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Phase 4 Surgery > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

Where is the location of ulcerative colitis?

A

Limited to rectum and large colon. Inflammation is limited to mucosa

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2
Q

What are the symptoms of ulcerative colitis?

A

Bloody diarrhoea or mucus
Abdominal pain
Tenesmus and urgency

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3
Q

What are some extra-intestinal features of UC and Crohns?

A

Other HLA-B27
Ankylosing spondylitis
Arthritis
Erythema nodosum
Episcleritis
Osteoporosis
Uveitis
Pyoderma gangrenosum
Clubbing

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4
Q

What disease can occur in ulcerative colitis?

A

Primary sclerosing cholangitis and cancer

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5
Q

What is the histopathology of ulcerative colitis?

A
  • Pseudopolyps,
  • No granulomas
  • Crypt abscesses
  • Depletion of goblet cells
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6
Q

What are the investigations for ulcerative colitis?

A
  • Stool culture to rule out infective cause
  • Faecal calprotectin
  • CRP/ESR
  • FBC/LFTs
  • Colonoscopy + biopsy
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7
Q

What are the differentials for UC?

A
  • Crohn’s,
  • Intermediate colitis
  • Infective colitis
  • Radiation colitis
  • Diverticulitis
  • IBS
  • Ischaemic colitis
  • Vasculitis
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8
Q

What is acute severe ulcerative colitis and the management?

A

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

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9
Q

What are the indications for surgery in UC?

A

Toxic megacolon, perforation, multiorgan dysfunction

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10
Q

What treatment is used to induce remission in UC

A

Proctitis and proctosigmoiditis - Mesalazine topical or oral (add oral if remission not acheieved in 4 weeks).
Left sided/extensive disease - Oral Mesalazine and topical

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11
Q

What is the treatment escalation for ulcerative colitis?

A

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.

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12
Q

What is toxic megacolon?

A

Dilated colon with signs of toxicity such as: fever (>38.6), Hr >120, weight cell > 10.5 or anaemia

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13
Q

What are the signs and symptoms of toxic megacolon

A

Fever, tachycardia, mental status change, hypotension and abdominal distention + pain and diarrhoea

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14
Q

What is the management of toxic megacolon?

A
  1. Resuscitation with IV fluids
  2. Antibiotics
  3. Supportive care
  4. NG decompression
  5. Emergency colectomy
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15
Q

What is a mild and moderate UC flare?

A

Mild - Less than 4 bowel movements per day and systemically well
Moderate - 4-6 stools per day and mild-severe blood but systemically well

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16
Q

What is the surgical management of UC?

A

Panproctocolectomy with ileostomy or ileo-anal anastamosis (J pouch)

17
Q

Describe features of crohn’s disease

A

IBD which can affect anywhere from mouth to anus. Transmural inflammation meaning it can fistulate. Commonly affects terminal ileum

18
Q

What are the symptoms of crohns disease?

A
  • Crampy abdominal pain,
  • Diarrhoea,
  • Weight loss and anorexia
  • Aphthous ulcers
  • Perianal lesions
19
Q

What are the extra intestinal manifestations of Crohn’s disease/

A
  • Erythema nodosum,
  • Pyoderma gangrenosum
  • Anterior uveitis
  • Episcleritis
  • Arthritis
  • Ankylosing spondylitis
    Eyes, bones and skin
20
Q

What are the investigations for Crohn’s disease?

A
  • 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
21
Q

What is the histopathology of crohn’s disease?

A

Skip lesions,
Cobblestone appearence,
Rose thorn ulcers (due to transmural inflammation)
Granulomas

22
Q

What is the treatment to induce remission in Crohn’s disease?

A
  • Glucocorticoids
  • Can add ASA or biological agent if failing to respond
23
Q

What treatment is used to maintain remission in Crohn’s disease?

A
  • Azathioprine or mercaptopurine
  • Methotrexate can be considered
  • Biologics eg, infliximab, adalimumab, ustekinumab
24
Q

What enzyme must be assessed before giving azathioprine or mercaptopurine?

A

TPMT

25
Q

What is the treatment of peri-anal fistula and what is it a complication of?

A

Complication of Crohn’s. Treat with drainage seaton, antibiotics and infliximab

26
Q

What is the management of peri-anal abscesses?

A
  • Incision, drainage and clean out.
  • IV antibiotics eg, ceftriaxone and metronidazole
27
Q

Explain the presentation, investigations and treatment for ischaemic collitis

A

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

Phase 4 Surgery (58 decks)

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