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Yr 5 GI & Breast > IBD &IBS& Constipation > Flashcards

IBD &IBS& Constipation Flashcards

1
Q

What is Crohn’s disease?

A

Chronic, continuous transmural inflammation of GI tract from mouth to anus

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2
Q

Where is Crohn’s most commonly found?

A

Terminal ileum & proximal colon

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3
Q

What are the risk factors for Crohn’s?

A 
SMOKING
COCP
NSAIDs
MMR
Fhx
20-40yo
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4
Q

How does Crohn’s disease present?

A 
↓Weight/ FTT
Diarrhoea & urgency
Abdo pain & tenderness
Fever, malaise, anorexia
Vomiting
Anaemia
Peri-anal abscess/fistula/skin tags
Apthous ulcers
Anal strictures & lesions
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5
Q

What are extra-intestinal signs of Crohn’s disease?

A 
Large joint arthritis
Episcleritis
Erythema nodosum
Clubbing
Skin & joint problems
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6
Q

How is Crohn’s disease investigated?

A

1) Colonoscopy- DIAGNOSTIC
2) Faecal calprotectin: +ve = intestinal inflammation
3) AXR: Strictures
4) Small bowel enema

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7
Q

What are the signs seen on colonoscopy which indicate Crohn’s?

A

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

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8
Q

What is the Harvey-Bradshaw index used for?

A

Severity scoring in Crohn’s
<3 = remission
8-9 = Severe

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9
Q

How is remission induced in Crohn’s?

A

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

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10
Q

How is remission maintained in Crohn’s?

A

1) Azathioprine/Mercaptopurine monotherapy

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11
Q

What are the complications of Crohn’s?

A 
Small bowel obstruction
Malnutrition
Abscess formation/ fistula
Perforation
Rectal haemorrhage
Colonic cancer/ Cholangiocarcinoma
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12
Q

What is UC?

A

Chronic, relapsing-remitting, diffuse, continuous inflammation of colonic & rectal mucosa ONLY

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13
Q

Where does UC stop?

A

NEVER spreads beyond ileocaecal valve

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14
Q

What are the risk factors for UC?

A

SMOKING = PROTECTIVE

20-40yo

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15
Q

What are the clinical patterns UC can take?

A

MAJORITY: Intermittent= <3r/year
Frequent: >3r/yr
Chronic continuous
Commonly procto-sigmoiditis

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16
Q

What are the initial signs of UC?

A 
Diarrhoea: Episodic/chronic, frequency relates to severity, 90% haemorrhage, some mucous
Urgency/tenesmus
Abdo pain- LLQ
Anaemia
Fever, malaise, anorexia, ↓weight
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17
Q

What are the extra-intestinal signs of UC?

A 
Large joint arthritis
Erythema nodosum
Conjunctivitis/episcleritis/iritis/uveitis
Clubbing
Sacroilitis
18
Q

What does urgency/tenesmus in UC indicate?

A

Rectal UC

19
Q

How is UC investigated?

A

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

20
Q

What are the findings for UC on colonoscopy?

A

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

21
Q

What is seen in histology for UC?

A 
Plasma cells at mucosal base = KEY FINDING
Polymorphs in LP &amp; crypt epithelium
Distorted &amp; atrophic crypts
Fibrosis
Paneth cells- METAPLASTIC FEATURE
22
Q

How is mild UC managed?

A 
INDUCE:
For proctitis
1) TOP Aminosalicylate (Rectal Mesalazine)
2) Prednisolone
MAINTAIN:
For L sided UC
1) High dose Sulfasalazine/Mesalazine
OR
Azathioprine + Mercaptopurine
23
Q

How is mild-moderate UC managed?

A

1) Prednisolone + Aminosalicylate
2) PO Tacrolimus if no response to steroids in 2-4w
3) Infliximab if severe

24
Q

How is remission maintained in UC?

A

Continue PO/TOP aminosalicylate + low dose steroid

25
Q

When is surgery required in UC?

A

Perforation
Massive haemorrhage
Toxic dilatation (megacolon)
Failed medical therapy

26
Q

What are the complications of UC?

A

Toxic megacolon
Carcinoma- Higher risk than Crohn’s
Perforation

27
Q

What is the cause of toxic megacolon?

A

Ulceration extending to muscle & impairing viability of contractile strength

28
Q

How is toxic megacolon treated?

A

Will have reactive thrombocytosis- IV Hydrocortisone 3d before surgery

29
Q

What is IBS?

A

Abdo Sx w/no organic cause due to abnormal intestinal motility or ↑visceral perception

30
Q

What are the features of IBS?

A

Criteria for diagnosis:
- Abdo pain/discomfort RELIEVED by defeacation
PLUS >2 of:
-Altered stool passage- urgency, straining, incomplete evaluation
- Mucous PR
-Abdo bloating/ distension
-Worsening Sx after food

31
Q

How is IBS investigated?

A

Bloods: FBC, ESR, CRP, LFT + TTG
Referral for colonoscopy: IF >50yo or marker of organic disease
Stool culture
Faecal calprotectin: normal

32
Q

How is IBS managed?

A

1) Dietary advice- reg fluids, restrict tea/coffee, dec fibre
2) Physical activity
3) Constipation = Sodium Picosulfate & Bisacodyl (AVOID Lactulose)
4) Diarrhoea = Loperamide 2mg after every loose stool
Consider psychological intervention (Amitriptyline)

33
Q

What are causes of constipation?

A 
↓fibre diet/fluid intake
Immobility
Elderly
Post-op
Anorectal disease
Drugs: Opiods, iron, anticholinergics
Intestinal obstruction
34
Q

Who needs investigating for constipation?

A

> 40yo
Recent change in bowel habits
Sx: weight↓, rectal bleeding, mucous discharge, tenesmus

35
Q

What investigations can be done for constipation?

A

Bloods: FBC, U&E, Ca2+, TFTs
Sigmoidoscopy +/- biopsy
Barium enema

36
Q

How is constipation managed?

A

Tx cause
Mobilise
↑fluids & fibre
Medications in short term

37
Q

What are the different types of laxatives?

A

Bulk-forming
Stimulant: Docusate, Picosulfate (used pre-op), Senna
Softener
Osmotic: Lactulose

38
Q

What are the causes of diarrhoea?

A

Travel: Salmonella, E.Coli, Shigella, Campylobacter
Viral: NoroV, RotaV
Gastroenteritis
UC

39
Q

Which antibiotics can be given to traveller’s incase of diarrhoea?

A

1) Ciprofloxacin

2) Azithromycin

40
Q

What are the causes of bloody diarrhoea?

A

Infections: Campylobacter, Shigella, Dysentry, E.Coli, C.Diff, Salmonella
Non-infectious: Diverticular disease, colorectal Ca, IBD, haemorrhoids, fissure, ischaemic colitis, intusussception

Yr 5 GI & Breast (13 decks)

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