Inflammatory Bowel Disease Flashcards
What are the two major forms of chronic idiopathic inflammatory bowel disease?
- Ulcerative colitis
2. Crohn’s disease
What is a chronic idiopathic inflammatory bowel disease?
Relapsing and remitting inflammatory condition of the GIT with characteristic extra-intestinal manifestations.
What are granulomas and in what conditions are they commonly seen?
- Aggregation of activated epithelial macrophages.
2. Mycobacterium infections, sarcoidosis, Crohn’s.
How do UC and Crohn’s compare in this feature?
Spread through GI wall.
UC - mucosa
Crohn’s - transmural (entire wall)
How do UC and Crohn’s compare in this feature?
Site affected.
UC - colon
Crohn’s - any part of GIT (terminal ileum and proximal colon commonly)
How do UC and Crohn’s compare in this feature?
Type of disease process.
UC - ulceration and inflammation
Crohn’s - granulomatous inflammation
How do UC and Crohn’s compare in this feature?
Pattern of spread.
UC - diffuse and continuous
Crohn’s - patchy and discontinuous (skip lesions)
How do UC and Crohn’s compare in this feature?
Type of ulcers.
UC - superficial ulcers
Crohn’s - deep fissuring ulcers
How do UC and Crohn’s compare in this feature?
Presence of granulomas.
UC - not present
Crohn’s - present
What is the pattern of extension of ulcerative colitis?
Can affect juts the rectum and spread proximally (continuous fashion) to left-sided colon or all of colon.
How do UC and Crohn’s compare in this feature?
Affect of smoking.
UC - stopping smoking may precipitate flares
Crohn’s - smoking exacerbates
What is the aetiology of ulcerative colitis and Crohn’s disease?
Inappropriate immune response against colonic flora in genetically susceptible individuals.
What are the risk factors of ulcerative colitis compared to Crohn’s disease?
UC - FHx, HLA-B27 positive
Crohn’s - FHx, Caucasian, 15-40 years old
What is this a presentation of?
Episodic/chronic diarrhoea (+/- blood or mucus), LLQ abdominal pain, bowel frequency relates to severity, urgency/tenesmus, fatigue, fever, malaise, anorexia.
Ulcerative colitis
What is this a presentation of?
Diarrhoea, RLQ abdominal pain, weight loss/failure to thrive, fatigue, fever, malaise, anorexia.
Crohn’s disease
What are the signs present on examination in ulcerative colitis compared to Crohn’s disease?
UC - may be none, fever, tachycardia, tender and distended abdomen.
Crohn’s - abdominal tenderness, perianal abscess/fistulae/skin tags/anal strictures.
What are the general extra-intestinal signs in inflammatory bowel disease?
Clubbing, oral ulcers, erythema nodosum, conjunctivitis, uveitis, large joint arthropathies.
What extra-intestinal conditions are seen in ulcerative colitis and not in Crohn’s?
Sclerosing cholangitis and cholangiocarcinoma
How is suspected inflammatory bowel syndrome investigated?
- Bloods - anaemia, leucocytosis, thrombocytosis, raised CRP and ESR, iron studies, B12, folate (malabsorption)
- Stool - elevated faecal calprotectin, discriminate between IBD and IBS, exclude infection
- Colonoscopy for diagnosis
- CT contrast/MRI for Crohn’s
What would you see on an AXR of ulcerative colitis?
Thumbprinting and leadpiping
What would you seen on a colonoscopy of someone with Crohn’s?
Cobblestone appearance - surviving mucosa between fissuring ulcers
What is faecal calprotectin and what does it help to distinguish between?
- Released during neutrophil degranulation
2. IBD (raised) and IBS (normal) - but has a high negative prediction value (if normal then IBD is unlikely)
What is the treatment for mild-moderate ulcerative colitis?
- Mild - 5-ASA (mesalazine) PR for distal disease, PO for extensive disease. Topical steroids may also be given.
- Moderate - induce remission with PO steroids, then maintain on 5-ASA.
What is the treatment for severe ulcerative colitis?
- IV fluids, IV steroids, PR steroids
- Cyclosporin/infliximab to avoid colectomy if still severe on day 3-5.
- Azathioprine if patients flare on steroid tapering.
- Subtotal colectomy and terminal ileostomy needed in 20%.
What is the treatment for mild-moderate Crohn’s disease?
Prednisolone PO and taper
What is the treatment for severe Crohn’s disease?
- IV fluids, IV steroids
- Azathioprine if patients flare on steroid tapering.
- Infliximab (anti-TNFa), anti-integrin, anti-IL12/23
- Surgery (not curative) in 50-80% - drug failure or GI obstruction.
What are the complications of ulcerative colitis?
- Increased risk of colorectal cancer - mucosal central disease (more likely than Crohn’s)
- Inflammatory polyps (not dysplastic)
- Toxic megacolon, perforated colon, VTE, dehydration.
What are the complications of Crohn’s disease?
- Increased risk of colorectal cancer (less likely than UC)
- Bowel obstruction - caecal volvulus, stricture formation
- Ulcers, fistulas, adhesions, anal fissures.
What is the important part of follow-up for inflammatory bowel disease?
Colonoscopy screening for cancer 8-10 years after diagnosis and sooner if higher risk factors.
