Inflammatory bowel disease Flashcards
Characteristic features of Crohn’s (crow’s NESTS)
- no bleeding
- entire GI tract can be affected
- skip lesions on endoscopy
- terminal ileum most common/transmural inflam
- smoking is a RF
- weight loss
- stricture & fistulas
characteristic features of UC (U-C-CLOSEUP)
- continuous inflammation
- limited to colon & rectum
- only superficial mucosa affected
- smoking is protective
- excrete blood & mucus
- use aminosalicylates
- primary sclerosis cholangitis
Presentation (typical of bowel inflammation)
- diarrhoea
- abdominal
- blood
- weight loss
When is faecal calprotectin released
Inflamed intestines
1st line inducing remission crohn’s
Steroids
Additive to 1st line inducing remission Crohn’s if 1st line on its own doesn’t work
- azathioprine
- mercaptopurine
- methotrexate
- infliximab
- adalimumab
1st line immunosuppressants maintaining remission Crohn’s
- azathioprine
- mercaptopurine
2nd line maintaining remission Crohn’s (chemotherapeutic immunosuppressant & 2 monoclonal Abs)
- methotrexate
- infliximab
- adalimumab
When to perform surgery in Crohn’s
If only ileum is affected
1st line mild-moderate UC inducing remission
- aminosalicylate
- mesalazine
- oral/rectal
2nd line mild-moderate UC inducing remission
Corticosteroids
1st line severe UC inducing remission
- IV corticosteroids
2nd line severe UC inducing remission (immunosuppressant calcineurin inhibitor)
- IV ciclosporin
UC maintains remission
- aminosalicylates
- azathioprine
- marcaptopurine
How is surgery for UC performed and what is removed
- ileo-anal anastomosis (J-pouch)
- colon & rectum