IBD + IBS Flashcards
What is the definition of Chron’s Disease?
Chronic inflammatory and ulcerative disease with skip lesions and transmural inflammation
What type of inflammatory inflitrate is found in CD?
Non-caseating granulomas
Where in the GI tract is CD most common? Can it occur anywhere in the GI tract?
Terminal ileum and colon
Can occur anywhere in GI tract
In what type of IBD would you find knife like fissures?
CD
Name two environmental triggers for CD
Smoking (big big one)
NSAIDS
What genetic factor is associated with CD?
NOD2
CARD15
Name 4 symptoms of CD
- Anaemia (commonly Fe deficient)
- Diarrhoea (rarely with blood and mucus)
- Abdominal pain (visceral)
- Weight loss and reduced growth in children (malabsoprion)
What investigations should be done for IBD?
Biopsy to stage disease
Colonscopy
Blood tests
Stool sample - faecal calprotectin
How can CD be managed through lifestyle?
Increase fruit and fibre
Smoking cessation
What drugs can be offered in CD?
- Steroids for managing flareups e.g. budesonide/prednisilone
- Immunosuppresnats - azathrioprine, methotrexate
- Anti-TNF - “-imab” - infliximab
When would surgery be offered in CD and is a patient likely to have many surgeries throughout their lifetime?
Symptomatic after treatment Peri-anal disease Complications Carcinoma Many surgeries
What type of IBD is more likely to present orally and give 3 examples of how it may present
CD
- Swollen Lips
- Linear ulceration
- Cobble-stoning of mucosa
Name 5 complications of IBD (many more)
- Peri-anal disease
- Malnutrition
- Fistulas
- Obstruction
- Perforation
- Toxic megacolon
- Sclerosing cholangitis (IMPORTANT)
- Colorectal cancer
What kind of inflammatory response is in CD and UC?
Linked to T cells CD - TH1
UC - TH1 and TH2
Where does inflammation start in UC?
Rectum and works back - (never affects small bowel)
What criteria is used to measure the severity of UC? What are the criteria on this?
Truelove and Witt Bowel movements <4 - mild 4-6 - moderate 6+ - severe
What is the main symptom of UC?
Diarrhoea with blood and mucus
What would be seen in examination of UC in a PR exam that would be different from CD?
Blood and mucus will very likely be present in UC
Blood is much rarely in CD
What is the method of drug management in UC?
- Mesalazine - 5-ASA (aminosalicyates) - remission
2. Steroids - prednisilone/Budesonide - flareups
What is the name of the anti-TNF drug?
Infliximab
What is the name for the removal of the colon?
Colectomy
What type of IBD is cured through surgery?
UC
What kind of surgery would a patient with CD get?
Many surgeries dependant on location of disease e.g. hemi-colectomies
What is the classical sign of mucosal inflammation/oedema on AXR?
Thumbprinting
What type of IBD is associated with toxic megacolon? What is toxic megacolon?
UC - presistent inflammation causes loss of muscle tone of the colon -> distension
What is one of the main indications for surgery in CD?
Fistula formation
What is the handy pneumonic to remember characteristics of UC and CD?
Crohns = NESTS N - no blood/mucus E - entire GI tract S - skip lesions T - transmural/ terminal ileum S - smoking increases (don't want the nest to catch fire)
UC = up close
U - use aminosalicylates P - primary sclerosing cholangitis (commonly tested) C - continuous inflam L - limited to colon and rectum O - only superfical mucosa S - smoking is protective E - excrete blood and mucus
What is IBS?
Functional bowel disorder in which abdo pain assoc. with defecation in ABSENCE OF STRUCTAL PATHOLOGY
Whats important for history of IBS?
SOCRATES
Impact on daily activties
Diet/exercise/mental well-being
Investigations for IBS?
Rule out IBD - negative faceal calprotectin
Rule out coeliac - negative anti-TTG antibodies
Regular - FBC, CRP, malabsorption
When can someone be diagonosed with IBS?
Doesn’t have IBD (negative faceal calprotectin) and coeliac (negative anti-tTg antibodies)
> 6mnths of abdo pain w/ improvement on defecation
Change in stool appearance/frequency
Bowel symptoms with other systemic conditions e.g. uveitis/ erythema nodosum - what should you think of?
IBD
Why do you test for B12 and ferritin in bloods?
Ferritin - iron levels
Test for malabsorption
How would Crohns present endoscopically?
Cobble-stoning (lumps in lumen) and skip lesions
What is short gut syndrome?
If keep removing areas of bowel = malabsorption
How will UC appear on endoscopcy?
Red and inflamed
Friable - easy to bleed (due to angiogenesis)
Pseudo-polyps (buzzword)
Differnce in area of pain felt in UC and CD?
RIF - CD (most likely to be found in terminal ileum)
LIF - UC (restricted to colon and rectum)
What clinical presentations are important to note in UC?
Finger clubbing
Apthous ulcers
Pallor
Surgery for UC?
Panproctocolectomy - removal of rectum and colon and anal canal = ileostomy
OR
Protcololectomy = removal of rectum and colon = formation of J-pouch (ileo-anal anastomosis) -> more bowel movements than before
A patient with Crohns comes in for a review and says she is still having trouble with her symptoms. She was put on steroids when she was first diagnosed 8 weeks ago. What would be the next line of treatment?
Immunosuppresants e.g. azathioprine, methotrexate
What test can be used on stool which is very accurate for IBD?
Faceal calprotectin - released by inflamed intestines
A patient with IBS would have what kind of bowel movements?
Change between diarrohea and constipation
Altered gut flora can be found in what disease?
IBD
Why does IBD occur?
An overactive immunological response to luminal antigens e.g. bacteria
What is the most common extra-intestinal disease in both UC and CD
Arthritis
What is the most important side effect of mesalazine?
agranulocytosis
