IBD

Question 1

Define IBD?

Answer 1

Inflammatory bowel disease. Consists of 2 main diseases: Ulcerative colitis and Crohn’s disease. Inflammation amd ulceration in the bowel.

Question 2

Diagnosis process?

Answer 2

Clinical presentation, full history/examination, Lab tests, endoscopy

Question 3

Investigations?

Answer 3

Bedside: stool test (faecal calprotectin), Blood tests: FBC (Hb down, WBC up), C-reactive, low albumin, Ferritin, Vitamins, electrolytes, amylase (pancreas)

Question 4

Imaging?

Answer 4

X-ray (abdominal, erect chest), Barium meal CN/enema UC, CT/MRI

Question 5

Endoscopy?

Answer 5

Flexible sigmoidoscopy
Colonoscopy
Gastroscopy
BIOPSY

Question 6

Prevalance?

Answer 6

1:250

Question 7

Aetiology?

Answer 7

Not fully understood: a mixture of genetics, environment/lifestyle and mucosal immunology

Question 8

Lifestyle?

Answer 8

Connection to diet? stress? breastfeeding?

Question 9

Genes?

Answer 9

Over 100 identified but only accounts for 20-30% of cases

Question 10

Pathogenesis?

Answer 10

Initial factor unknown but -> Initial inflammation -> does not heal correctly -> overgrowth of mucosal bacteria, Inefficient killing phagocytosed bacteria, reduced bacterial clearance, increased permeability-> T-cell response leads to chronic inflammation

Question 11

UC? location? Inflamed?

Answer 11

Colon always involved sometimes rectal. Inflammation continues areas of large bowel

Question 12

CN? location?

Answer 12

Anywhere, pacthed areas with inflammation and ulcers, granulomas (gobblestone effect)

Question 13

Clinical signs and symptoms? CD

Answer 13

Diarrhoea, possible bleeding with rectal involvement, commonly lactose intolerant, weight loss common, nausea/vomiting and fatigue. Abdominal pain and discomfort.

Question 14

Clinical signs and symptoms? UC

Answer 14

Diarrhoea common with mucus, rectal bleeding common, often normal weight, anaemia, lethargy, constipation, abdominal pain/cramps relieved by using toilet

Question 15

Extra-intestinal signs?

Answer 15

Skin, eyes, joints. Clubbing and osteoporosis

Question 16

Complications

Answer 16

UC: Bleeding, perforations, cancers, stricture
CD: Abscess, cancers, fistulas, strictures/blockages and perforations

Question 17

Severity?

Answer 17

CDAI (Crohn’s disease activity index)
Remission CDAI <150, severe CDAI >450
Response medication, drop of 70 points
Harvey Bradshaw Index

Question 18

Treatment? AIM?

Answer 18

To induce and maintain remission. Medicines: Corticosteroids, antibiotics, 5-ASAs (UC), immunomodulators. Depending: Laxatives, Anti diarrhoeas, pain med. Supplement: Iron, Vit D, multivit
Enteral feeding: induce remission 10 days, 6-8 weeks. Treat deficiencies. Surgery: Over half at some point. UC can be cured

Question 19

Stoma?

Answer 19

Be aware of fluids. Hydration, anti-motility drugs, anti-secretory drugs