IBD and IBS Flashcards
Signs of Crohn’s disease?
- Can be non-specific (weight loss and lethargy)
- Diarrhoea (most common symptom in adults; usually not bloody but can be bloody in Crohn’s colitis)
- Abdominal pain (most common symptom in children)
- Peri-anal disease (skin tags and ulcers)
- Can hav mouth ulcers
- Extra-intestinal features
- Mainly affects terminal ileum
Investigations for Crohn’s disease?
- FBC with CRP: raised inflammatory markers & anaemia, CRP correlates to disease activity
- Raised faecal calprotectin
- Low B12 and vitamin D
- Colonoscopy: deep ulcers and skip lesions, cobblestone appearance
- Histology: Full thickness inflammation, granulomas, increased goblet cells
- Small bowel enema
Inducing remission in Crohn’s disease?
1) Oral steroids
2) Oral steroids + oral 5-ASA
3 Oral steroids + oral 5-ASA + azathioprine or mercaptopurine (need to assess TPMT activity)
- Infliximab may be usedfoor refractory disease or fistulating Crohn’s
Maintaining remission in Crohns?
Much the same as inducing remission but azathioprine o mercaptopurine first line
Complications of Crohn’s disease?
- Strictures (80% of patients ill eventually need surgery)
- Small bowel cancer
- Colorectal cancer
- Osteoporosis
Signs of ulcerative colitis?
- Bloody diarrhoea
- Urgency
- Tenesmus
- Abdominal pain (particularly LLQ)
- Extra-intestinal features
Investigations forr ulcerative colitis?
- FBC with CRP: raised inflammatory markers & anaemia
- Raised faecal calprotectin
- Colonoscopy with biopsy (if severe colitis do flexible sigmoidoscopy instead): red, raw mucosa that bleeds easily, inflammation limited to mucosa, continuous inflammation, crypt abscesses, pseudo polyps, reduced goblet cells and mucin, inflammatory cells in lamina propria
- Barium enema: loss of haustra, superficial ulceration (psudopolyps), short narrow colon in long-standing disease (drainpipe colon),
Inducing remission in ulcerative colitis?
1) Topical aminosalicylates
2) Topical aminosalicylates + oral aminosalicylates
3) Topical aminosalicylate, oral aminosalicylate + oral steroids (stop tocial treatment if inflammation beyond rctum, othersie continue)
Treatment of sever UC flare?
- Admission
- IV steroids and fluids
- If no improvement in 3 days add IV ciclosporirn
Maintaining remission in UC?
- Proctitis and proctosigmoiditis: choose on of remission steps
- Left side or extensive UC: low dose oral aminosalicylate
- If severe relapse or >=2 a year: start azathioprine or mercaptopurine (check TPMT)
Classification of UC flares?
- Mild: <4 stools a day with (can be bloody) no systemic disturbance
- Moderate: 4-6 stools (can be bloody) a day with mild systemic disturbance
- Severe: >6 bloody stools a day with significant systemic disturbance
Extraintestinal manifestations of IBD?
- Related to disease activity: arthritis, erythema nodosum, episcleritis (more common in Crohn’s), osteoporosis
- Not related to disease activity: arthritis, uveitis (more common in UC), pyderma gangrenous, clubbing, PSC (more common in UC)
Signs of IBS?
- Abdominal pain, bloating, change in bowel habits for at least 6 months
- Abdominal pain relieved by defection
- Straining urgency or incomplete evacuation
- Abdominal bloating, distension, tension, or hardness
- Symptoms worse on eating
- Passage of mucus
- Lethargy, nausea, backache, urinary symptoms also support IBS
Red flag signs of IBS?
- Bloody diarrhoea
- Weight loss
- Family history of bowel or ovarian cancer
- Onset after 60
Investigations for IBS?
- FBC
ESR/CRP - Coeliac screen (anti-TTG, IgA, anti-EMO)
