IBD and IBS Flashcards
What are the clinical features of IBD?
Diarrhoea
Abdominal pain
Rectal bleeding
Fatigue
Weight loss
How can you differentiate Crohn’s from UC? What are you more likely to see or have if you have Crohn’s?
N – No blood or mucus (PR bleeding is less common)
E – Entire gastrointestinal tract affected (from mouth to anus)
S – “Skip lesions” on endoscopy
T – Terminal ileum most affected and Transmural (full thickness) inflammation
S – Smoking is a risk factor
Crohn’s is also associated with strictures and fistulas
What are differentiating features seen in UC?
Continuous inflammation (no skip lesions like in Crohn’s)
Is limited to the colon and rectum
ONLY the superficial mucosa is affected
Smoking may be protective (smokers with UC appear to suffer a milder form of the condition)
Excrete blood and mucus
Use aminosalicylates (for management)
Primary sclerosing cholangitis is associated with UC
What investiagtions do you do if you suspect a patient has IBD?
Faecal calprotectin (do BEORE endoscopy). It is very sensitive and specific for IBD
Stool microscopy and culture (to exclude infection as a differential diagnosis e.g. salmonella)
FBC for Hb (low in anaemia) and platelet count (raised in inflammation)
CRP indicates inflammation
U&Es indicate electrolyte imbalances and kidney function
LFTs can show low albumin severe disease (protein is lost in the bowel)
TFTs for hyperthyroidism (as a cause of diarrhoea)
anti-TTG for excluding coeliac disease
Colonoscopy with multiple intestinal biopsies (IS THE INVESTIGATION TO ESTABLISH DIAGNOSIS)
Imaging investigations (e.g. ultrasound, CT or MRI) can be used to look for complications such as fistulas,abcesses and strictures
What conditions can be associated with IBD? An example is erythema nodosum.
Pyoderma gangrenosum (rapidly enlarging, painful skin ulcers)
Enteropathic arthritis (a type of inflammatory arthritis)
Primary sclerosing cholangitis (particularly with UC)
Red eye conditions (e.g. episcleritis, scleritis and anterior uveitis)
What does management for IBD include?
Remissions during acute exacerbation
Maintaining remission
What is the management for ulcerative colitis?
FIRST LINE: Aminosalicylate (oral or rectal mesalazine)
SECOND LINE: Corticosteroids (like oral or rectal prednisolone)
How is severe acute ulcerative colitis treated and if that doesn’t work, what are the other options?
IV steroids like IV hydrocortisone
The other options are intravenous ciclosporin, infliximab therapy or surgery
What are the options for maintaining a REMISSION in UC?
Aminosalicylate (e.g. oral or rectal mesalazine) first line
Azanthioprine, mercaptopurine
A patient can have surgery to manage their UC. What are the options?
Panproctolectomy (removes entire bowel)
Permanent ileostomy
ileo-anal anastomosis (J pouch)
A J pouch is where the ileum is folded back onto it’s self and is attached to the anus and functions like a rectum, collecting stool.
How do you manage Crohn’s disease?
Steroids (oral prednisolone or IV hydrocortisone) FIRST LINE
Enteral nutrition (as an alternative where steroids may affect growth)
What medications can you give patients if using steroids alone are inadequate in Crohn’s?
Azathioprine
Mercaptopurine
Methotrexate
Infliximab
Adalimumab
What are the FIRST-LINE medications in maintaining remission in Crohn’s disease?
Azathioprine
Mercaptopurine
What medications can be given to patients with Crohn’s if the first-line medications in maintaining remission are not suitable?
METHOTREXATE
What are the surgical options for Crohn’s?
Resecting the distal ileum when the disease is isolated to this area
Treating strictures
Treating fistulas
