IBD Clinical Flashcards
clinical presentation of Crohn’s
abdominal pain
peri-anal disease
aetiology of IBD
genetic predisposition
mucosal immune system
environmental triggers
genetic predisposition of IBD
homozygous twins
early onset indicates family hx - high concordance rates
mutated gene in IBD
NOD2/CARD15 (IBD-1) - codes for bacterial recognition and normal mucosa defence
involvement of gut flora in ulcerative colitis
altered bacterial flora indispensable to development of colitis
innate immunity - role of tight junctions
regulates epithelial permeability
overactive effect T cell response
inflammation/disease
absence of regulatory T cells
uncontrolled inflammation/aggressive disease
immune system response of Crohn’s
Th1
immune response of Ulcerative colitis
mixed Th1/Th2/NKTC
pathogenesis of IBD
pathogenic bacteria
abnormal microbial competition
defective host contaminant of commensal bacteria
defective hose immunoregulation
reduced antimicrobial activity in Crohn’s
environment factors of IBD
smoking - aggravates Crohn’s but protects against ulcerative colitis
NSAIDS
ulcerative colitis disease extent
proctitis - rectum
left sided colitis
pan colitis - whole of large bowel
course of left sided colitis
rectum to colon, stopping at splenic flexure
clinical presentation of ulcerative colitis
diarrhoea and bleeding (red flag! >6) increased bowel frequency incontinence night rising lower abdominal pain (left iliac fossa)
history red flags of IBD
recent travel antibiotics NSAIDS family hx smoking skin, eyes, joints
determining the severity of ulcerative colitis
truelove and Witt criteria
truelove and witt criteria
>6 bloody stools and 1 or more; fever tachycardia (>90BPM) anaemia (Hb<10.5) ESR (>30mm/hr)
what is ESR
blood test that detects and monitors inflammation in the body
tests for IBD
bloods; CRP albumin AXR endoscopy histology
what is CRP
C-reactive protein;
a marker of inflammation
presentation of AXR with IBD
stool distribution - absent in inflamed colon
mucosal oedema/’cobblestone’
toxic megacolon
presentation of endoscopy with IBD
confluent inflammation extending proximally from anal margin to transition zone;
loss of vessel pattern
granular mucosa
contact bleeding
histology of ulcerative colitis
affects mucosal layer only;
absence of goblet cells
crypts distortion and abscesses
complication of ulcerative colitis
increased risk of colorectal cancer extensive colitis (beyond splenic flexure)
what determines risk of colorectal cancer in ulcerative cancer
severity of inflammation
duration of disease
disease extent
extra-intestinal manifestations of IBD
skin joints - axial, peripheral joints eyes deranged LFTs oxalate renal stones
what is primary sclerosis cholangitis
chronic inflammatory disease of biliary tree
80% patients have associated IBD (UC>Crohn’s)
symptoms of PSC
asymptomatic or itch, rigors cholestatic LFTs (raised ALP + GGT)
Crohn’s - peri-anal disease
recurrent abscess formation
can lead to fistula with persistent leakage
damaged sphincters
causes pain
disease phenotypes of Crohn’s
stenosis
inflammation
fistula
Crohn’s symptoms - small intestine
abdominal cramps
diarrhoea
weight loss
Crohn’s symptoms - colon
abdominal cramps (lower abdomen)
diarrhoea with blood
weight loss
Crohn’s symptoms - mouth
painful ulcers
swollen lips
angular chielitis
Crohn’s symptoms - anus
peri-anal pain
abscess
tests for Crohn’s
bloods; CRP albumin platelets vitamin B12 ferritin
colonoscopy
histology of Crohn’s
granuloma +/- caseating
tests for small bowel
barium swallow
small bowel MRI
technetium-labelled white cell scan
