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TCA 15 - Abdominal Pain > IBD > Flashcards

IBD Flashcards

1
Q

What are the signs and symptoms of IBD?

A
  • Persistent diarrhoea with possible blood or mucus in the stool
  • Rectal bleeding
  • Abdominal pain
  • Tenesmus
  • Fever
  • Weight loss
  • Vomiting
  • Cramps
  • Muscle spasms
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2
Q

What is IBD?

A

A group of conditions that causes inflammation of the GI tract
It is relapse remitting

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3
Q

What is Crohn’s disease?

A

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)

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4
Q

What is Ulcerative colitis?

A

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
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5
Q

What is the site of origin of CD?

A

Terminal ileum

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6
Q

What is the site of origin of UC?

A

Rectum/distal colon

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7
Q

What are the common features of CD?

A
  • Diarrhoea usually non-bloody
  • Weight loss more prominent
  • Upper GI symptoms (mouth ulcers, perianal disease)
  • Abdominal mass palpable in right iliac fossa
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8
Q

What are the common features of UC?

A
  • Bloody diarrhoea
  • Abdominal pain in LLQ
  • Tenesmus
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9
Q

What are the extra-intestinal features of CD?

A
  • Gallstones secondary to reduced bile acid reabsorption

* Oxalate renal stones

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10
Q

What are the extra-intestinal features of UC?

A

• Primary sclerosing cholangitis

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11
Q

What are the complications of CD?

A
  • Obstruction cause by bowel stricture
  • Fistula
  • Colorectal cancer
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12
Q

What are the complications of UC?

A

• Higher rx of colorectal cancer

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13
Q

What is the pathology of CD?

A
  • Lesions may be seen anywhere from the mouth to anus

* Skip lesions -> patchy inflammation

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14
Q

What is the pathology of UC?

A
  • Inflammation starts in the rectum and never spreads beyond the ileocaecal valve
  • Continuous disease
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15
Q

What is the histology of CD?

A

Inflammation in all layers from mucosa to serosa
• Increased goblet cells
• Granulomas

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16
Q

What is the histology of UC?

A

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

17
Q

What is seen on endoscopy with CD?

A
  • Deep ulcers
  • Skip lesions
  • ‘Cobble-stone’ appearance
18
Q

What is seen on endoscopy with UC?

A

Widespread ulceration with preservation of adjacent mucosa which has appearance of polyps (pseudopolyps)

19
Q

What is seen on radiology with CD?

A 
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
20
Q

What is seen on radiology with UC?

A

Barium enema
• Loss of haustrations
• Superficial ulcerations, ‘pseudopolyps’
• Long standing disease: colon is narrow and short -> ‘drainpipe colon’

21
Q

When do you not prescribe anti-diarrhoea drugs for IBD?

A

When unsure of the diagnosis

- can precipitate toxic megacolon in UC

22
Q

What investigations would you order for IBD?

A
  • 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
23
Q

How do you manage CD and UC?

A
  • Assess risk of osteoporosis

* Screening for colorectal cancer

24
Q

How do you induce remission in CD?

A

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
25
Q

What is the risk with immunosuppressants?

A

Increase risk of melanoma

26
Q

How do you maintain remission in CD?

A

1st = immunosuppressants

2nd = biologic therapy
• Infliximab and Adalimumab

27
Q

How do you induce remission in UC?

A

1st Aminosalicylates
• Mesalazine and sulfasalazine (oral or rectal)

2nd Corticosteroids
• Prednisolone

Severe disease:
• IV hydrocortisone
• IV ciclosporin

28
Q

How do you maintain remission in UC?

A

1st Aminosalicylates
• Mesalazine and sulfasalazine (oral or rectal)

Immunosuppressants
• Thiopurines (azathioprine, mercaptopurine)

TCA 15 - Abdominal Pain (5 decks)

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