Inflammatory Bowel Disease Flashcards
Where is the location of ulcerative colitis?
Limited to rectum and large colon. Inflammation is limited to mucosa
What are the symptoms of ulcerative colitis?
Bloody diarrhoea or mucus
Abdominal pain
Tenesmus and urgency
What are some extra-intestinal features of UC and Crohns?
Other HLA-B27
Ankylosing spondylitis
Arthritis
Erythema nodosum
Episcleritis
Osteoporosis
Uveitis
Pyoderma gangrenosum
Clubbing
What disease can occur in ulcerative colitis?
Primary sclerosing cholangitis and cancer
What is the histopathology of ulcerative colitis?
- Pseudopolyps,
- No granulomas
- Crypt abscesses
- Depletion of goblet cells
What are the investigations for ulcerative colitis?
- Stool culture to rule out infective cause
- Faecal calprotectin
- CRP/ESR
- FBC/LFTs
- Colonoscopy + biopsy
What are the differentials for UC?
- Crohn’s,
- Intermediate colitis
- Infective colitis
- Radiation colitis
- Diverticulitis
- IBS
- Ischaemic colitis
- Vasculitis
What is acute severe ulcerative colitis and the management?
Passing > 6 stools per day and at least one of: Temp > 37.8, HR > 90, Hb <105 or CRP > 30.
Manage with IV hydrocortisone. If not response in 3 days then start IV Infliximab in addition to steroids
What are the indications for surgery in UC?
Toxic megacolon, perforation, multiorgan dysfunction
What treatment is used to induce remission in UC
Proctitis and proctosigmoiditis - Mesalazine topical or oral (add oral if remission not acheieved in 4 weeks).
Left sided/extensive disease - Oral Mesalazine and topical
What is the treatment escalation for ulcerative colitis?
When patient is having severe or frequent relapses (>2 per year). Start on azathioprine or mercaptopurine. However it increases risk of lymphoma.
Further escilation - add biologic eg, infliximab.
What is toxic megacolon?
Dilated colon with signs of toxicity such as: fever (>38.6), Hr >120, weight cell > 10.5 or anaemia
What are the signs and symptoms of toxic megacolon
Fever, tachycardia, mental status change, hypotension and abdominal distention + pain and diarrhoea
What is the management of toxic megacolon?
- Resuscitation with IV fluids
- Antibiotics
- Supportive care
- NG decompression
- Emergency colectomy
What is a mild and moderate UC flare?
Mild - Less than 4 bowel movements per day and systemically well
Moderate - 4-6 stools per day and mild-severe blood but systemically well
What is the surgical management of UC?
Panproctocolectomy with ileostomy or ileo-anal anastamosis (J pouch)
Describe features of crohn’s disease
IBD which can affect anywhere from mouth to anus. Transmural inflammation meaning it can fistulate. Commonly affects terminal ileum
What are the symptoms of crohns disease?
- Crampy abdominal pain,
- Diarrhoea,
- Weight loss and anorexia
- Aphthous ulcers
- Perianal lesions
What are the extra intestinal manifestations of Crohn’s disease/
- Erythema nodosum,
- Pyoderma gangrenosum
- Anterior uveitis
- Episcleritis
- Arthritis
- Ankylosing spondylitis
Eyes, bones and skin
What are the investigations for Crohn’s disease?
- FBC, Iron studies, B12 and folate, CRP
- Faecal calprotectin
- Stool culture to rule out infective cause
- Endoscopy
- Imaging such as CT or MRI enterography to look for fistula, abscesses and strictures
What is the histopathology of crohn’s disease?
Skip lesions,
Cobblestone appearence,
Rose thorn ulcers (due to transmural inflammation)
Granulomas
What is the treatment to induce remission in Crohn’s disease?
- Glucocorticoids
- Can add ASA or biological agent if failing to respond
What treatment is used to maintain remission in Crohn’s disease?
- Azathioprine or mercaptopurine
- Methotrexate can be considered
- Biologics eg, infliximab, adalimumab, ustekinumab
What enzyme must be assessed before giving azathioprine or mercaptopurine?
TPMT
What is the treatment of peri-anal fistula and what is it a complication of?
Complication of Crohn’s. Treat with drainage seaton, antibiotics and infliximab
What is the management of peri-anal abscesses?
- Incision, drainage and clean out.
- IV antibiotics eg, ceftriaxone and metronidazole
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
