IBD symptoms and complications Flashcards
What are the common symptoms of IBD?
Diarrhoea
Abdominal pain
Fever
Nausea and vomiting
Malaise
Lethargy
Weight loss
Malabsorption
Growth retardation in children
Which symptoms as highlighted in IBD symptoms tend to be more associated with Crohn’s disease?
Nausea and vomiting (associated with inflammation in the upper GI)
Weight loss (if inflammation is in the small intestine then lack of absorption can lead to weight loss, however you can feel generally unwell in both conditions and therefore it is possible to experience weight loss in both).
Which condition tends to be more disabling?
Crohn’s disease
What are some of the symptoms specific to Crohn’s disease?
Abdominal pain (specifically in the lower right quadrant where the terminal ileum is)
Anaemia (loss of blood or generally not eating much)
Palpable masses (feeling a lump- due to swelling)
Small bowel obstructions
Abscesses
Fistulas
Gut perforation
What are the main symptoms associated with UC?
Diarrhoea with blood and mucus (up to 20 stools a day)
Abdominal pain
Fever
Constipation (due to narrowing)
What percentage of UC relapse each year?
50%
In reference to the distinguishable features, which IBD condition has skip areas?
Common in Crohn’s disease
Never occurs in Colitis
In reference to the distinguishable features, which IBD condition has cobblestone mucosa?
Common in Crohn’s disease
Rare in Colitis (unless pseudopolyps are present)
In reference to the distinguishable features, which IBD condition has transmural involvement?
Common in Crohn’s disease
Occasional in Colitis
In reference to the distinguishable features, which IBD condition has rectal sparing?
Common in Crohn’s
Never in Colitis
In reference to the distinguishable features, which IBD condition has perianal involvement?
Common in Crohn’s disease
Never in Colitis
In reference to the distinguishable features, which IBD condition has fistulas?
Common in Crohn’s disease
Never in Colitis
In reference to the distinguishable features, which IBD condition has strictures?
Common in Crohn’s disease
Occasional in Colitis
In reference to the distinguishable features, which IBD condition has Granulomas?
Common in Crohn’s disease
Occasional in Colitis
What percentage of patients with IBD develop other complications elsewhere in the body? What causes this?
10-20%
This is caused by the over spill of immune cells, which then travels elsewhere in the body
What are the complications in the joints and bones?
Arthropies and Osteopenia (loss of bone matrix), pro-inflammatory cytokines cause breakdown in the bone due to activating osteoclasts
What are some of the skin complications associated with IBD?
Erythema nodosum
Tender hot and red nodules, which subside over a few days to then leave skin discolouration
Pyoderma gangrenosum
Pustule develops into an ulcer
What are the ocular complications associated with IBD?
Episcleritis
Intense burning & itching of blood vessels
involved
Uveitis
Headache, burning red eye, blurred vision
What are some of the complications liver associated with IBD?
Sclerosing Cholangitis
Chronic inflammation of the biliary tree
– Leads to progressive fibrosis & biliary
strictures
When is the quality of life worse in Crohn’s or Colitis?
Crohn’s disease - unable to remove the small intestine so there are reoccurrences even after surgery
What are some of the other risks associated with IBD?
Increased risk of cancer
Increased risk of malnutrition and chronic anaemia (especially Crohn’s disease)
Risk of peronitis
What are some of the tests for diagnosing IBD?
- Biochemical
– Endoscopic
– Radiological
– Histological
– Nuclear medicine based
What would some of the history taking that would be required for diagnosis?
- Recent travel
– Medication
– Smoking
– Family history
What are some of the symptom details that you would want to record?
- Stool frequency & consistency
– Urgency
– Rectal bleeding
– Abdominal pain
– Fever
What are some of the physical signs you may want to explore?
General well-being
– Pulse
– Blood pressure
– Temperature
– Weight loss
– Abdomen tenderness or distension
(Right iliac fossa mass)
– Anus
(Oedematous anal tags, fissures or perianal abscesses)
What are some of the blood test results would align to IBD?
Anaemia
Iron deficiency and or folate deficiency
Raised ESR , CRP, WCC
Hypoalbuminaemia (protein loss in the gut)
LFTs may be abnormal
May test for infective diarrhoea
What serological tests can be used to distinguish between Crohn’s and Colitis?
Saccharomyces cerevisae antibody is present in Crohn’s disease
p-ANCA antibody is present in Colitis
What is the purpose of abdominal radiography?
Helps to assess the disease extent
Excludes colonic dilatation
Identifies proximal constipation
Gives an impression of right iliac fossa mass in Crohn’s disease
Can show evidence of small bowel dilation
What does a sigmoidoscopy involve?
Internal examination of the colon (the lower third)
It is used for all patients presenting with diarrhoea
Confirms UC diagnosis
What is the purpose of a rectal biopsy?
Detects non-specific histological changes
What is the purpose of a colonoscopy?
Internal examination of the entire length of the colon
Used for mild to moderate disease to assess disease extent
Used in addition to a biopsy
What are some of the other investigations that may be made in diagnosis?
Double contrast barium enema
Inferior to colonoscopy
Detect early mucosal changes
Small bowel radiology
Current standard for assessing small intestine
Ultrasound
Sensitive & non-invasive
Identifies thickened small bowel loops in Crohn’s disease
Computer tomography & magnetic resonance imaging
Evaluates activity & complications of the disease
