Inflammatory Bowel Disease Flashcards by Kayla Halliwell

What is IBD?

Chronic, relapsing and remitting inflammation of the GI tract

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What are the 2 main types of IBD?

Ulcerative Colitis
Chron’s disease

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How do UC and CD differ?

Differ in type and location of inflammation

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What is IBD-U?

Unclassified. Isolated colonic IBD where the diagnosis remains unnkown.

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What is microscopic colitis?

A type of IBD that can only be seen under the microscope

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What are 2 types of microscopic colitis?

Collagenous colitis
Lymphocytic colitis

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What is the cause of IBD?

Inappropriate immune response against colonic flora in genetically susceptible individuals

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What is UC?

A relapsing and remitting inflammatory disorder of the colonic mucosa

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What is proctitis?

Inflammation of the rectum only

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What is proctosigmoiditis?

Inflammation of the rectum and sigmoid

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What is left sided colitis?

Inflammation up to the splenic flexure?

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What is extensive colitis?

Inflammation up to the hepatic flexure?

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What is pancolitis?

Inflammation of the entire colon

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What is the pathology of UC?

Large bowel only
Continuous pattern of inflammation
Rectum to proximal
Pseudo polyps
Ulceration
Limited to mucosa

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What are the symptoms of UC?

Bloody/mucus diarrhoea
Abdominal pain
Urgency/tenesmus (Proctitis)
Weight loss
Fatigue
Fever

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What are the signs of UC?

Fever
Tachycardia
Distended abdomen

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What are the extra-intestinal manifestations of IBD?

Clubbing
Oral ulcers
Erythema nodosum
Conjunctivitis
Arthritis
PSC
Nutritional deficits

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What are the investigations for UC?

Bloods: FBC, ESR, CRP, U&E, LEFT, Blood culture
Stool culture
Faecal calprotectin
AXR
Lower GI endoscopy

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What is calprotectin?

Protein biomarker released by inflamed gut mucosa

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What are the complications of UC?

Toxic dilatation of colon
Perforation
Haemorrhage
Venous thromboembolism
Dysplasia -> colonic cancer

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What is mild UC?

Fewer than 4 bowel movements a day
No more than small amounts of blood
ESR 30 or below

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What is moderate UC?

4-6 bowel movements a day
Mild-severe amounts of blood
ESR 30 or below

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What is severe UC?

6 or more bowel movements a day
Visible blood
Pyrexia
Pulse>90
Anaemia
ESR above 30

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What is CD?

A chronic inflammatory disease characterised by transmural granulomatous inflammation affecting any part of the gut from mouth to anus

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What are skip lesions?

Unaffected bowel between areas of active disease Not present in UC

What is the pathology of CD?

Granular serosa Thickened, oedematous, fibrotic mesentery Narrowed lumen Sharp demarcation of disease segments from normal tissue Ulceration

What are the symptoms of CD?

Diarrhoea Abdominal pain Weight loss Malaise Lethargy Anorexia Fever Malabsorption

What are the signs of CD?

Bowel ulceration Abdominal tenderness Perianal abscess/fistulae/skin tags Anal strictures

What are the investigations for CD?

Bloods: FBC, ESR, CRP, U&E, LEFT, B12 Stool culture Faecal calprotectin Colonoscopy + biopsy MRI small bowel study Capsule endoscopy

What are the complications of CD?

Small bowel obstruction Toxic dilatation (rarer than in UC) Strictures Fistula Abscess Cancer risk

What are the perianal manifestations of Chron's disease?

Perianal fistula Perianal abscess Anal canal lesions (anal fissures and anal stricture)

What are the investigations for perianal CD?

MRI pelvis Examination under anaesthetic (EUA)

Is UC more common in males or females?

Equal

Is CD more common in males or females?

Females

What bowel regions do CD and UC cover?

CD- entire gut UC- colon only

What is the macroscopic distribution of CD and UC?

CD- Skip lesion UC- Diffuse

Are strictures present in CD and UC?

CD- variable UC- Late, rare

What is the wall appearance in CD and UC?

CD- Thick UC- Thin

What is the type of inflammation in CD and UC?

CD- Transmural UC- Limited to mucosa

Are pseudopolyps present in CD and UC?

CD- marked UC- marked

Are ulcers present in CD and UC?

CD- Deep UC- Superficial

Are there granulomas in CD and UC?

CD- Yes UC- No

Are there fistulae in CD and UC?

CD- Yes UC- No

What are the inflammatory markers in a flare of IBD?

High CRP High platelets High WCC Anaemia Low albumin

Is there fibrosis in CD and UC?

CD- Moderate UC- Mild

What is the treatment for IBD?

Step up/ top down approach

What are the steps to the step up/top down approach?

1. 5-ASA 2. Steroids 3. Immunomodulators 4. Biologic agents 5. Surgery

What is the aim of IBD treatment?

Induction and maintenance of remission?

What are 5-ASAs given for?

Mild UC, not CD 1st line therapy for induction and maintenance of remission

What are some examples of 5-ASAs?

Mesalazine Pentasa

How are 5-ASAs given?

PR: suppositories or enemas for distal disease PO: for more extensive disease Combine PR + PO in a flare

What are some examples of steroids?

Prednisolone Budesonide

What is the first line of treatment for flare up of IBD?

IV steroids

Why are steroids not give for long term use?

Adverse side effects

What is immunomodulation?

Adjustment of the immune response to a desired level

What are immunomodulators used for?

Maintenance or remission in UC and CD Used on steroid dependant patients

What are some examples of immunomodulators?

Azathioprine Methotrexate

What percentage of patients are intolerant to immunomodulators?

28%

What are the side effects of immunomodulators?

- Leukopenia - Hepatotoxicity - Pancreatitis - Long term lymphoma risk

What are biologics?

Monoclonal antibodies

When are biologics used?

For patients intolerant of immunomodulation or developing symptoms despite and immunomodulator

What are some examples of anti-TNF antibodies?

Infliximab Adalimumab

How do TNF antibodies work?

Counter neutrophil accumulation and granuloma formation and cause cytotoxicity to CD4+ T cells, thus clearing cells that drive the immune response

What are some examples of anti-integrin antibodies?

Vedolizumab

How do anti-integrin antibodies work?

Target adhesion molecules involved in gut lymphocyte trafficking

What are examples of anti-L12/23 antibodies?

Ustekinumab

How do anti-L12/23 antibodies work?

Cytokine target

What is the surgery for IBD?

Subtotal colectomy + terminal ileostomy

What is subsequent surgery options?

Completion proctectomy (permanent stoma) Ileo anal pouch

What is pouch surgery?

Only for UC not CD Stoma reversal and the possibility of long term continence

What are the indications for surgery in IBD?

Drug failure Perforation OGI obstruction from stricture Fistulae Abscess Steroid dependant

What are the indications for surgery in IBD?

Drug failure Perforation OGI obstruction from stricture Fistulae Abscess Steroid dependant