Inflammatory Bowel Disease Flashcards
Name the two types of IBD
Crohn’s Disease
Ulcerative Colitis
When do these IBD conditions usually present?
Teens and twenties
What is meant by IBD?
Chronic relapsing inflammatory conditions of the bowel
Some patients have features of both types of IBD- what is this known as?
IBD-U (IBD unclassified)
Microscopic colitis is another type of IBD but very rare and less problematic.
What are the two types of microscopic colitis?
Collagenous colitis
Lymphocytic collitis
How does microscopic colitis present?
Chronic, watery, non-bloody diarrhoea
Who would be more likely to get microscopic colitis?
Older women
Which conditions can microscopic colitis be associated with?
Autoimmune conditions like rheumatoid arthritis, coeliac disease and thyroid conditions.
Which medications can cause microscopic colitis?
NSAIDs
PPI
SSRI drugs (taken for depression)
What is the first line treatment for microscopic colitis?
Stop any drugs that could be causing it.
Start on a steroid called budesonide.
Discuss the affects of smoking on CD and UC.
Smoking gives greater risk of CD.
However, stopping smoking increases risk of UC.
What are some of the factors which contribute to IBD?
Environmental factors
Genetic factors
Microbiome/diet
Who is more likely to develop UC?
Males = females
Which age range is where most people with UC find out?
20-40
What are the symptoms of UC?
Bloody diarrhoea
Abdominal pain
Weight loss
Fatigue
Which of the GIT is affected by UC?
Colon
Whereabouts does UC begin?
Rectum and spreads proximally
What is proctitis?
Inflammation of rectum only
What are the symptoms of proctisis?
Frequency, urgency, incontinence, tenesmus
What is tenesmus?
Frequent urge to go to the toilet without actually needing to go
What may be passed instead of poo in those with proctitis?
Small volume of mucus and blood
What is the treatment for proctisis?
Topical therapies
What can cause proctisis?
UC
STD’s like chlamydia or gonorrhoea
Which investigations are carried out in someone with suspected UC?
Bloods
Stool culture
Faecal calprotectin
Colonoscopy
What will blood tests show in someone with UC?
Decreased albumin levels
Increased CRP/WCC/platelets
Why is a stool culture done in investigations for UC?
To see if it is infection causing the bloody diarrhoea
Which level of calprotectin is considered to be elevated?
> 200ug/g
What is faecal calprotectin?
Protein biomarker that’s released when there’s inflammation of the colon.
High faecal calprotectin does not always mean IBD. Which other conditions will there be a high calprotectin level?
Gastroenteritis, diverticulitis, ischaemic colitis.
Initial treatment of acute severe colitis is very important.
Describe the initial treatment.
Blood tests
Stool chart, stool cultures
IV glucocorticoids
IV hydration
AXR
Which drugs should you stop in someone who has acute severe colitis?
Non-steroidal analgesics
Opiates
Anti-diarrhoeals
Anti-cholinergics
How many stool cultures are required to detect C.difficile?
4
Where can Crohn’s disease affect?
Anywhere in the GIT
Why do symptoms for Crohn’s disease vary?
It can affect anywhere in the GIT so symptoms differ depending on the location
List some of the possible symptoms seen in CD.
Diarrhoea
Abdominal pain
Weight loss
Malabsorption
Lethargy
Nausea and vomiting
ANorexia
List the investigation done in someone with possible CD.
Bloods (for markers of inflammation)
Stool culture
Faecal calprotectin
Colonoscopy
MRI small bowel study
Capsule endoscopy
Describe the difference in pathology between UC and CD in histology.
CD- granulomas, transmural inflammation
UC- depleted goblet cells, more crypt abscesses than CD, inflammation limited to mucosa
Which evolves over time- UC or CD?
Crohn’s disease
What can CD form as it progresses?
Forms strictures which can develop into fistulas
Okay, just checking, what is a fistula?
An abnormal connection between two parts of the body
What are some of the perianal symptoms of CD?
