IBD Flashcards
Name the two types of inflammatory bowel disease
Crohn’s disease
Ulcerative Colitis
How does smoking relate to Inflammatory bowel disease?
In Crohn’s disease smoking Accelerates disease progression
Less likely to respond to treatment
Smoking cessation effective treatment
In ulcerative colitis smoking has a protective effect. Onset of UC commonly follows
smoking cessation
nicotine patches as effective
as 5 ASA
Which drugs are known to initiate IBD or cause a relapse?
NSAIDS
Oral contraceptives
Opioids (loperamide, codeine)
How does physical activity relate to IBD and the different types?
Regular exercise reduces the risk of developing crohn’s disease - not ulcerative colitis
Reduces the relapse of crohn’s disease and possibly ulcerative colitis
At what age group is ulcerative colitis likely to happen?
20-40
Which areas of the bowel does Ulcerative colitis effect?
Colon and rectum only
Almost always rectum plus various amounts of colon
Describe the nature of inflammation found in ulcerative colitis?
Continues inflammation limited to the lamina propria / Mucosa- inner most layer
When someone presents with ulcerative colitis, what may their presenting complains be?
Diarrhoea - urgency Blood in stool Fatigue Weight loss low grade pyrexia Cancer Extra- intestinal manifestations
If proctitis (confined to rectum only) PR bleeding and mucus discharge, increased frequency and urgency of defecation, and tenesmus
How does having an appendectomy relate to IBD?
It has a proactive effect with ulcerative colitis
Where in the abdomen is a patient likely to experience pain with IBD?
Crohns- lower right abdomen - right iliac/right lumbar
Ulcerative colitis- Umbilical region
The pain is cramping pain
What are the signs of ulcerative colitis?
Tender abdomen – LIF generally mild
Pallor
Tachycardia
Leuconychia - malnutrition- white discoloration on the nails
Hypotensive
Extra-intestinal manifestations
In IBD what are the extra intestinal symptoms people may present with? (13)
- Joint inflammation and pain (arthritis) usually effects large joint, elbows, wrists, knees and ankles
- small joints of hands and feet can also be effected. Pain tends to be longer lasting and persist even after IBD is in remeission
More common in crohns and UC
sacroiliitis; ankylosing spondylitis
-Skin conditions such as erythema nodosum - raised tender red or violet swellings 1.5 cm in diameter, usually on the front of legs bellow the knee
Sweet’s Syndrome- sudden tender/ painful red nodules on the upper limbs, face and neck, sometimes with a fever. Assocaited with IBD treated with steroids or immunosurpressants
Pyoderma gangrenosum
Painful mouth sores/ ulcers- may go on their own or with steroid treatment
episcleritis, which affects the layer of tissue covering the sclera. scleritis (inflammation of the sclera itself) and uveitis (inflammation of the iris). These conditions are a lot more serious and can lead to loss of vision if not treated
Kidney stones- due to due to inflammation in the small bowel causing fat malabsorption, so the fat binds to calcium, leaving a molecule called oxalate free to be absorbed and deposited in the kidneys where it can form stones. Another cause of kidney stones is dehydration, which can be caused by fluid loss from diarrhea
Liver- About one in three people with Crohn’s develop gallstones. Primary sclerosing cholangitis, fatty liver, Autoimmunehepatitis
People with IBD are more than twice as likely to develop blood clots, including DVT (deep vein thrombosis) in the legs, and pulmonary embolisms in the lungs
osteoporosis
Anaemia- Iron deficiency, vitamin deficiency (B12, folate)- block loss and lack of absorption
Clubbing
In the blood tests for someone with ulcerative colitis, what are you likely to find?
Anaemia – microcytic Low ferritin, low albumin Raised inflammatory markers Low magnesium (absorbed in the colon) Low potassium
Which imaging techniques are used in someone with suspected ulcerative colitis?
Plain AXR
Endoscopy
Under which circumstance will Ulcerative colitis spread beyond the ileocaecal valve?
backwash ileitis
What is the cause of ulcerative colitis?
Inappropriate immune response against (?abnormal) colonic flora in genetically susceptibile individuals
If you suspect someone may have ulcerative colitis, which tests/ investigations should your order?
FBC ESR CRP U&E LFT Blood cultures Stool MC&S/CDT Faecal calprotectin- for GI inflammation Abdominal X ray Lower GI endoscopy / biopsy: flexible sigmoidoscopy in acute cases to assess and biposy full colonoscopy once controlled to define disease extent
