IBD Flashcards
What’s the macroscopic difference between Chron’s and UC?
- Chron’s anywhere along the bowel - UC only the large bowel
- Chron’s has oral and perianal disease - UC starts at the rectum and spreads from there
- Chron’s has discontinuous involvement - UC has continuous involvement
- Chron’s deep ulcers and fissures - UC superical red mucosa, bleeds easily
- chron’s has a stronger genetic association
What are the microscopic difference between chron’s and UC?
- Chron’s is transmural inflammation - UC mucosal layer inflammation
- Chron’s granuloma’s - UC none
- UC crypt abcess & goblet cell depletion - Chron’s none
What are some macroscopic presentations of chron’s?
- mouth to anal disease
- skip lesions (none diseased areas)
- fistulae and abscess
- ulcers
When does chron’s present? Typical Sx?
- adolescence/early adulthood.
- triad - abdo pain (colicky), weight loss, diarrhoea (may be bloody, may be fatty)
- peri-anal disease
- anal disease - fistulae
what are the extra-intestinal manifestation?
- erythema nodosum
- arthritis
- anterior uveitis, scleritis, episcleritis
- osteoporosis
- clubbing
Investigations for chron’s?
- bloods - FBC, folate, B12, CRP (disease activity)
- stool - faecal caprotectin
- colonoscopy + biopsy
What lifestyle advice is important for chron’s?
-STOP SMOKING
What is the stepwise ladder for inducing remission in chron’s?
same as usual expect mesalazine before MTX/azathio
- steroids - oral or IV (+/- parenteral feeding)
- 5-ASA - mesalazine
- azathioprine/MTX/mercaptopurine (test TMPTbefore start)
- infliximab
metronidazole in isolated peri-anal disease
How is remission maintained in chron’s?
- stop smoking
- azathioprine or metacapurine
- MTX
- mesalazine (if patient had previous surgery) (test TMPT before start)
What is the most common surgical intervention in chron’s?
-ileocecal resection - most common affected disease site
4 main complications of chron’s?
- obstruction
- small bowel cancer
- large bowel cancer (greater risk in UC)
- osteoporosis
What’s the anti-bodies present in UC and Chron’s?
Chron's = ASCA +ve (anti-saccharomyces cerevisiae) UC = ANCA -VE
Symptoms of UC?
- bloody diarrhoea
- urgency
- tenesmus (recurrent or continual feeling of needing to empty ones bowels)
- lower abdo pain
- systemic features
- extra intestinal features
investigations for UC are the same as Chron’s BUT there is one extra test you might do in an acute flare of UC. What is it and why?
- abdominal Xray
- rule out bowel dilation
- toxic mega colon is a complication of UC and needs treating aggressively FAST
What findings on a barium enema may you find for UC?
- loss of haustrations
- superficial ulcers
- colon is narrow and short
