inflammatory bowel disease Flashcards
what are the two main types of IBD ?
crohns and ulcerative colitis
what is the main aetiology of IBD ?
genetic susceptibility HLA-B27
host immune response
environmental factors
what areas of the gut are affected by Crohns disease ?
any part of the GI tract especially the terminal ileum and ascending colon
which IBD is known for having skip lesions?
Crohns disease
where is the affection of ulcerative colitis ?
can affect the rectum alone (procititis) and can extend proximally to involve the sigmoid and descending colon (left-sided colitis) or may involve the whole colon
what is backwash colitis ?
due to severity of inflammation towards the ileum the inflammation goes backwards into the ileum but in very severe cases of ulcerative colitis
what does Crohns look like on endoscope ?
apthoid ulcers along with cobblestone appearance
what does ulcerative colitis look like on endoscopy ?
inflammatory polyps ( superficial inflammation )
what is fulimant colonic disease ?
when ulcerative colitis progresses and affects all the layers of the mucosa
what are the microscopic features of crohns disease ?
transmural
lymphoid hyperplasia
granuloma
what are the microscopic features of ulcerative colitis ?
superficial inflammation
crypt abscess
goblet cell depletion
what are the extra gastrointestinal manifestations of IBD?
joints especially sacro-illiac and the knees
eyes uveitis
skin pyoderma gangrenosum erythema nodosum
liver primary sclerosing cholangitis
what are the clinical features of Crohn’s disease ?
diarrhea , abdominal pain and weight loss
constitutional symptoms
steatorrhea due to malabsorption
anal and perianal diseases
what investigations would be required for crohn’s disease ?
CBC - shows normocytic normochromic anemia iron deficiency raised ESR , CRP hypoalbuminemia CT faecal calprotectin
what is the cause of the hypoalbuminemia ?
is a negative phase reactant so it decreases with inflammation
and inn cholitis there is a loss of protein
which serological investigation is for each IBD ?
ulcerative colitis - ANCA +ve
Crohns disease - ASCA +ve
what imaging would be required for the imaging of the small intestine ?
MRI
why would we use CT in an IBD patient ?
to look for abscess and perforation
what is faecal calprotectin ?
calprotectin is an inflammatory marker specific to the gut
and is raised in cases of IBD and is very high in colorectal cancer
what is the general treatment approach in CD ?
induce then maintain a remission
cigarrette smoking should be stopped
we provide symptomatic treatment- loperamide
anemia due to B12 deficiency/folic acid or iron deficiency
what are the two approaches of management for Crohns disease ?
step down approach
step up approach
what are the medications used for the induction phase in Crohns disease ?
steroids along with azathioprine ( by the time azathioprine works it reaches the maintenance phase)
what are the medications for the maintenance of remission in Crohns disease ?
give immunosuppressive therapy :
azathioprine
mycophenolate
what is an alternative method to induce remission inn crohns patients ?
enteral nutrition
what are the possible side effects of mycophenolate ?
leucopenia
what is the best management for patients with immunosuppressive therapy resistant crohns disease ?
methotrexate or IV cyclosporine which is effective in inducing remission but not maintaining it
When are biological treatments indicated ?
when the patient suffers from :
- fistulas
- abscess
- colorectal cancer
when are biological treatments contraindicated?
when there is a latent infections such as :
TB
HBV
what are the clinical features of ulcerative colitis ?
diarrhea with blood and mucus which is sometimes accompanied by lower abdominal pain
general features of fatigue
when do we say that the patient is suffering from an acute attack of ulcerative colitis ?
stool frequency of more than t6 times with blood fever above 37.5 tachycardia elevated ESR anemia less than 10 hb albumin less than 30
what investigations would be required for ulcerative colitis ?
full CBC- elevated ESR and CRP, anemia,
positive for pANCA
stool cultures should always be performed
why should a stool culture be performed in ulcerative colitis patients ?
to exclude infective cause of colitis
what imaging modality could be used for ulcerative colitis ?
a plain abdominal X-ray with an abdominal ultrasound are the key investigations
how can the extent of the disease be judged in ulcerative colitis ?
by the air distribution in the colon and the presence of colonic dilatation
when should you avoid performing a colonoscopy ?
in severe attacks of the disease for fear of perforation
what should be maintained with patients that have had ulcerative colitis for more than 10 years ?
colonoscopy and multiple biopsy to exclude biopsy
what should patients with ulcerative colitis be treated with ?
5-ASA
where is 5-ASA absorbed ?
in the small intestine so patients who have affection of the small intestine cannot take 5-ASA
what is the management inn proctitis ?
oral aminosalicylates plus a local rectal steroid preparation
what is composition of the local rectal steroid preparation for ulcerative colitis ?
10% hydrocortisone foam
predinsolone 20mg enemas or foam
in moderate or severe attacks of ulcerative colitis what is the best management option ?
patient should be admitted to the hospital and treated initially with hydrocortisone 100 mg
when is surgery required for toxic dilatation ?
if it hasn’t revolved inn 48 hours
what are the three types of remission ?
clinical remission
histological remission
colonoscopic remission
