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Colorectal > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

What is IBD?

A

A term used to describe two chronic GI inflammatory conditions

  • Ulcerative colitis
  • Chron’s disease
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2
Q

What are the risk factors for Crohn’s?

A

Poor diet
FH
Smoking
Altered immune states

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3
Q

What is the underlying pathophysiology of Crohn’s?

A

Inflammation can affect any part of GI tract
-most commonly terminal ileum/ascending colon
-skip lesions present
-narrowed bowel, thickened wall
-deep ulcers (Rose thorn, cobblestone appearance on CT)
Inflammation throughout all layers of bowel
-fistulae/stenosis common

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4
Q

What are the clinical features of Crohn’s?

A

Abdo pain
Diarrhoea (steatorrhoea in ileal disease, bloody in colonic)
Wt loss
Severe apthous ulceration of mouth (early sign)
Anal complications- fistula, fissure, haemorrhoids
Extra GI manifestations
Acute RIF pain/mass

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5
Q

What are the anal complications of Crohn’s?

A 
Fissure
Fistula
Haemorrhoids
Skin tags
Abscesses
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6
Q

What effect does smoking have on UC?

A

Protective

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7
Q

What is the underlying pathophysiology of UC?

A

Inflammation starts in rectum, extends proximally along colon
-proctitis if affects rectum only
Inflammation of distal terminal ileum (backwash ileitis)
Inflammation only affects mucosa (excessively ulcerate)
-adjacent mucosa looks like inflam polyps

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8
Q

What are the clinical features of UC?

A

Crampy lower abdo discomfort
Gradual onset diarrhoea (often bloody)
Urgency/tenesmus (if disease confined to rectum)
Extra-GI sx

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9
Q

What is the histological difference b/w UC & Crohn’s?

A

Chron’s - transmural inflammation, lymphoid hyperplasia, granulomas

UC - mucosal inflammation, crypt abscesses, goblet cell depletion

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10
Q

What is indeterminate inflammatory colitis?

A

Diagnosis given when biopsy taken in acute phase, not always possible to distinguish UC/Chron’s

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11
Q

What is fulminant IBD?

A

Most of mucosa lost, leaving only a few islands of normal tissue
Toxic dilatation can occur

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12
Q

What investigations are appropriate in suspected IBD?

A

Bloods - FBC, U&Es, CRP/ESR, LFTs, Fe/B12
Stool studies - stool chart, MCS x3, calprotectin
AXR/CXR/CT
Endoscopy (+/- biopsy)

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13
Q

What medical therapy is available for a mild acute Crohn’s flare?

A

SYMPTOMATIC BUT SYSTEMICALLY WELL

  • oral prednisolone
  • tapered steroids
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14
Q

What medical therapy is available for a severe acute Crohn’s flare?

A

SYMPTOMATIC AND SYSTEMICALLY UNWELL

  • admission (if raised temp, pulse, CPR/ESR, low albumin)
  • IV hydrocortisone 100mg/6h
  • make pt NBM w/ parenteral nutrition)
  • high level monitoring
  • thiopurines/methotrexate if not responding
  • infliximab (if refractory)
  • transfer to oral prednisolone
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15
Q

What medical therapy is available for Crohn’s maintenance?

A 
1st Line = Thiopurines (azathiopurine/6-mercaptopurine)
2nd Line = Methotrexate/infliximab 
Oral metronidazole (if anal disease)
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16
Q

What screening should always be done before prescribing Thiopurines?

A

TPMT deficiency

-unable to metabolise thiopurine

17
Q

What is classed as a mild flare of UC?

A

<4 diarrhoea stools a day- can have blood

Systemically well

18
Q

What medical therapy is available for acute severe/fulminating UC?

A

MDT management (consider surgical intervention)
IV corticosteroids
SC heparin
Avoid anti-motility drugs (including opioids)
2nd line = IV ciclosporin (if sx worsen/no improvement w/i 72hrs steroids)
3rd line = biological agents (specialist)

19
Q

What are the indications for surgical treatment of acute severe/fulminating UC?

A 
>8motions/day
Pyrexia
Tachycardia
Colonic dilatation
Low albumin
Low Hb
CRP >45
20
Q

What medical therapy is available for UC maintenance?

A

Post mild-moderate flare

  • proctitis= topical mesalazine OR oral and topical OR oral alone (not as effective)
  • sigmoiditis= low dose oral mesalazine

Severe

  • 1 severe exacerbation or >2 exacerbations in 1 yr
  • azathioprine or mercaptopurine
21
Q

What monitoring do UC pts require?

A

Monitoring appropriate to specific drug

Bone health monitoring

22
Q

What are the general complications of Crohns?

A 
Episcleritis
Colonic cancer
Small bowel cancer
Osteoporosis
Malabsorption
Fistula and abscess
23
Q

What are the features of toxic dilatation?

A

Persistent fever
Tachycardia
Loose-blood stained stool

24
Q

What investigations are appropriate in suspected toxic dilatation?

A

Falling albumin/K

AXR (dilated colon, >6cm, w/ mucosal islands)

25
Q

What is the management of toxic dilatation?

A

Perforation imminent

Surgical management

26
Q

What are the surgical options for Chron’s disease?

A

Never curative
Temporary ileostomies - ‘rest’ distal diseased bowel
Limited resection of worst areas

27
Q

What is short bowel syndrome?

A

Malabsorption if <1m small bowel remains

28
Q

What are the surgical options for UC?

A 
Bowel resection curative
Emergency
   -subtotal colectomy & end ileostomy
   -proctolectomy & end ileostomy
Elective
   -completion proctocolectomy & ileoanal pouch reconstruction
   -colectomy & ileorectal anastomosis
29
Q

What are the extra colonic manifestations of IBD present during the active phase?

A

Eyes - conjunctivitis/episcleritis/iritis
Joints - arthralgia of large joints
Skin - erythema nodosum, pyoderma gangrenosum
VTE
Fatty liver

30
Q

What are the extra colonic manifestations of IBD unrelated to disease activity?

A

Autoimmune hepatitis
Gallstones
Renal calculi

31
Q

What is a moderate flare of UC?

A

4-6 stools a day with minimal systemic disturbance

32
Q

What is a severe flare of UC?

A

> 6 bloody stools a day
Systemic upset
-fever
-tachycardia

33
Q

What is the management of a mild-moderate flare of UC?

A

Proctitis

  • topical mesalazine
  • if no improvement in 4 wks then add oral
  • still no improvement then add oral prednisolone

Sigmoiditis and descending colitis

  • topical mesalazine
  • no improvement after 4wks then add oral OR switch to oral mesalazine and topical steroid
  • still no improvement then add oral prednisolone

Extensive disease

  • oral and topical mesalazine
  • no improvement after 4wks then add either topical or oral steroid
34
Q

What are complications of UC?

A

Toxic megacolon
Uveitis
Primary sclerosing cholangitis
Cholangiocarcinoma

Colorectal (7 decks)

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