IBD - Crohn's + Ulcerative Colitis Flashcards
Which IBD is most common?
Ulcerative Colitis
Which age are you most likely to be diagnosed with ulcerative colitis?
15-25
55 -65
Where is abdominal pain most likely to be in ulcerative colitis?
Left iliac fossa.
What is PSC?
Primary sclerosis cholangitis - much more common in ulcerative colitis than crowns.
Which part of the GI system can ulcerative colitis affect?
the colon and rectum.
Which part of the mucosa is affected in ulcerative colitis?
Only superficial mucosa.
Which IBD has skip lesions?
Crohns
Ulcerative colitis is continuous.
What is a protective factor for ulcerative colitis?
Smoking
What are GI signs of ulcerative colitis?
Excretion of blood and mucous Diarrhoea Urgency Pain in left iliac fossa Weight loss Fever
Which medication is used to induce remission of MILD TO MODERATE ulcerative colitis?
1st line: Aminosalicylate - mesalazine (Oral or rectal)
2nd line: corticosteroids (prednisolone)
What are non GI signs in ulcerative colitis?
Primary sclerosis cholangitis Clubbing Anterior uveitis erythema nodosum asymmetrical arthritis
What are very serious complications of ulcerative colitis?
Toxic megacolon
Colorectal cancer
What medication is used to induce remission of SEVERE ulcerative colitis?
1st line: Corticosteroids (Hydrocortisone)
2nd line: IV ciclosporin
Which medications can be used to maintain remission of ulcerative colitis?
Aminosalicylate (mesalazine) - oral or rectal
Azathioprine
Mercaptopurine
What surgery can be done in ulcerative colitis?
Panproctolectomy - left with permanent ileostomy or J pouch.
Colectomy - left with temporary end ileostomy.
What is seen on histology in ulcerative colitis?
inflammatory granulomas that only affect the superficial layer
What is seen on histology in crohns?
inflammatory granulomas that are transmural (full thickness).
What age is crohns commonly diagnosed at?
15-40
60-80
What risk factors are there for crohns?
Caucasian
Family history
smoking (a protective factor in UC)
What are the GI symptoms of crohns?
Crampy abdominal pain
RIGHT lower quadrant pain
diarrhoea
Gallstones (more common in crohns than UC)
What are the non GI symptoms of crohns?
Weight loss fever aphthous ulcers in mouth erythema nodosum anterior uveitis arthritis gallstones
Which test can be done for both ulcerative colitis and crohns to distinguish the difference between IBD and IBS?
Faecal calprotectin - calprotectin is released by the intestines when they are inflamed
90% specific to IBD
What other tests can be done for IBD?
Routine bloods CRP - to indicate infection Faecal calprotectin Endoscopy (OGD) Colonoscopy CT MRI
Which sign is seen on imaging of crohns?
String of kantor
Is blood or mucous seen in crohns?
Much rarer than in ulcerative colitis
which parts of the GI tract does crohns affect?
Can affect whe whole tract from the mouth to the anus - has skip lesions (parts that aren’t affected)
What is seen on endoscopy?
Skip lesions
Transmural inflammation
Which part of the Gi tract is affected most in crohns?
terminal ileum.
What are the complications of crohns?
primary sclerosis cholangitis (much less common than UC) Gallstones (more common than UC) Strictures Fistulas Weight loss
Which medication can be used to induce remission of crohns?
Steroids:
prednisolone
hydrocortisone
OR (if this doesn't work) add an immunosuppressant: Azathioprine Mercaptopurine Methotrexate Infliximab Adalimumab
Which medication is used to maintain remission in crohns?
tailored to the patient
1st line:
azathioprine
mercaptopurine
OR
methotrexate
inflixumab
adalimumab
(Lots of people don’t take medications when they are well)
What might children be offered for treatment of crohns instead of steroids?
Enteral feeding
Because steroids stunt growth
What are the main points when considering crohns?
Signs - Intermittent abdo pain, NON bloody diarrhoea, Aphthous ulcers in the mouth, Arthritis, Erythema nodosum
Linear patches of damaged colon with normal mucosa in between
Can happen anywhere but rectum is spared
Worst at terminal ileum
Smoking is risk factor
Complications – strictures, fistulas, High risk of kidney and gallstones, colorectal cancer
string sign on barium enema
Inflammation only part of the way round
What are the main points when considering ulcerative colitis?
Signs - Intermittent abdo pain, NON bloody diarrhoea, Aphthous ulcers in the mouth, Arthritis, Erythema nodosum
Linear patches of damaged colon with normal mucosa in between
Can happen anywhere but rectum is spared
Worst at terminal ileum
Smoking is risk factor
Complications – strictures, fistulas, High risk of kidney and gallstones, colorectal cancer
lead pipe sign (inflammation all round)
Is surgery done in crohns?
Very rarely as its very rarely curative.
