IBD - Crohn’s and Ulcerative Colitis (2) Flashcards
What is it?
How does it present?
What are the differentials?
What are the investigations to do?
What is the main blood test result that differentiates IBD from IBS?
➊ Inflammation of the gut wall with periods of remission and exacerbation
➋ • Diarrhoea
• Mucous/blood in stool
• Abdominal pain - LLQ with UC, RLQ with Crohn’s
• Weight loss
➌ • IBS
• Diverticulitis
• Appendicitis
➍ • Bloods - FBC, U&E, LFT, CRP, ESR, INR, Ferritin, B12, Folate, TFT, Albumin
• Stool culture - exclude c.diff
➎ Raised Faecal Calprotectin
Crohn’s:
What is it characterised by?
→ Which part of the gut is most commonly affected?
What are its manifestations?
What is a major risk factor here?
What is found on Colonoscopy?
What may be seen on Imaging?
What are its complications?
➊ Transmural inflammation, which affects the entire GI tract
→ Terminal ileum and Proximal colon
➋ • Mouth ulcers
• Perianal abscesses/fistulas/fissures, Skin tags
• Erythema nodosum
• Anterior uveitis
• Gallstones
➌ Smoking
➍ • Skip lesions
• Cobblestone mucosa (due to ulceration and mural oedema)
• Non-caseating granulomas
➎ • Bowel wall thickening
• Increased bowel wall brightness (damaged area takes up more contrast)
• Comb sign (Hypervascularity of mesentery)
➏ • Strictures
• Fistulas
• Adhesions
Management:
What’s an important lifestyle change to make?
What is given to induce remission?
What is given to maintain remission?
➊ Stop smoking
➋ Steroids (1st line) e.g. pred, hydro
• Azathioprine or Methotrexate can be added on/used instead
➌ Azathioprine (1st line)
• Methotrexate can be used instead
Ulcerative Colitis:
What is it characterised by?
What are its manifestations?
What is found on Colonoscopy?
What may be seen on Imaging?
What are its complications?
➊ Inner mucosal inflammation, which only affects the colon
➋ • PR blood and mucous
• Anterior uveitis
➌ • Continuous inflammation
• Crypt abscesses (full of neutrophils)
➍ • Thumbprinting - thickened mucosal folds due to bowel wall oedema
• Lead Piping - occurs in chronic cases as bowel becomes featureless w/loss of haustral marking, luminal narrowing and bowel shortening
➎ • Toxic megacolon
• Colorectal ca.
• Primary Sclerosing Cholangitis
• Cholangiocarcinoma
• Stricture
Management:
What is given to induce remission?
What is given to maintain remission?
How is it definitively managed?
➊ * Mild-moderate disease:
‣ Topical/Oral Aminosalicylate (1st line) e.g. Mesalazine
‣ Consider adding prednisolone if no response in 72 hrs
* Severe disease:
‣ IV Prednisolone (1st line)
‣ Add IV Ciclosporin or consider surgery if no response in 72 hrs
N.B. Loperamide should never be given to these pts during flares as it can cause paralysis of the colonic muscles, therefore leading to serious complications.
➋ Topical/Oral Aminosalicylate
➌ Total Panproctocolectomy
