Inflammatory Bowel Disease Flashcards

1
Q

Define IBD.

A

Chronic idiopathic inflammatory condition affecting the bowel encompassing two related but distinct disorders: ulcerative colitis (UC) and Crohn’s disease (CD).

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2
Q

Explain the aetiology/risk factors for IBD.

A

Unknown aetiology, likely 2 to environmental factors (infections, medications) triggering a response in genetically susceptible patients (multiple genes identified).

Genetic component: CD > UC.

Smoking: increased CD risk and decreased UC risk.

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3
Q

What is the pathophysiology of UC?

A

Diffuse mucosal inflammation of the rectum extending proximally (variable length). Subdivision into distal (proctitis and proctosigmoiditis) and extensive disease (left-sided or extensive colitis and pancolitis).

Macro: Mucosal erythema, friability, ulceration and inflammatory pseudopolyps.

Micro: Distortion of crypt architecture, inflammatory cell infiltrate, goblet cell depletion and crypt abscesses.

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4
Q

What is the pathophysiology of CD?

A

Patchy transmural inflammation affecting one or several segments of the intestinal tract (segmental/skip lesions). Defined by anatomical location or pattern of disease (inflammatory, fistulating or stricturing).

Macro: Mucosal (oedema/fibrosis), deep ulceration (serpiginous or fissuring), fistulas.

Micro: Transmural inflammation, lymphoid aggregates, non-caseating granulomas.

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5
Q

What is indeterminate colitis?

A

10% of children are unclassifiable as features of both conditions present.

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6
Q

Summarise the epidemiology of IBD.

A

5.2/100,000 (<16 years); 60% CD, 28% UC and 12% IC. Mean age (diagnosis): 11.9 years. Bimodal peaks at 10 and 40 years.

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7
Q

What are general presenting signs and symptoms of IBD?

A

UC characterised by exacerbation and remission episodes (50% relapse per year), skin manifestations rare, typically present with bleeding/diarrhoea/abdominal pain. CD are more heterogeneous and non-specific; classic triad now uncommon (abdominal pain/diarrhoea/weight loss).

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8
Q

What are common presenting signs and symptoms of IBD?

A

Abdominal pain (CD 72%, UC 62%, IC 72%), diarrhoea (CD 56%, UC 74%, IC 78%), rectal bleeding (CD 22%, UC 84%, IC 49%), weight loss (CD 58%, UC 31%, IC 35%), lethargy (CD 27%, UC 12%, IC 14%) and anorexia (CD 25%, UC 6%, IC 13%).

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9
Q

What are additional presenting signs and symptoms of IBD?

A

Arthropathy, N&V, constipation, encopresis, psychiatric symptoms, secondary amenorrhoea.

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10
Q

What are common signs of IBD?

A

Anal fistula, growth failure/delayed puberty, anal abscess/ulcer, erythema nodosum/rash, liver disease, toxic megacolon.

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11
Q

What are appropriate investigations for IBD?

A

General: ESPGHAN IBD Working Group consensus protocol. Bloods: low Hb, high ESR/CRP, serum folate, B12, LFTs (abnormality requires investigation with ERCP, USS and biopsy for primary sclerosing cholangitis (PSE)), albumin.

Specific: Limited use of perinuclear antineutrophil cytoplasmic antibody (pANCA) with UC and anti-Saccharomyces cerevisiae antibody (ASCA) with CD; sensitivity.60–80%.

Microbiology: Stool culture (infective causes), Clostridium difficile toxins A and B.

Radiology: AXR (toxic dilation), small bowel follow-through, technetium white cell scanning (highlights areas of inflammation).

Endoscopy: Ileocolonoscopy and upper GI endoscopy with histology of multiple biopsies from all segments.

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12
Q

What is the management plan for UC?

A

Induction – ASA/sulphasalazine or corticosteroids

Maintenance – AZA/mesalazine

2nd line – AZA/6-MPU

Surgery for toxic megacolon or resistance to medical treatment

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13
Q

What is the management plan for CD?

A

1st line - Exclusive liquid enteral nutrition -> corticosteroids -> aminosalicylates (mesalazine/sulphasalazine) -> budesonide -> IV steroid (add antiobiotics for perianal disease)

2nd line – AZAm parenteral nutrition

3rd line – Infliximab and surgery

Remission maintenance: AZA/6-MPU

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14
Q

What are some complications associated with UC?

A

Toxic megacolon, perforation, colorectal carcinoma, PSE.

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15
Q

What are some complications associated with CD?

A

Megaloblastic anaemia, gallstones, perianal disease (tags, fissures, fistulas, purulent discharge), strictures, obstruction.

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16
Q

What is the prognosis of IBD?

A

Good with early detection and treatment, mortality highest in first 2 years of diagnosis.