Inflammatory Bowel Disease Flashcards
Chrons vs. Ulcerative Colitis?
-Distribution
- Macroscopic Chnges
- depth
- Distribution
- Histology
Ulcerative colitis affects the colon and is characterized by inflammation of the mucosal layer whereas Crohn’s disease can involve any component of the gastrointestinal tract from the mouth to the perianal area and is characterized by transmural inflammation
Presentation of UC?
Extraintestinal Manifestations?
o Bloody diarrhoea
o Urgency
o Tenesmus
o Abdominal pain (particularly left lower quadrant)
Criteria for UC?
Truelove & Witts Criteria for Severity of Ulcerative Colitiis
Investigations for Ulcerative Colitis?
Grading system on Endoscopy?
Medical Management of UC?
Mild:
- 5-aminosalicylic acid (5-ASA)
- Steroids
Severe:
- LMWH – DVT prophylaxis
- Steroids
- Anti-TNF Alpha (Infliximab) if unresponsive to steroids
- Cyclosporin (if steroids contraindicated)
Indications for Surgery for UC?
- Emergency
- Elective
Types of Procedures performed for UC and their complications?
Total abdominal colectomy with End Ileostomy
- Entire colon removed and end ileostomy fashioned
- Due to the risk of developing rectal cancer in the remnant rectal stump, it is recommended that all patients ultimately undergo a completion proctectomy following a total colectomy for UC.
Panproctocolecctomy with Ileal Pouch Anal Anastomosis (IPAA)
- Elective procedure common of younger pts.
- Removal of entire rectum/colon => formation of ‘J pouch’ from terminal ileum which is anastamosed to anus
- Complications include pouchitis, faecal incontinence, frequency and pouch failure
Epidemiology of UC?
Peak incidence in patients aged 15-25 years with a second peak at 55-65 years
Smoking DECREASED the risk of UC (Increased in Chrons)
Classification system for Chrons?
Smoking increases the risk of Crohn’s disease (the reverse is true of UC)
Classification System for Ulcerative Collits?
Presentation of Chron’s Disease
Extraintesinal Manifestations?
Features of transmural inflammation and form of IBD it is associated with?
Associated with Chron’s
Investigations for Chron’s.
Grading system on Endoscopy?
Medical Management of Chron’s?
Mild:
- 5-aminosalicylic acid (5-ASA)
- Steroids
Severe:
- LMWH – DVT prophylaxis
- Steroids
- Anti-TNF Alpha (Infliximab) if unresponsive to steroids
- Anti IL 12/23 (ustekinumab)
- Azathioprine, 6-mercaptopurine, methotrexate
Indications for Surgery for UC?
Types of Procedures performed? and their complications?
Small Bowel Surgery
- Stricturoplasty:Short strictures – bowel opened longitudinally and closed transversely to widenlumen and preserve bowel
- Small bowel resection: Longer strictures / diseased segments of bowel. Preserve as much healthy bowel as possible
- Ileocolic resection
Colorectal Surgery
- Total colectomy with ileorectal anastomosis: for 2 or more involved segments of colon
- Total proctocolectomy with end ileostomy: For patients with disease of colon and rectum
- Proctectomy: For isolated rectal disease
Surgical Measures to Reduce the Risk of Recurrent Crohn’s Disease?
