IBD Flashcards
What are the three types of IBD?
- UC
- Crohn’s
- Indeterminate Colitis
What are the features of Crohn’s Disease?
NESTS (Crows Nests)
No blood or mucus Entire GI tract Skip lesions Transmural inflammation Smoking is a RF
What other features are seen in Crohn’s?
- WL
- Strictures
- Fistulae
Where does Crohn’s usually affect?
Terminal Ileum
What are the features of UC?
CLOSE-UP
Continuous inflammation Limited to colon and rectum Only superficial Smoking protects Excrete blood and mucus Use aminoalicylates PSC association
How does IBD present?
- Diarrhoea
- Abdominal pain
- Passing blood
- Weight loss
What bloods should be done in IBD?
- FBC (anaemia, white cells)
- Thyroid function
- UsEs (Kidney function, bleeds)
- LFTs
- CRP (active disease/inflammation)
What orifice tests should be done for IBD?
- Faecal calprotectin
- Colonoscopy with biopsy
What is faecal calprotectin?
- Measure of inflammation anywhere in the GI tract
How specific and sensitive is faecal calprotectin for IBD?
90%
What can also raise faecal calprotectin?
- Diverticulitis
- Colorectal Ca
- RTI
What imaging is useful for IBD?
CT (for complications)
- Fistulae
- Abscesses
- Strictures
How is remission induced in CROHN’S?
Steroids (PO Pred/IV Hydro)
If steroids alone don’t induce remission in CROHN’S, what can you do?
Add an immunosuppressant
What drugs are first line for maintaining remission in CROHN’S?
- Azathioprine
- Mercaptopurine
How does azathioprine work?
Inhibits purine synthesis (cannot produce DNA/RNA)
How does mercaptopurine work?
Inhibits PRPP amidotransferase in PURINE SYNTHESIS
What alternatives are there for IBD?
- Methotrexate
- Infliximab
- Adalimumab
What surgery is used in CROHN’S?
Treat complications e.g. strictures, fistulae
How is remission induced in mild/moderate UC?
1st- Aminosalicylate (Mesalazine PO)
2nd- Corticosteroids (PO Pred)
How is remission induced in severe UC?
1st- IV Corticost. (Pred)
2nd- IV Ciclosporin
How is remission maintained in UC?
1st- Aminosalicylate (Mesalazine PO/PR)
2nd- Azathioprine/mercaptopurine
How is UC surgically treated?
Colon resection is curative
What surgery may be used to resect the colon for UC?
- Panproproctocolectomy (colon and rectum)
What may be used following panproctocolectomy?
- Ileostomy
- Ileo-anal anastamosis (‘J-Pouch’)
What is a J-pouch?
Ileum folded back on itself to make a storage pouch for faeces
