IBD- Crohn's Flashcards
what is it?
chronic inflammatory disorder that affects any part of GIT from mouth to anus- terminal ileum most commonly
Pathophysiological changes?
Cobblestone mucosa
Rosethorn ulcers
Obstruction
Hyperplasia of lymph nodes
Narrowing lumen (strictures)–> inflammatory, not usually malignant
Skip lesions –> normal space in between affected areas
Fistula formation
describe the inflammation
patchy, transmural, non-caseating granulomas
aetiology?
- Genetics: genetic predisposition
- Immune system: abnormal immunological response to normal intestinal flora
- Environmental: smoking increases risk
epidemiology?
peaks between ages of 15-30
Symptoms?
- diarrhoea
- abdo pain
- blood in stools
- wt loss
- fatigue
- N&V
how may it present acutely?
acute abdo simulating appendicitis, intestinal obstruction, peritonitis due to bowel perforation
signs?
- dehydration
- abdo tenderness
- tachycardia
- hypotension
- pyrexia
- perianal lesions
extra-intestinal:
- MSK-enteropathic arthritis
- Derm-erythema nodosum & pyoderma gangrenosum
- Eyes- episcleritis / uveitis / conjunctivits
- Mouth- apthuous ulcers
Ix?
Diagnosis = macroscopic ie endoscopy & histological evidence ie biopsy
- bloods
- haematinics
- FBC
- B12
- folate
- CRP
- U&E
- stool microscopy / culture
- faecal calprotectin
- endsocopy w biopsy
- imaging
- barium studies
- MR enterography
- high diagnostic accuracy for small bowel disease
- CT
- for acute presentation & to diagnose complications
Aim of Mx?
induce and maintain remission
Medical Mx?
Inducing:
corticosteroids (if contraindicated- 5-ASA or budenoside)
Maintaining:
- 1st line –> azathioprine
- others: methotrexate, infliximab, adalimumab
Surgical Mx?
Indicated in acute flares refractory to medical mx /pts at risk of perforation / to treat complications
- resection of affected area of bowel w end to end anastomosis
- strictureplasty
- for mutliple relatively short strictures
- by-pass surgery for duodenal disease
complications?
- strictures
- fistula
- abscess
- obstruction
