IBD, Coeliac + Peptic Ulcers Flashcards
What is UC?
Inflammation of the large colon
What causes UC?
Autoimmune - T cells destroy the mucosa and submucosa of large bowel (superficial inflammation)
How does UC progress?
Starts in the rectum and progressively goes up the colon linearly
- Proctitis to left-sided colitis to pancolitis
What disease is UC associated with?
Primary sclerosing cholangitis
What are symptoms of a UC flare?
- Diarrhoea
- Urgency
- Blood in stool
- LLQ pain
- Weight loss
How do you diagnose UC?
Lower GI endoscopy (colonsocopy)
- Flexible sigmoidoscopy in acute stage to assess and biopsy
- Full colonoscopy when stable to define disease extent
What would you see on other investigations for UC?
- Raised CRP/ESR
- Anaemia (bc bleeding)
- Raised faecal calprotectin
- P-ANCA
- Low albumin
How do you treat UC?
- Aminosalicylates (mesalazine)
- Steroids/immunosuppressants (azathioprine, methotrexate)
- Biologics (infliximab - anti-TNF)
- Colectomy (curative)
What is Crohn’s disease?
Immune related disease that affects all layers of the whole GI tract in patches (rather than continuously)
What are symptoms of Crohn’s?
- Abdominal pain
- Diarrhoea
- Weight loss
- N&V
- Dysphagia
- Systemic - fatigue, fever, malaise, anorexia
What conditions are associated with Crohn’s?
- Oral ulcers
- Anal abscesses
- Stricture (narrowing of bowel - normally small bowel)
- Fistulas
- Erythema nodosum (red tender patches on shin)
- Pyoderma gangrinosum
What are the 3 types of disease distribution in Crohn’s?
1) Terminal ileum (causes less B12 to be absorbed)
2) Colonic
3) Ileo-colonic
How do you diagnose Crohn’s?
Endoscopy ± MRI small bowel
What would you see on other investigations for Crohn’s?
- Anaemia, B12, folate
- Faecal calprotectin
How do you treat Crohn’s?
- Steroids - prednisolone
- Abx - ciprofloxacin, metronidazole (short term)
- Immunosuppressants (azathioprine)
- Sulfasalazine
- Biologics (anti-TNF)
- Surgery
After what does Crohn’s often present?
Gastroenteritis
What would you see on histology in UC?
Crypt abscesses and mucosal inflammation
What would you see on histology in Crohn’s?
Granulomas and transmural inflammation
What is the deal with smoking in IBD?
UC - smoking protective
Crohn’s - smoking detrimental
What causes toxic megacolon in UC?
Nerve plexuses exposed to gastric contents so become damaged - colon doesn’t keep tone so just dilates (doesn’t happen in Crohn’s bc of patchy distribution)
What is coeliac disease?
Autoimmune disease where T cells react to gliadin (part of gluten) causing inflammation and destruction of duodenal lining - FH link
What are symptoms of coeliac disease?
- Bloating
- Abdominal pain/cramping
- Diarrhoea/steatorrhoea
- Failure to thrive
- Anaemia (low iron and B12)/osteoporosis (osteomalacia) due to malabsorption and diarrhoea
- Muscle weakness
- Amenorrhoea and infertility
- Angular stomatitis
What skin condition is associated with coeliac disease?
Dermatitis herpetiformis (often on abdomen)
How do you diagnose coeliac disease?
Duodenal biopsy ± OGD
What do you see on duodenal biopsy in coeliac disease?
- Villous atrophy
- Crypt hyperplasia
- Immune cell infiltration
What antibodies might you see in coeliac disease?
- Anti-TTG (tissue transglutaminase) - most important for diagnosis
- Anti-gliadin
- Anti-endomysial
What is the treatment for coeliac disease?
GFD
Where do peptic ulcers occur?
Stomach or duodenum
What are common causes of peptic ulcers?
NSAIDs and H pylori
How do you diagnose H pylori?
Urease breath test
What is a big risk factor for peptic ulcers?
Smoking
What are symptoms of peptic ulcers?
- Epigastric pain
- Bloating
- Can lead to bleeding - haematemesis or malaena
How do you treat H pylori?
Triple therapy
- Amoxicillin
- Omeprazole
- Clarithromycin/metronidazole
How do you treat peptic ulcers?
- Stop NSAIDs and smoking
- Treat H pylori
What diseases is coeliac associated with?
Thyroid, T1D, RA
What genes are present in coeliac?
HLA-DQ2 or DQ9
What classification is used in coeliac?
Marsh classification
When does coeliac disease peak?
Childhood and 50s-60s