Pain
Pus secretion
Unable to sit down
What are the investigations for perianal CD?
MRI pelvis
Examination under anaesthesic (EUA)
What is treatment for perianal CD?
Surgery to drain abscess and place seton stitch
Antibiotic and biologic therapy
What are some of the extra-intestinal manifestations of CD?
Mouth ulcers
Skin rashes/lesions
Musculoskeletal problems
Eye problems
Liver- primary sclerosing cholangitis
What are some of the differential diagnoses for IBD?
Chronic diarrhoea
Ileo-caecal TB
Infective colitis, amoebic colitis, ischaemic colitis
Which conditions can cause chronic diarrhoea which are not IBD?
Malabsorption e.g. pancreatic insufficiency, bile acid malabsorption, coeliac disease.
IBS
Overflow diarrhoea
What is the long term complication of colonitis?
Colonic carcinoma
What in is place to reduce bowel cancer?
Bowel cancer screening for those who have IBD
Describe what is meant by the relapse and remission nature of UC and CD.
Patients can go through stages of being completely well and then have a flare up.
What is the initial drug treatment for those with UC?
5-ASAs (aminosalicyclates)
Are 5ASAs used for induction of remission for UC or maintenance of remission?
Both
->Induce remission but also help to maintain it (remission=period where the patient is completely well)
How can 5-ASAs be taken?
Orally
Topically if affecting the distal GIT
What are the side effects of 5ASAs?
Usually pretty well tolerated but can cause sickness and nausea, sometimes watery diarrhoea
What is the second line of treatment for UC which can also be used to treat those with CD?
Steroids
What do patients on prednisolone also need to take?
Calcium and vitamin D supplements
These steroids are not for long term use. What are some of the side effects of prednisolone?
Increased risks of obesity, diabetes, mood changes, cataracts and osteoporosis.
Which drugs are used for immunomodulation in UC and CD?
Thiopurines- used for maintenence of remission
->this makes sense as they are third line of treatment (at least for UC) so induction of remission has already started
Name the type of thiopurine most commonly used for immunomodulation.
Azathioprine
There are many side effects to azathioprine, name some.
Hepatotoxicity
Leucopoenia (lots of WBC)
Pancreatitis
Long term risk of lymphoma and non-melanoma skin cancers
Name an immunomodulator which is only used in individuals with CD.
Methotrexate
Biologics can be used in treatment of IBD.
Name some of the groups of monoclonal anitbody biologics.
Anti-TNF alpha antibodies (like Infliximab containing Remicade, remsima)
Alpha 4b7 antibodies (like Adalimumab containing Humira, amgevita)
IL12/ IL23 blockers (like Ustekinumab)
Which order of treatment should IBD patients get?
Uncertain…personalised medicine
In which situations would surgery be performed as an ‘emergency’ choice for those with acute severe colitis?
If the acute severe colitis is not responding to high dose IV steroids +/- anti-TNF biologic therapy
OR
There are complications such as abscess, perforation or obstruction
In which elective settings may surgery be performed in those with acute severe colitis?
- Frequent relapses despite medical therapy
- Not able to tolerate medical therapy
- Steroid dependant
- Patient choice
Which surgeries may be carried out for acute severe colitis?
Subtotal colectomy
What happens in a subtotal colectomy?
Large bowel removed but rectal stump kept.
Ileum is brought out the anterior wall be a stoma.
-Liz:)
What are the two options after the subtotal colectomy?
- Rectal removal at later date
or - Pouch procedure
What happens during the pouch procedure?
Small intestine is lengthened and mobilised and stapled into place
Which IBD is pouch procedure recommended in?
UC
->btw idk if this is what Liz had done…think it’s more to do w the rectum, might be worth a quick google x
What are some of the indications for surgery in those with CD?
-Failure of medical management
-Relief of obstructive symptoms
-Management of fistulae
-Management of intra-abdominal abscess
-Management of anal conditions
-Failure to thrive
