IBD Flashcards

1
Q

IBS symptoms

A

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

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2
Q

Crohn’s epidemiology

A

50/100,000
Incidence peaks at 15-30, then 60y
Risk factors: poor diet, smoking, altered immune states

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3
Q

Crohn’s pathology

A

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

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4
Q

Crohn’s clinical features

A
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
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5
Q

Ulcerative colitis epidemiology

A

100-200/100,000
Incidence peaks at 15-30, then 60y
Smoking is protective
F>M

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6
Q

Ulcerative colitis pathology

A

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

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7
Q

Ulcerative colitis clinical features

A

Crampy lower abdominal discomfort
Gradual onset diarrhoea (often bloody)
Urgency and tenesmus (if disease confined to rectum)
Extra GI symptoms

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8
Q

IBD investigations

A

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

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9
Q

General IBD complications

A

Bowel perforation
Lower GI haemorrhage
Toxic dilatation (more common in UC)
Colonic carcinoma: crohn’s>UC

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10
Q

Toxic dilatation presentation

A

Persistent pyrexia, tachycardia, loose blood-stained stool
Falling albumin/K+
AXR: dilated >6cm colon with mucosal islands
Perforation imminent

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11
Q

Crohn’s disease complications

A

Small bowel obstruction
Fistulae (10%)
Abscess formation
B12/folate/iron deficiency

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12
Q

Extra-colonic manifestations of IBD

A

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)

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13
Q

What can trigger symptoms of IBS?

A

Fructose and lactose
Visceral hypersensitivity
Diarrhoea/flatus

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14
Q

What is a risk factor for IBS?

A

Gastroenteritis (norovirus, rotavirus)

Stress

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