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Gastrointestinal Block > IBD - Crohns and Ulcerative colitis > Flashcards

IBD - Crohns and Ulcerative colitis Flashcards

1
Q
A
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2
Q

What is IBD?

A

Umbrella term encompassing UC and Crohn’s

Involves inflammation of the walls of the GI tract and are a/w with periods of remission and exacerbation

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3
Q

Features differentiating IBS vs IBD

A

IBD may have night time diarrhoea and/or weight loss and bleeding

IBS does not

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4
Q

Which areas of the bowel does Crohn’s affect?

A

Terminal ileum and colon

Can affect any part of GIT (from mouth to anus)

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5
Q

Which areas of the bowel does UC affect?

A

Starts at rectum (most common site for UC)

Never spreads beyond ileocaecal valve

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6
Q

When does Crohn’s present?

A

Typically in late adolescence or early adulthood

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7
Q

When does UC present?

A

Peak incidence is in people aged 15-25 years and in those aged 55-65 years

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8
Q

Clinical features of Crohn’s?

A
  1. Diarrhoea (usually non-bloody)
  2. Weight loss more prominent
  3. Crampy abdo pain
  4. Mouth ulcers
  5. Perianal disease
  6. Abdominal mass palpable in the right iliac fossa
  7. Extra-intestinal features (more common in colitis or perianal disease)
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9
Q

Clinical features of UC?

A
  1. Bloody diarrhoea
  2. Urgency
  3. Tenesmus
  4. Abdo pain, particularly in left lower quadrant
  5. Extra-intestinal features
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10
Q

List 2 Dermatological manifestations seen in both Crohn’s and UC

A
  1. Erythema nodosum (painful erythematous nodules/plaques on the shins)
  2. Pyoderma gangrenosum (a well-defined ulcer with a purple overhanging edge)
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11
Q

List 2 Ocular manifestations seen in both Crohn’s and UC

A
  1. Anterior uveitis (painful red eye with blurred vision and photophobia)
  2. Episcleritis (painless red eye)
  3. Conjunctivitis
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12
Q

List 2 MSK manifestations seen in both Crohn’s and UC

A
  1. Arthritis (asymmetrical and non-deforming)
  2. Sacro-iliitis (similar to Ankylosis spondylitis)
  3. Clubbing
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13
Q

List a Hepatobiliary manifestation more common in Crohn’s

A

Gallstones secondary to reduced bile acid reabsorption

Oxalate renal stones*

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14
Q

List a Hepatobiliary manifestation more common in UC

A

Primary sclerosing cholangitis

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15
Q

List 2 other extra-intestinal manifestations seen in both Crohn’s and UC

A
  1. AA amyloidosis (secondary to chronic inflammation)
  2. Renal stones (more common in Crohn’s)
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16
Q

Investigations for Crohn’s and UC?

A
  1. Blood tests
  2. Stool culture to exclude infection
  3. Faecal calprotectin
  4. Endoscopy + biopsy
  5. MRI
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17
Q

Gold standard investigation to diagnose Crohn’s?

A

Colonoscopy + biopsy

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18
Q

List 4 blood test findings seen in Crohn’s and UC?

A
  1. ↑ ESR/CRP
  2. ↑ WCC
  3. Anaemia
  4. ↓ B12 and Vit D
  5. ↓ Albumin
19
Q

List 3 Endoscopy findings in Crohn’s

A
  1. Skip lesions
  2. Cobblestone mucosa
  3. Deep ulcers
20
Q

List 2 biopsy (histology) findings in Crohn’s

A

Inflammation in all layers from mucosa to serosa

  1. ↑ goblet cells
  2. Non-caseating granulomas
21
Q

List 4 Radiology findings in Crohn’s?

A

Small bowel enema

  1. Strictures: ‘Kantor’s string sign’
  2. Proximal bowel dilation
  3. ‘Rose thorn’ ulcers
  4. Fistulae
22
Q

Gold standard investigation to diagnose UC?

