IBD Flashcards
What are the signs and symptoms of IBD?
- Persistent diarrhoea with possible blood or mucus in the stool
- Rectal bleeding
- Abdominal pain
- Tenesmus
- Fever
- Weight loss
- Vomiting
- Cramps
- Muscle spasms
What is IBD?
A group of conditions that causes inflammation of the GI tract
It is relapse remitting
What is Crohn’s disease?
Can affect any part of the GI tract
Crow’s NESTS
N - No blood or mucus (less common)
E - Entire GI tract
S - Skip lesions
T - Terminal ileum most affected and Transmural (full thickness) inflammation
S - Smoking is a risk factor (don’t set the nest on fire)
What is Ulcerative colitis?
Inflammation of the colon
Spreads distal to proximal
U – C – CLOSEUP C - Continuous inflammation L - Limited to colon and rectum O - Only superficial mucosa affected S - Smoking is protective E - Excrete blood and mucus U - Use aminosalicylates P - Primary sclerosing cholangitis
What is the site of origin of CD?
Terminal ileum
What is the site of origin of UC?
Rectum/distal colon
What are the common features of CD?
- Diarrhoea usually non-bloody
- Weight loss more prominent
- Upper GI symptoms (mouth ulcers, perianal disease)
- Abdominal mass palpable in right iliac fossa
What are the common features of UC?
- Bloody diarrhoea
- Abdominal pain in LLQ
- Tenesmus
What are the extra-intestinal features of CD?
- Gallstones secondary to reduced bile acid reabsorption
* Oxalate renal stones
What are the extra-intestinal features of UC?
• Primary sclerosing cholangitis
What are the complications of CD?
- Obstruction cause by bowel stricture
- Fistula
- Colorectal cancer
What are the complications of UC?
• Higher rx of colorectal cancer
What is the pathology of CD?
- Lesions may be seen anywhere from the mouth to anus
* Skip lesions -> patchy inflammation
What is the pathology of UC?
- Inflammation starts in the rectum and never spreads beyond the ileocaecal valve
- Continuous disease
What is the histology of CD?
Inflammation in all layers from mucosa to serosa
• Increased goblet cells
• Granulomas
What is the histology of UC?
No inflammation beyond submucosa (unless fulminant disease) – inflammatory cells infiltrate lamina propria
• Neutrophils migrate through walls of glands to form crypt abscesses
• Depletion of goblet cells and mucin from gland epithelium
• Granulomas are infrequent
What is seen on endoscopy with CD?
- Deep ulcers
- Skip lesions
- ‘Cobble-stone’ appearance
What is seen on endoscopy with UC?
Widespread ulceration with preservation of adjacent mucosa which has appearance of polyps (pseudopolyps)
What is seen on radiology with CD?
Small bowel enema • High sensitivity and specificity for examination of the terminal ileum • Strictures: Kantor’s string sign • Proximal bowel dilation • ‘Rose-thorn’ ulcers • Fistulae
What is seen on radiology with UC?
Barium enema
• Loss of haustrations
• Superficial ulcerations, ‘pseudopolyps’
• Long standing disease: colon is narrow and short -> ‘drainpipe colon’
When do you not prescribe anti-diarrhoea drugs for IBD?
When unsure of the diagnosis
- can precipitate toxic megacolon in UC
What investigations would you order for IBD?
- Routine bloods for anaemia, infection, thyroid, kidney and liver function
- CRP
- Faecal calprotein
- Endoscopy with biopsy is diagnostic
- Imaging with US, CT and MRI can be used to look for complications
How do you manage CD and UC?
- Assess risk of osteoporosis
* Screening for colorectal cancer
How do you induce remission in CD?
1st Prednisolone
2nd Immunosuppressants
- Azathioprine, Mercaptopurine or Methotrexate
- Added to corticosteroid therapy if 2 + exacerbations in a year or if the corticosteroid dose cannot be tapered
What is the risk with immunosuppressants?
Increase risk of melanoma
How do you maintain remission in CD?
1st = immunosuppressants
2nd = biologic therapy
• Infliximab and Adalimumab
How do you induce remission in UC?
1st Aminosalicylates
• Mesalazine and sulfasalazine (oral or rectal)
2nd Corticosteroids
• Prednisolone
Severe disease:
• IV hydrocortisone
• IV ciclosporin
How do you maintain remission in UC?
1st Aminosalicylates
• Mesalazine and sulfasalazine (oral or rectal)
Immunosuppressants
• Thiopurines (azathioprine, mercaptopurine)
