Inflammatory Bowel Disease Flashcards
What are two types of IBD?
- Crohn’s disease
2. Ulcerative Colitis
What are RF for CD?
- White
- FHx of CD
- 15-40year or 60-80years
- Smoking increases risk by 3-4times
What are causes of CD?
unknown
What is the defintion of Crohn’s disease?
A disease of unkown aetiology, characterised by TRANSMURAL inflammation of the GI tract that can affect any part from mouth to anus
What does transmural mean?
affects WHOLE THICKNESS of the GI layer
What sort of lesions are in Crohn’s?
skip
What are the most commonly affected areas for Crohn’s?
- Terminal ileum
2. Peri anal
What does the Crohn’s inflammation lead to?
ulceration to all layers affected to NON CEASTING Granuloma formation
What is the tissue like between the lesions in Crohn’s?
Tissue is healthy between lesions
What is the deinfiton of UC?
diffuse inflammation of colonic mucosa and relapsing remitting course
What areas of the gastro tract are affected by UC?
Only RECTUM + COLON
Where does UC start and extend?
- Starts from the rectum
- Extends proximally
- Affects variable lengths of the colon
What layers of the bowel are affected in UC?
just mucosa (corhn’s affects all)
What are RF for UC?
- Fhx
- HLA-B27 positive
- Not-smoking
What is the cause of UC?
inappropriate immune response
What is the usual epi of UC?
- M>F
- Western Countries
- Bimodal Peak
- 20-40 years
- 60 years
What are the abdominal symptoms in Crohn’s?
- Abdominal pain
- Crampy or constant
- Right Lower Quadrant + Peri Umbilical (terminal ileum)
What is the diarrhoea like in Crohn’s?
- Mucus, Blood, Pus
2. Nocturnal sometimes
What are the perianal lesions like in Crohn’s?
skin tags, fistulae, absesses
What are general symptoms of Crohn’s?
- Fatigue
- Weight loss (as malnourished)
- Painful oral lesions
How common are extra-intestinal symptoms of Crohn’s?
20-40% have
What are examples of extraintestinal manifestations in Crohn’s?
- Arthropathy (joint pain)
- Skin lesions
- Occular symptoms
What skin lesions are in Crohn’s?
- Erythema nodosum
2. Pyoderma gangrenosum
What are the occular symptoms of Crohn’s?
- Uveitis
2. Episcleritis
What are the examination findings for Crohn’s?
- Abdominal tenderness / mass
- lower right (terminal ileum) - Oral exam:
- Apthous ulcers - Peri anal lesions:
- Skin tags
- Fistulae
- Absesses
What are symptoms of UC?
- Bloody diarrhoea
- Rectal bleeding + mucus
- Abdominal pain + cramps
- Tenesmus
- Weight loss
- Clubbing
What are the joint extraintestinal manifestations of Crohn’s?
- Peripheral arthritis
2. Ankylosing spondylitis – HLA B27 gene
What are the skin extraintestinal manifestations of Crohn’s?
- Erythema nodosum
2. Pyoderma Gangrenosum
What are the eye extraintestinal manifestations of Crohn’s?
Episcleritis > Uveitis
What would you find on examination for UC?
- Anemia signs: pallor
- DRE: dross or occult blood comes out
- Abdominal tenderness
What are possible DDx for UC and CD?
- UC/CD
- Infectious colitis
- Pseudomembranous colitis
- Ischaemic colitis
- Radiation colitis
- IBS
What bloods are ordered for Crohn’s?
- FBC
- Serum vitamin B12
- Serum folate
- Serum iron, ferritin, TIBC, transferrin saturation
- CMP: hypoalbuminaemia, hypocholesterolaemia, hypocalcaemia
- CRP and ESR: high
- Yersinia enterocolitica serology
What would FBC show in Crohn’s?
anaemia; leukocytosis; may be thrombocytosis
What would ESR and CRP be in Crohn’s?
high
What imaging is done in Crohn’s?
- ABx
- Ct abdo
- MRI abdomen.pelvis
- Bowel series
- Colonscopy and biopsy
What would plain Abx show in Crohn’s?
bowel dilation
What would CT abdo show for Crohn’s?
- bowel wall thickening
2. skip lesions
What would Bowel series ( Xray and barium enema) show in corhn’s?
