IBD - Crohn's disease and ulcerative colitis Flashcards
1
Q
what is IBD
A
- inflammatory bowel disease
- can be crohn’s disease or ulcerative colitis
2
Q
what are significant GI malabsorption diseases
A
- pernicious anaemia
- coeliac disease
- Crohn’s disease
3
Q
what are significant GI diseases in the large bowel
A
- IBD
- colonic cancer
- infections
4
Q
what is IBD characterised by
A
- inflammation of the bowel
5
Q
what is the prevalence of IBD
A
- quite prevalent
- incidence is 20x more in Western societies
- occurs more in white people than black
6
Q
at what age are patients usually diagnosed with IBD
A
- 15-25 years old
- could have had it for longer at a low level but it has only become critical at this age
7
Q
in what gender is Crohn’s disease more common
A
male
8
Q
in what gender is ulcerative colitis more common
A
female
9
Q
what is the aetiology of IBD
A
- bit of a mystery
- is a change in gut lining and mucosa = trigger for this change is different person to person
- likely that there is more than one cause = but once you have the disease the pattern of disease is the same
- there is a whole range of things that can set off change in mucosa
10
Q
what are the 4 main factors that can cause IBD
A
- immunological = if immune system is overreactive
- psychological = perhaps a cause of IBD but definitely a consequence
- smoking = less risk of IBD
- genetic = clearly tendencies that run in families
11
Q
what do granulomas do in crohn’s
A
- cause granulomatous inflammation
- have granulomas in tissue
12
Q
how does food intolerance affect Crohn’s disease
A
- something happens in tissues causing immune stimulation that the body can’t handle
- if you don’t feed patients it gets better
- unclear what the food intolerance
13
Q
how can viral infections/immune activation affect Crohn’s
A
- passed to people which in the right susceptibility causes problems
14
Q
what can infection with mycobacteria do for Crohn’s
A
- causes paratuberculosis
- causes Johne’s disease = problem cattle get similar to Crohn’s
- get bacterium that causes Johne’s in farms which then passes milk to the dairy industry which then passes disease to us
15
Q
what is the link between Johne’s disease and Crohn’s
A
- incidence of Johne’s in cattle and Crohn’s in people both increased over time with about 10 years between
- some people think it is passed down from cattle
- pasteurised milk kills a lot of bacteria but not m.paratuberculosis
- should have ultra-high-temperature milk all the time as it would kill m.paratuberculosis
16
Q
what is the changes to the bowel and mucosa in Crohn’s disease
A
- has lots of bumps
- areas of oedema caused by granulomas blocking lymphatics so preventing drainage from tissue
- can affect any part of the bowel
- get cobblestoning of mucosa
17
Q
where are Crohn’s disease sites
A
- anywhere = mouth, oesophagus, stomach, large intestine, small intestine, rectum, anus
- can be in sections = skip lesions, may not affect whole GIT only certain parts
18
Q
where are ulcerative colitis sites
A
- only colonic disease
- starts in rectum and works way back up the colon
- continuous inflammation = not in sections
- changes bowel activity
19
Q
what happens in ulcerative colitis
A
- disease continuous = easier to identify
- rectum always involved
- anal fissures = 25%
- ileum involved = 10%
- mucosa granulomas and ulcers = only affects top layer of bowel wall (superficial)
- vascular
- serosa normal
20
Q
what happens in Crohn’s disease
A
- discontinuous
- rectum involved 50%
- anal fissures 75%
- ileum involved 30%
- mucosa cobbled and fissures
- non vascular
- serosa inflamed = affects entire thickness of bowel
21
Q
what are the microscopic features of Crohn’s
A
- transmural
- oedematous = as granulomas blocking lymphatics
- granulomas
22
Q
what are the microscopic features of ulcerative colitis
A
- mucosal
- vascular
- mucosal abscesses
23
Q
what does Crohn’s disease look like
A
- red appearance around mouth
- inflammation/swelling of bowel wall so lumen is narrower so difficult to pass bowel connects through
- cobblestone appearance of mucosal surface due to linear ulceration
- abscess can form on outside of bowel as well as inside as inflammation has gone right through wall = can even extend to adjacent bowel loop which can then form a fistula between the bowel
24
Q
what does ulcerative colitis look like
A
- superficial problem = affects mucosal layer only, absence of goblet cells, crypt distortion and abscess
- inflammation never extends to outside = bottom area remains fairly normal
25
what are the different types of ulcerative colitis
- proctitis = involves only rectum
- proctosigmoiditis = involves the rectum and sigmoid colon
- distal colitis = involves only left side of the colon
- pan colitis = involves entire colon
- backwash ileum = involves distal ileum, fairly unusual
26
what would happen to the patient if you removed the colon in ulcerative colitis
- it would go away as it doesn't affect the small bowel
27
what are the ulcerative colitis symptoms
- diarrhoea = as water absorption decreased so stool volume is more
- abdominal pain
- PR bleeding = get when you have bowel infections, mucosa is fragile so is easily damaged
28
what are Crohn's disease symptoms
- colonic disease = same as UC
- small bowel disease = pain form obstruction as tube narrower, malabsorption
- mouth = orofacial granulomatous
- patent rarely complains of discomfort until obstruction
29
what is orofacial granulomatosis
- OFG
- not a single condition
- granuloma formation blocks lymphatics
- lip and oral swelling then noted from other causes of increased capillary leakage
- can be a very localised disease
30
what are the causes of OFG
- food preservative and additives = benzoate's/sorbate/cinnamon, can benefit from cutting out certain foods
- some have to identifiable trigger
- not clear why people get it
31
what are the clinical features of OFG
- lip swelling
- angular cheilitis
- cobblestoning
- gingivitis
- ulceration
- microscopic granulomas
32
what is gingivitis
- very red thick gums
- can be in one part of the mouth or whole area
- common in 6-12 year olds
33
what is the link between OFG and Crohn's disease
- younger you get OFG the more likely you are to get Crohn's disease
34
what are the investigations for IBD
same for OFG and Crohn's disease
- blood tests = anaemia, CRP, ESR (look for anaemia due to low level bleed)
- foetal calprotectin = released the bowel cells inflamed, measure in stool, high amount = inflamed bowel
- endoscopy
- leukocyte scan
- barium studies
- bullet endoscopy = swallow capsule that takes pictures of bowel as it passes through
35
what are IBD complications
- ulcerative colitis develops carcinoma = risk increases with time
- judgements whether colectomy is justified = attitude to risk, carcinoma surveillance potential
- risk is less now as we are more aware
36
what is the treatment for IBD
- medical treatment and surgical treatment
37
what is the medical treatment for IBD
- based on removing inflammation
- systemic steroids = prednisolone
- local steroids = rectal administered, colorectal disease
- anti-inflammatory drugs = 5-ASA based drugs = pentasa, mesalazine, sulphasalazine (topical)
- non-steroid immunosuppressants = azathiopine, methotrexate
- manufactured antibody drugs = anti TNF-alpha therapy, infliximab, adalimumab
38
what is the problem with using steroids
- can cause other problems
39
what is the surgical treatment for IBD
- colectomy = cures ulcerative colitis
- for Crohn's disease you palliate symptoms = remove obstructive bowel segments, drain abscess, close fistula (especially perianal)
- usually results in a stoma bag = may be reversible in some patients, problem is social issue, can be a big help with bowel disease
40
what are oral issues in IBD
- oral lesions in Crohn's = OFG
- oral ulceration = ulcers worse when UC is worse
- haematinic deficiency caused by malabsorption or intestinal bleeding = if have inflamed bowel gradually work away your iron stores an can get malabsorption
