IBD &IBS& Constipation Flashcards
What is Crohn’s disease?
Chronic, continuous transmural inflammation of GI tract from mouth to anus
Where is Crohn’s most commonly found?
Terminal ileum & proximal colon
What are the risk factors for Crohn’s?
SMOKING COCP NSAIDs MMR Fhx 20-40yo
How does Crohn’s disease present?
↓Weight/ FTT Diarrhoea & urgency Abdo pain & tenderness Fever, malaise, anorexia Vomiting Anaemia Peri-anal abscess/fistula/skin tags Apthous ulcers Anal strictures & lesions
What are extra-intestinal signs of Crohn’s disease?
Large joint arthritis Episcleritis Erythema nodosum Clubbing Skin & joint problems
How is Crohn’s disease investigated?
1) Colonoscopy- DIAGNOSTIC
2) Faecal calprotectin: +ve = intestinal inflammation
3) AXR: Strictures
4) Small bowel enema
What are the signs seen on colonoscopy which indicate Crohn’s?
Transmural inflammation
Cobblestone mucosa (submucosal oedema & interconnecting ulcers)
Deep fissuring ulcers
Apthous ulcers (1-2mm punched out lesions in colonic mucosa)
Skip lesions
Histology: Goblet cells & granulomas
What is the Harvey-Bradshaw index used for?
Severity scoring in Crohn’s
<3 = remission
8-9 = Severe
How is remission induced in Crohn’s?
1) MONO: Prednisolone or Mesalazine if steroid CI
2) Add Azathioprine/Mercaptopurine
3) TNF-a (Infliximab) as mono or combined
4) Surgery: If disease limited to distal ileum
How is remission maintained in Crohn’s?
1) Azathioprine/Mercaptopurine monotherapy
What are the complications of Crohn’s?
Small bowel obstruction Malnutrition Abscess formation/ fistula Perforation Rectal haemorrhage Colonic cancer/ Cholangiocarcinoma
What is UC?
Chronic, relapsing-remitting, diffuse, continuous inflammation of colonic & rectal mucosa ONLY
Where does UC stop?
NEVER spreads beyond ileocaecal valve
What are the risk factors for UC?
SMOKING = PROTECTIVE
20-40yo
What are the clinical patterns UC can take?
MAJORITY: Intermittent= <3r/year
Frequent: >3r/yr
Chronic continuous
Commonly procto-sigmoiditis
What are the initial signs of UC?
Diarrhoea: Episodic/chronic, frequency relates to severity, 90% haemorrhage, some mucous Urgency/tenesmus Abdo pain- LLQ Anaemia Fever, malaise, anorexia, ↓weight
What are the extra-intestinal signs of UC?
Large joint arthritis Erythema nodosum Conjunctivitis/episcleritis/iritis/uveitis Clubbing Sacroilitis
What does urgency/tenesmus in UC indicate?
Rectal UC
How is UC investigated?
1) Colonoscopy & biopsy= DIAGNOSTIC
2) AXR: Thumb printing, lead pipe, megacolon
3) Stool sample: Exclude infective causes
4) Faecal calprotectin: +ve inflammation
5) Barium enema: Loss of normal haustra markings
What are the findings for UC on colonoscopy?
Extends from distal margin & sharp cut-off from proximal colon
Continuous inflamed red colon & rectum- bleeds easily
Red granulomatous appearance
Crypt abscesses
Shallow ulcers
Colitis polposa: Multiple post-inflam pseudopolyps
Dilated & thin bowel wall
What is seen in histology for UC?
Plasma cells at mucosal base = KEY FINDING Polymorphs in LP & crypt epithelium Distorted & atrophic crypts Fibrosis Paneth cells- METAPLASTIC FEATURE
How is mild UC managed?
INDUCE: For proctitis 1) TOP Aminosalicylate (Rectal Mesalazine) 2) Prednisolone MAINTAIN: For L sided UC 1) High dose Sulfasalazine/Mesalazine OR Azathioprine + Mercaptopurine
How is mild-moderate UC managed?
1) Prednisolone + Aminosalicylate
2) PO Tacrolimus if no response to steroids in 2-4w
3) Infliximab if severe
How is remission maintained in UC?
Continue PO/TOP aminosalicylate + low dose steroid
