IBD Flashcards
what is Crohns?
a disorder charcaterised by transmural granuomatous inflammation of the GI tract. It can involve any part of the GI tract and is characterised by skips lesions
what are the pathological features of Crohns ?
commonly focused in terminal ileum and caecum but can affect anywhere
affected bowel looks blue-grey, thickened with spiral surface vessels and fat wrapping
transmural granulomatous inflammation in the form of lymphoid aggregates. Mucosal crypt ulceration and fissures
perforation, fistulation and abscess
extensive fibrosis and SM hyperplasia may lead to stenosis
what are the clinical features of Crohns ?
Abdo pain
- Right lower quadrant and peri-umbilical usually. Colicky nature
Diarrhoea
- typically non-bloody and mucous
Systemic symptoms
- malaise, anorexia, low grade fever
Oral ulcers
perianal disease
- skin tags, abscesses, fistulae and stenosis
what are the extra-intestinal features of crohn’s ?
MSK
- enteropathic arthritis
- nail clubbing
- metabolic bone disease
Skin
- erythema nodosum
- pyoderma gangrenosum
Eyes
- episcleritis
- uveitis
- iritis
Hepatobiliary
- PSC (more common in UC)
- Gallstones
Renal
- stones
what InV are done in crohn’s ?
FBC
- leukocytosis and anaemia
- possible thrombocytosis
Increased CRP
Faecal calprotectin
Colonoscopy and biopsy
CT abdo-pelvis
- obstruction, perforation, fistula
Iron, B12 and folate studies
- ?deficiency due to malabsorption
what is the medical management of crohns?
Prednisolone for acute exacerbations
Budesonide for chronic
Immunosupression
- Azathioprine
- MTX
Assess thiopurine methyltransferase (TPMT) activity before offering
azathioprine or mercaptopurine.
5-ASA (sulfasalazine and mesalazine)
Biologics
- infliximab usually
what is the surgical management of Crohns ?
around 70-80% of crohns patients require surgery
ileocaecal resection - removal of terminal ileum and caecum with primary anastomoses
Sugery for peri-anal disease - abscess drainage, stent insertion
stricturoplasty
bowel resection
what are the complications of crohns?
fistula - enterovesical, enterocutaneous, rectovaginal
stricture
perianal abscess
colorectal cancer
malabsorption
what is ulcerative colitis?
an inflammatory bowel disease that characteristically involves the rectum and extends proximally to affect a variable lenght of the colon
bimodal age incidence of 15-25 and 50-65
that are the pathological features of UC?
grannular, hypervascular and oedematous mucosa wiht loss of vascular pattern seen at endoscopy
acute neutrophil infiltration of the colonic mucosa and submucosa with mucosal crypt abscess and goblet cell mucin depletion
ulceration which becomes confluent with only islands of inflammed mucosa and granulation tissue remanining (pseudopolyposis)
chronic ‘burnt out disease’ leads to a pale, featureless, ahaustral pattern to the colon
what are the clinical features of UC?
proctitis
- loose, bloody, mucous stools
- rectal bleeding
- urgency and frequency
left sided colitis
- abdo pain
- dehydration and electrolyte imbalance
- systemic symptoms of malaise, anorexia and low grade pyrexia
Pancolitis
- backwask ilitis
- anaemia, hypoalbuminaemia, hypokalaemia
what are the extra-intestinal features of UC?
enteropathic arthritis clubbing erythema nodosum uveitis or iritis PSC
what are the InV of UC?
FBC and CRP
- increased WCC and CRP
- decreased Hb and albumin
faecal calprotectin
AXR
- thumbprinting (i.e oedematous colonic mucosa)
- toxic megacolon
- lead pipe colon (v. severe disease)
Colonoscopy/flexi-sig with biopsy
- loss of vascular markings
- diffuse erythema
- mucosal granularity
- biopsy = mucosal atrophy, basal plasmacytosis
stool microscopy and culture
- exclude infectious cause
what is the medical management of UC?
5-ASA corticosteroid azathioprine tacrolimus infliximab
what is the surgical management of UC ?
indicated when refractory to medical treatment or complications
total protocolectomy with ileostomy
sub-total colectomy with preservation of rectum