- rose thorn ulcers = deep ulceration
2. string sign of Kantor = fibrosis + strictures
What would the colonscopy show with biopsy in Crohn’s?
- Ulcers
- “cobblestone” appearance
- skip lesions
What is the string sign of Kantor?
edema and/or fibrosis with ulcerated mucosa (resembling frayed string)
What would histology of Crohn’s be?
transmural involvement with non-ceasating granulomas
What do you need for UC?
endoscopy with biopsy and negative stool culture for diagnosis
What bloods are done for UC?
- FBC
- Metabolic panel
- ESR
- CRP
- LFTS
- pANCA (70% positive)
What would FBC show in UC?
anaemia, leukocytosis, or thrombocytosis
What would ESR and CRP be like in UC?
high
Why do you do LFTs in UC?
primary sclerositing cholangitis
What would stool sample in UC show?
increased faecal calprotectin (indicates inflammation)
What imaging is done for UC?
- Plain AXR
- Double contrast barium enema)
- Colonscopy and biopsy
- histology
What would plain XRAY show in UC?
- dilated bowel (≧6cm = toxic megacolon)
2. “thumbprinting”
What would double contrast barium enema show in UC?
- “lead pipe appearance”
- complete loss of haustral marking
- single is not sensitive enough
What would colonscopy and biopsy show in UC?
- CONTINUOUS* erythema
2, bleeding - ulcers
What would histology show in UC?
- Crypt abscesses
2. depletion of goblet cell mucin
What is the aim of Corhn’s treatment?
induce and maintain remission and prevent relapse
What is the medication order for treating Crohn’s?
- Steroids
- Immunomodulators
- Biological therapy
- Surgery
What steroids can be given for Crohn’s?
- (oral or IV +/- topical)
2. Prednisolone
3. Budesonide
What immunomodulators are used in Crohn’s?
- (oral or IV)
1. Azathioprine
2. Mercaptopurine
3. Methotrexate
What biological therapy can be given for Crohn’s?
- IV
1. Adalimumab
2. Infliximab
3. Vedolizumab
What surgery can be offered to Crohn’s?
for severe remissions/presentation, refractory disease and obstructed pts
What adjuncts are used in Crohn’s management?
- Nutritional therapy
- Perianal disease mx
- Smoking cessation
What are the extra-intestinal manifestations of Crohn’s?
Require specific individualised management which may be best provided by a MDT
What treatment is used for acute relapse/intial presentation of Crohn’s?
INTRAVENOUS administration (versus oral) for steroids + immunomodulator GIVEN IN acute relapse/ initial presentation
What type of medication is Adalimumab, Infliximab?
TNF alpha inhibitors
What type of medication if vedolizumab?
integrin receptor antagonsits
What medications are used to maintain remission in Crohn’s?
- IMMUNOMODULATORS
• Azathioprine, Mercaptopurine, Methotrexate - / - BIOLOGICS
• Infliximab, Adalimumab, Vedolizumab
- / - BIOLOGICS
What adjuncts are used to maintain remission in Crohn’s?
- Anti-spasmotics (cramp relief)
2. Anti-diarrhoeals
What medications are used to induce remission in UC?
- MESALAZINE (5-ASA)
- Oral / topical - STEROIDS
- Oral Beclamethasone
What treatments are used to maintain remission in UC?
- Immunosuppresives
- Biologics (anti TNF alpha)
- Biologics (integrin receptor antagonsits)
- Ciclosporin
- Total colectomy
What immunosuppresive are used to maintain remission in UC?
- Azathioprine
2. Mercaptopurine
What anti TNF alpha biologics are used to maintain remission in UC?
- Infliximab
2. Adalimumab
What integrin receptor antagonsits alpha biologics are used to maintain remission in UC?
Vedolizumab
What sort of Drug is ciclosporin?
type of immunosuppresant
Why would you do a total colectomy in UC?
cure
What are examples of 5ASA?
Aminosalicylates — mesalazine and sulfasalazine may be considered for a mild-to-moderate first presentation
What are possible complications of CD?
- Extraintestinal involvement
- Intestinal obstruction
- Abscess formation
- Sinuses
- Fistulae
- SBO
- Anaemia
- Toxic megacolon
- Perianal disease: 50%
What are possible complications of UC?
- Colon adenocarcinoma: 3-5% patients
- Toxic megacolon
- Primary sclerosting cholangitis
- Perofration
- Infection
- Benign stricture
