obstruction
Fistulae (10%)
Abscess formation
B12/folate/iron deficiency
Extra-colonic manifestations of IBD
Eye’s : conjunctivitis/episcescleritis/iritis
Joints: arthralgia of large joints
Skin: erythema nodosum, pyoderma gangrenosum
Venous thrombosis
Fatty liver
Associated: autoimmune hepatitis, gallstones, renal calculi, primary sclerosing cholangitis (UC), cholangiocarcinoma (UC), ankylosing spondylitis (HLA B27 +ve crohns)
What can trigger symptoms of IBS?
Fructose and lactose
Visceral hypersensitivity
Diarrhoea/flatus
What is a risk factor for IBS?
Gastroenteritis (norovirus, rotavirus)
Stress