A

Colonoscopy and biopsy (Sigmoidoscopy)

23
Q

List 3 Endoscopy findings in UC

A
  1. Continuous inflammation with an erythematous mucosa
  2. Loss of haustral markings
  3. Pseudopolyps
24
Q

List 3 biopsy (histology) findings in UC

A

No inflammation beyond submucosa (unless fulminant disease)

  1. Inflammatory cell infiltrate in lamina propria
  2. Crypt abscesses
  3. ↓ Goblet cells and mucin from gland epithelium
25
Q

List 4 Radiology findings in UC

A

Barium enema

  1. loss of haustrations
  2. superficial ulceration
  3. ‘pseudopolyps’
  4. long standing disease: colon is narrow and short ‘drainpipe colon’
26
Q

List 3 Complications of Crohn’s

A
  1. Obstruction
  2. Fistula
  3. Abscess

Note: there is a risk of colorectal cancer but this is much higher in UC

27
Q

List 3 Complications of UC

A
  1. Bleeding
  2. Toxic megacolon
  3. Colorectal Cancer (↑ risk in UC)
28
Q

How does toxic megacolon present?

A

Sever colitis + tachycardia, fever, abdo pain, distension and constipation

29
Q

Management of toxic megacolon?

A
  1. NMB
  2. Call the supervising doctor
  3. IV fluids and antibiotics
  4. Surgical referral for urgent colectomy
30
Q

What is the predominant inflammatory cell in Crohn’s vs UC?

A

???? RISH If you see this card plz help

31
Q

What are the 3 types of UC?

A
32
Q

In the acute setting, what imaging is used for an individual with UC?

Explain

A

CT, abdominal X-ray and erect chest x-ray (to exclude TMC and perforation)

Colonoscopy and barium enema are contraindicated due to the risk of bowel perforation

33
Q

What criteria is used to assess an acute exacerbation of UC?

A

Truelove and Witt’s Criteria for Severity

34
Q

Management to induce remission in Crohn’s

A
  1. First line: Steroids (oral prednisolone or IV hydrocortisone)
  2. Add on Azathioprine or Mercaptopurine (Methotrexate if not tolerated)
  3. Biological agents (eg. Infliximab or Adalimumab) in severe disease who fail to respond to the above
35
Q

What must be assessed before offering azathioprine or mercaptopurine?

A

Thiopurine methyltransferase (TPMT) activity

36
Q

Management to maintain remission in Crohn’s

A
  1. First line: Azathioprine or Mercaptopurine
  2. Second line: Methotrexate if above not tolerated
37
Q

Surgical management for Crohn’s?

A

Rarely curative in Crohn’s (unlike in ulcerative colitis)

Options depend on the part of the GIT affected

38
Q

Management to induce remission in mild-to-moderate UC?

A

First line: ASA (eg. mesalazine oral or rectal)

Second line: add corticosteroids (eg. prednisolone)

If no improvement after 2-4 weeks or worsening symptoms, add oral Tacrolimus

39
Q

Management of Acute severe UC?

A

First line: IV corticosteroids (eg. hydrocortisone)

Second line: IV ciclosporin

Consider emergency surgery if no improvement with the above

40
Q

Medical management to maintain remission following a mild-to-moderate UC flare?

A
  1. ASA (e.g. mesalazine oral or rectal)
  2. Azathioprine
  3. Mercaptopurine
41
Q

Indications for emergency surgery in acute severe UC? (3)

A
  1. Acute fulminant UC
  2. Toxic megacolon with little improvement after 48-72 hours of IV steroids
  3. Symptoms worsening despite IV steroids
42
Q

Surgical management for UC?

A

Can be curative

  1. Panproctocolectomy with permanent end ilesotomy
  2. Colectomy with temporary end ileostomy
42
Q

When should elective surgery be considered in UC?

A

If there is failure to induce remission by medical means

Gastrointestinal Block (26 decks)

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