Inflammatory Bowel Disease Flashcards
What are the two types of IBD
Ulcerative colitis + Crohns
What is the inflammatory pattern UC?
relapsing-remitting
continuous mucosal inflammation of the GI lining rectum and proximally the colon.
What is the inflammatory pattern of Crohn’s
Patchy, transmural inflammation of gut mucosa from mouth to Anus
Termed ‘Cobblestone’ appearance on endoscopy
What cause IBD?
Theory - abnormal immune response to microflora
NOD 2 mutation, T cell response to indigenous microflora or exposure to environmental factors:
What are the risk factors for IBD?
Common RF - Age, Fhx, Jewish, HLA B27
Crohns - Smoking -
UC - smoking is protective
Describe the pathophysiology of UC?
Continous superficial - mucosal/submucosal inflammation of the gut starting from the rectum and extends proximally along the colon
Microscopically:
* goblet cell depletion
* crypt abcesses
* inflammatory infiltrate (neutrophillic)
macroscopically
continous inflammation of the mucosa +/- inflam polups
Describe the pathophysiology of crohns?
Non-caseating granulomatous transmural inflammation of the gut from the mouth to the anus
CROHNS:
Cobblestone appearance
Rosethorn Ulcers / mouth
Obstruction
Hyperplasia (Lymphnodes)
Narrowing (Lumen)
Skip Lesion
+/- strictures
How does Crohns present?
Patients with CD are at risk of a number of intestinal complication due to wall thickening, lumen narrowing and ulceration:
Abdo pain (RQ/Central) and tenderness
N/V
Non-Bloody Diarrhea
Big Big malnutrition and weight loss
Slight fever and fatigue
Aphthous mouth ulcers
1/3 Perianal Disease (skin tags, fissure, abcess, fistulae)
How does Ulcerative Colitis Present?
Hall mark - Blood diarrheal/rectal bleeding
Abdo Pain and tenderness (LLQ)
Wt loss and malnutrition
Fever
Tenesmus
What are the common extra-intestinal manifestations of IBD
Skin -Erythema Nodusum
MSK - Osteoporosis, Arthiritis
Eyes - Uvitis, episcleritis
Hepatobiliary:
UC - >PSC< PBC / AI Hepatitis/ cholangiocarcinoma
Crohns- Gall stones
Investigation for IBD?
Primary: Faecal Calprotectin (DDx IBS)
Serum markers: pANCA UC + / ASCA Crohns +
XRAY - Crohns - ‘Thumb Print’ UC - lead pipe appearance
Colonoscopy (GS) and biopsy
Ulcerative colitis - Red and raw mucosa with widespread shallow ulceration.
UC BIOPSY : crypt abscess due to neutrophil infiltration and goblet cell depletion
Crohns - Mucosal inflammation, deep ulcers, skip lesions and cobblestone mucosa
Biopsy: transmural inflammation, non-caseating granulomas and goblet cells
Other investigation for severity of disease:
* U/E - nutrition status
CT ABDO - assess distribution
FBC - Leucocytosis - inflammation
Anemia due to PR bleed /malnutrition
Stool microscopy and culture: to exclude infective gastroenteritis or pseudomembranous colitis (including Clostridium difficile toxin)
How to treat IBD - Ulcerative Colitis
UC
Induce remission/for flares:
1st -
5ASA - Mesalazine (topical->oral)
Then
+ Prednisolone (severe - IV hydrocortisone)
Maintain remission
Azathioprine
ASUC -
1st IV corticosteroid
2nd IV Infliximab/ciclosporin
Last resort - Colectomy (curative for UC)
How to treat IBD - Crohns
Crohns
SMOKING CESSATION
Induce remission/for flares:
1st Prednisolone (IV hydrocortisone if Severe)
Then Add
5ASA - Mesalazine
Adjunct depending on severity: Azathioprine/ methotrexate/Infliximab
Maintain remission:
1st - Azathioprine
2nd - Methotrexate
Last resort - Colectomy (curative for UC)
What Are the indication of acute severe UC?
Toxic megacolon: toxic non-obstructive dilation of the colon (suspect if patient with UC Px w/ Abdo distention and tenderness)
fever
haematologically unstable: shock> tachycardia/hypotension
Dehydration
Altered mental status
biochemical abnormalities (anaemia, leucocytosis, electrolyte )
what are the intestinal complications?
Crohns -
Perianal disease
UC - Toxic megacolon (acute colonic distention and px septic and perforation) and malignancy
Both
Stricture and obstruction
Perforation due to walls weakened by inflammation can rupture
