Inflamatory Bowel Disease

Question 1

Clinical features and common sites for CD and what is it

Answer 1

CD  is a full bowel wall inflamatory illness 
Typical sites are 
Terminal illeum 40%
Illeo Cecal 30%
Colonic 20% 
Upper GI 10% 
Inflammatory condition of the bowel that causes 
1 anaemia
2 growth retardation 
3 pubertal delay
4 diarrhoea 
5 bone effects 39% have decreased BMD 

Always check the anus for typical changes
Fistulaes and strictures can happen when they happen
Get pain / anorexia/ bowel obstruction
Fistula skin pelvic organ and can causes torrential bleeding
Incidence is 3/100,000

Question 2

UC

Answer 2

Incidence is 1/100,000
Bloody Diarrhoea
Pain nocturnal stooling
Anaemia

Pancolitis 80%
Proctitis 5-10%
Left sided 20%

Question 3

Typical features of CD depends on the site of the inflamation

Answer 3

Colonic CD gives you blood y diarrhoea and pain on defecation perinatal fistula
Small intestine abdominal pain and post prandial pain

Question 4

Other effects of IBD other organs effects

Answer 4

1 skin pyoderma gangranosum/ erythema nodosum
2 joints 1/10 UC and colitis CD swollen joints , ankylosis spondylitis
3 eyes episcleritis/ uveitis (10% get this can cause blindness)
4 bones CD 30% have osteoporosis/ DEXA scan needed
5 Kidneys GN RARE
6 liver /GB gallstones autoimmune hepatitis / primary sclerosis get cholangitis will need e/LFTs uss and mri to diagnose

Question 5

Diagnosis of IBD dd UC/CD and irritable bowel

Answer 5

BLOODS FBC and inflamatory markers
Fecal calprotection USEFUL
MANTOUX. Test TB can masquerade as CD/US
Faeces MCS exclude salmonella
Imaging nuclear scan dd UC/CD strictures/ fistula/mass and site this will help say the side and complications
ENDOSCOPY
CD skip lesions/ ulceration/ cobblestone
UC diffuse colon only polyps No cobblestoneing

Question 6

Surgical Treatment of UC/CD

Answer 6

1 surgery in CD 70% recurrence in 10 years
Conservative avoid major resection do very limited if possible
Inflamatory mass/abscess
Fistula
Hemorrhage rare but very important

UC surgery can be curative can leave a J pouch

Question 7

Medical treatment of UC/CD

Answer 7

1 salazoprine and antibiotics 15% response
2 steroids / MTX/Azathroprine good in remission not good at inducing remission monitor the metabolites of the azathiopine
3 Anti TNF monoclonal antibodies use with azathroprine /MTX decreases the risk of AB monitor the dose of the drug
4 TPN good for remission of CD but patient in hospital a long time