IBD Flashcards
What is the difference between UC and Crohns
UC- mainly colon
Crohns - mouth to anus, most common in terminal ileum
UC has contiguous distribution
Crohns - skip lesions
Is UC or Crohn’s more likely to have pseudopolyps?
UC
Granulomas
Crohns
What complications are associated with crohns?
fibrosis -> strictures
Fistulae
Why are fistula more common in …?
Crohns because the inflammation is transmural
Tell me about Crohns
A type IBD that can affect any part of digestive tract from mouth to anus.
most common in women in their 20s.
characterised by skip lesions of ulceration that resembles cobblestone mucosa.
Granulomas are often present.
There is marked fibrosis and complications include strictures and fistulae.
What would a patient with Crohn’s present with?
Diarrhoea, weight loss, abdominal pain.
on exam - glossitis, aphthous ulcers, may have a RIF mass if severe fibrosis
- perianal abscesses
systemic
- fever and malaise in active disease
What in a history would lead you to a diagnosis of Crohns over UC?
no blood PR
younger age of presentation 20s
smoker (increased risk in crohns, protective in uc)
if presented with perianal abscess or tags
weight loss -> more supportive of crohns because most absorption occurs in the ileum.
What could be seen on colonoscopy in patient with UC?
Inflammation of the mucosa
a continuous pattern of shallow, broad ulceration
in the colon
Which is more likely to resent with blood PR?
UC
Which is more likely to present with bowel obstruction?
Crohns
more likely a SBO
Why would a patient with Crohns have gallstones?
Fat malabsorption
What are the consequences of malabsorption in crohns?
weight loss fat - steatorrhoea B12 - megaloblastic anaemia vitD - osteomalacia Protein - oedema
Which is tenesmus most associated with?
UC
What are the symptoms of UC?
Diarrhoea, often bloody ±mucous PR
abdominal discomfort
tenesmis and faecal urgency
What are extra-abdominal findings of IBD?
Skin - clubbing, erythema nodosum , pyoderma gangrenous
Eyes - iris
joints - arthritis, sacroilitis
Oxyaate renal stones
What markers can be used for assessing the severity of crohns disease?
FBC - low HB+ high WCC
LFTs showing low albumin
Elevated CRP
Ddx in patient w/ Diarrhoea
Gastroenteritis - bloody causes ( camp, e coli, shigella, salmonella) age - CRC -> scope UC or Crohns Diverticulitis
What are the acute complications of UC?
Perforation
Bleeding
toxic megacolon
VTE
How would you quantify the severity of UC?
Truelove and Witts Critera ( only for UC, not crohns )
based on no of bowel motions, amount of PR bleeding, fever, HR, Hb,ESR
Also a Mayo score
How would you manage a patient with acute severe UC?
Admit them for rests fluids
IV Hydrocortisone 100mg QDS
Thromboprophylaxis - LMWH enoxaparin
continuo monitoring until improvement then move to oral therapy - oral prednisolone + a mesalamine durgand then taper after remission
If no improvement - medical options include cyclosporin, infliximab
or surgery - colectomy
What are the indications for surgery in UC?
Toxic megacolon Perforation Massive haemorrhage Failure to respond to medical tx elective surgery may be done in patients with chronic symptoms despite medical therapy or for carcinoma or high grade dysphasia
What are the surgical options for UC?
- Panproctocolectomy with an end ileostomy or J pouch ( oleo-anal anastomosis)
- total colectomy with Ileo-rectal anastamosis ( but there is a risk of recurrence in the rectum and higher risk of rectal carcinoma than rest of population)
What treatment is used for inducing remission in mild/mod disease uc?
Generally can be done as an outpatient 1st line is mesalazine ( a 5asa) 2nd line is prednisolone PO or if left sided disease suppositories may be an option or enemas or foams for more proximal disease
additional steroid sparing options include azathioprine or mercaptopurine or infliximab
What does 5ASA stand for?
5 aminosalycilic acid
Treatment of IBD
Intervene early to avoid the later complications
Terminal ileal disease = budesonide 8 weeks
UC and Crohns
1st line - least toxic, less side effects - mesalazine
mesalazine does NOT work in crohns
2nd line - steroid depending on severity
- If hospitalised IV hydrocortisone
3rd line - azathioprine (an immunomodulator) (takes 10weeks to take effect)
4th - biological treatments - anti-TNF e.g. infliximab/adilumab ( must exclude a latent TB infection before starting)
if perianal disease - oral abx metronidazole. local surgery ±seton insertion
( liquid enema, foam, suppository if proctitis)
Drainpipe colon
UC
Gallstones
Crohns
a 20-year-old woman presents with recurrent episodes of abdominal pain associated with bloating. The pain is relieved on defecation. She normal passes 3 loose stools with mucous in the mornings
IBS
Primary sclerosing cholangitis is associated with what type of IBD?
Ulcerative colitis
Perianal disease associated with which IBD?
Crohns
Small bowel lymphoma is associated with what GI disease?
Coeliac
goblet cells in crohns and uc
increased in crohns
deplete in uc
tx of mild-mod flare of UC
In a mild-moderate flare of distal ulcerative colitis, the first-line treatment is topical (rectal) aminosalicylates
What is typically used to used to induce remission of Crohn’s disease?
Glucocorticoids oral, topical or IV e.g. prednisolone
