Inflammatory Bowel Disease Flashcards
What are the common causes of IBD?
- Environmental factors,
- Genetic predisposition,
- Gut microbiota,
- Host immune response
What is the presentation of infective collitis?
- Short history of diarrhoea +/- vomiting,
- Abrupt onset,
- Systemic upset,
- History of travel,
- Unwell contacts,
- Immunocompromisation
What are the investigations and treatment for infective colitis?
- 4x stool cultures.
- Treatment is usually conservative
Explain the presentation, investigations and treatment for ischaemic collitis
- Presents with abrupt onset of pain, bloody diarrhoea +/- SIRS. Usually pain is in left abdomen.
- CT may show segmental colitis in watershed areas.
- Treatment is usually conservative with IV fluids +/- abx
When should you admit a patient with collitis?
If they have over 6 stools per day and they have systemic upset
What is the definition of a Megacolon and toxic megacolon
Megacolon = Diameter of over 5.5cm on x ray or caecum diameter over 9cm.
Toxic megacolon = megacolon + signs of systemic toxicity. Requires emergent colectomy
What are the investigations of a patient presenting with acute ulcerative colitis
- Stool cultures,
- Flexible sigmoidoscopy within 72 hrs, ideally 24hrs.
- CT scan
What are the acute and chronic histological changes seen in chronic inflammatory bowel disease
Acute - acute inflammation, ulcerations, loss of goblet cells and crypt abscess formation.
Chronic - Architectural changes, paneth cell metaplasia (endocrine cells), chronic inflammatory infiltrates in lamina propria, neuronal hyperplasia and fibrosis
What are the macroscopic and microscopic features of ulcerative colitis
Macroscopic - diffuse involvement of large bowel. Often affects the left side.
Microscopically - Marked crypt architectural changes, little to no fibrosis and no granulomas
What is the medical treatment for ulcerative colitis
- Mesalazine (often high dose for induction of remission and then 2.4g maintenance. Oral and topical treatment is optimum.)
- Escalation involves azathioprine or mercaptopurine. Given if there is severe relapse or patient requires 2+ corticosteroid courses in 12mths.
- Biological agents
- Surgery (only curative measure)
By day 3 of treatment of acute UC presentation, what indicated need for further escalation
Stool frequency over 8/day or less than 3/day with CRP over 45. Escalation could be colectomy or treatment with infliximab (anti TNF alpha)
What are the complications of ulcerative colitis
Locally - haemorrhage or toxic megacolon.
Skin - erythema nodosum or pyoderma gangrenosum.
Liver - Sclerosing cholangitis or cholangiocarcinoma.
Eyes - Iritis, uveitis, episcleritis
- Ankylosing spondylitis
- Risk of malignancy so endoscopic surveillance after 10years of disease
Describe the features and symptoms of Crohn’s disease
- Inflammation affecting anywhere from mouth to anus. Peak incidence between 15-25 y
- Smoking is a considerable risk factor. Stopping reduces relapse rate, need for immunosupression.
- Symptoms include abdominal pain, watery diarrhoea, weight loss, fistulae, abscesses, oropharyngeal or gastroduodenal involvement
What are the extra-intestinal symptoms of crohn’s disease?
- Eyes (episcleritis, uveitis)
- Joints (sacroilitis, inflammatory arthropathy),
- Skin (erythema nodosum)
What are the investigations for suspected severe Crohn’s disease?
- Abdominal X ray,
- Ileocolonoscopy (aphthous ulcers)
- Faecal Calprotectin,
- Stool cultures,
- MR/CT enterography, MRI preferred in young patients to avoid radiation exposure
