IBD Flashcards
What are all the forms of IBD?
Crohn's disease Ulcerative colitis Microscopic ulcerative colitis Microscopic lymphatic colitis Microscopic collagenous colitis
What factors affect likelihood of developing IBD?
Genetics
Environmental susceptibility
Immune response
Which environmental factors are risk factors for IBD?
Smoking
NSAIDs
Good hygiene
Psychological stress
In what way is intestinal microbiota different in IBD?
Reduced diversity of gut flora
Decreased mucosal and chemical barrier
In what way is the immune response different in IBD?
Overactive mucosal immunological response
Leaky epithelium increases chance of immune response
Where does CD most commonly affect?
Terminal ileum and ascending colon
What is proctitis?
UC affecting the rectum alone
What is extensive colitis?
UC affecting the whole colon
What is backwash colitis?
UC with inflammation of the distal terminal ileum
What are the macroscopic changes in CD?
Involved bowel is thickened and often narrowed
Cobblestone appearance
Intra-abdominal fistulae and abscesses may be seen
What are the macroscopic changes in UC?
Mucosa is red, inflamed and friable
Severe disease may have extensive ulceration with pseudo-polyps
What are the microscopic changes in CD?
Transmural inflammation
Increase in inflammatory cells
Lymphoid hyperplasia
Granulomas in over half
What are the microscopic changes in UC?
Superficial inflammation
Chronic inflammatory cell infiltrate in the lamina propria
Crypt abscesses
Goblet cell depletion
What is the term for when it is not possible to distinguish between CD or UC?
Indeterminate colitis
What are the extraintestinal manifestations of IBD that can manifest in the eyes?
Uveitis
Episcleritis
Conjunctivitis
What are the extraintestinal manifestations of IBD that can manifest in the skin?
Erythema nodosum
Pyoderma gangrenosum
What are the extraintestinal manifestations of IBD that can manifest in the liver and biliary tree?
Sclerosing cholangitis Fatty liver Chronic hepatitis Cirrhosis Gallstones
How does microscopic colitis present?
Chronic or fluctuating watery diarrhoea
Describe microscopic ulcerative colitis
Chronic inflammatory cell infiltrate in the lamina propria
Deformed crypt architecture
Goblet cell depletion
Describe microscopic lymphocytic colitis
Surface epithelial cell injury
Prominent lymphocytic infiltration in surface epithelium
Increase in lamina propria mononuclear cells
Describe microscopic collagenous colitis
Thickened sub epithelial collagen later adjacent to basal membrane
Increased infiltration of the lamina propria with lymphocytes and plasma cells
Surface epithelium damage
What are the symptoms of CD?
Diarrhoea (+/- blood) Abdominal pain Weight loss and anorexia Malaise, lethargy Nausea and vomiting Low grade fever
What signs of CD can be seen on examination?
Weight loss Signs of malnutrition Aphthous ulceration Abdominal tenderness or iliac fossa mass occasionally Anal fissures or abscesses
What blood tests are done in suspected IBD?
FBC CRP/ESR LFTs Blood culture if septicaemia suspected Serology
Which stool tests may be done in suspected IBD?
Stool culture, including C. diff if diarrhoea
Stool microscopy if travel history
Faecal calprotectin raised in active intestinal disease
Which endoscopic and imaging tests are done in suspected CD?
Colonoscopy with biopsy Upper GI endoscopy Small bowel imaging Ultrasound scanning Capsule endoscopy if radiological examination is normal
How is disease activity of CD assessed?
Hb White cell count Inflammatory markers Serum albumin Faecal calprotectin or lactoferrin
What medication is used to induce remission in a flare up of CD?
Steroids
Enteral nutrition
TNF-alpha if resistant to steroids or if disease is more extensive, preferably in combination with immunosuppressants
What medication is used to maintain remission of CD?
Long-term immunosuppressants, e.g. azathioprine, methotrexate
Anti-TNF (infliximab) for patients who are resistant to immunosuppressants
What are the symptoms of UC?
Diarrhoea with blood and mucus Abdominal discomfort Malaise, lethargy Anorexia and weight loss Aphthous ulceration may be seen
How is a severe attack of UC defined?
Stool frequency >6 per day with blood Fever Tachycardia ESR >30 Anaemia - Hb<100 Albumin <30
What is the management for a severe attack of UC?
- Admit to hospital
- Exclude enteric infection
- Confirm diagnosis with limited flexible sigmoidoscopy
- Assess fluid status
- Give prophylactic anti-coagulation
- IV hydrocortisone
- Monitor
What is toxic megacolon?
AXR showing thin walled colon with diameter of >6cm
Gas filled and containing mucosal islands
Impending perforation and high mortality
What signs of UC can be seen on examination?
Abdomen may be slightly distended and tender
Tacycardia and pyrexia indicate severe disease
PR exam reveals the presence of blood
What medication is used by most UC patients?
Aminosalicyclate
What is the order medication is tried in UC?
5-ASA (aminosalicyclate)
Steroids
Immunosuppressant
Anti-TNF
What are the indications for surgery in UC?
In an acute attack: failure of medical treatment, toxic megacolon, haemorrhage, imminent perforation
In chronic disease: incomplete response to medical treatment
Dysplasia on surveillance colonoscopy
What is the operation of choice for UC in acute disease?
Subtotal colectomy with end ileostomy and preservation of rectum
