Inflammatory Bowel Disease Flashcards
What is inflammatory bowel disease?
Group of condition characterised by idiopathic inflammation of the GI tract
What are the 2 common types of inflammatory bowel disease?
Crohn’s disease
Ulcerative colitis
Location of Crohn’s disease
- Affects anywhere in GI tract: terminal ileum in most cases + rarely affects rectum
- Skip lesions (multiple places)
- transmural (full thickness)
Location of ulcerative colitis
Begins in rectum
Can extend to involve the entire colon
Continuous pattern
Presentation of Crohn’s disease
- weight loss
- right lower quadrant pain
- low grade fever
- mildly anaemic
- perianal inflammation/ulceration/lesions e.g. skin tags, fistulae, abscesses, scarring
- multiple non-bloody loose stools a day
- 15-30 year olds
Presentation of ulcerative colitis
- multiple blood stools per day
- mild abdominal pain
- no perianal disease
- normal temperature
- 20-30 year olds
Skin changes in inflammatory bowel disease
Erythema nodosum
Pyoderma gangrenosum
Psoriasis
What other symptoms can you get if you have inflammatory bowel disease other than the GI?
- arthritis
- MSK pain
- skin problems: erythema nodosum, pyoderma gangrenosum, psoriasis
- primary sclerosing cholangitis
- uveitis
Causes of inflammatory bowel disease
- genetic pre-disposition
- gut organisms
- immune response
- triggers: antibiotics, infection, diet
Affect of smoking on Crohn’s disease and ulcerative colitis
- worsens Crohn’s disease
- can be beneficial to ulcerative colitis
What is a fistula?
Abnormal connection between two epithelial lined things
Classic microscopic presentation of Crohn’s disease
Epitheloid granuloma formation
What are people with Crohn’s disease likely to have that those with UC don’t?
Perianal disease
e.g. skin tags, fistula, abscesses, scarring
Investigation of IBD
- FBC: anaemic
- U&Es: possibly deranged electrolytes or AKI due to GI losses
- stool sample: exclude infective colitis
- CT/MRI scan: bowel wall thickening, obstruction
- barium enema/follow through
- colonoscopy
- flexible sigmoidoscopy
What is the safest test in cases of bloody diarrhoea?
flexible sigmoidoscopy
What does Crohn’s disease look like?
- skip lesions
- red appearance
- ulcers
- mucosal oedema
- transmural inflammation + thickening of bowel wall + narrowing lumen (strictures)
- cobblestone appearance
Features of Crohn’s disease
- C: obblestone appearance
- R:ose thorn ulcers (deep penetrating linear ulcers)
- O:bstruction of bowel
- H:yperplasia of mesenteric lymph nodes
- N:arrowing of intestinal lumen
- S:kip lesions
granuloma formation
What is pathognomonic to Crohn’s disease?
Epithelioid granuloma formation
Pathological changes in ulcerative colitis
- chronic inflammatory infiltrate of lamina propria
- crypt abscesses + distortion
- reduced numbers of goblet cells
- pseudopolyps after repeated episodes
- loss of haustra (inflammation reduces appearance)
Compare Crohn’s disease + ulcerative colitis:
- location
- rectal involvement
- continuous
- gross bleeding
- perianal disease
- fistula formation
- malnutrition
- smoking affect
- transmural inflammation
- granulomas
- fibrosis
- crypt abscesses
_Crohn’s disease
- location: anywhere in GI tract, mainly terminal ileum
- rectal involvement: rarely
- continuous: no, skip lesions
- gross bleeding: 25%
- perianal disease: yes
- fistula formation: yes
- malnutrition: potential
- smoking affect: damaging
- transmural inflammation: yes
- granulomas: yes
- fibrosis: common
- crypt abscesses: rare
Ulcerative colitis
- location: from rectum to colon
- rectal involvement: yes
- continuous: yes
- gross bleeding: yes
- perianal disease: no
- fistula formation: no
- malnutrition: no
- smoking affect: potentially beneficial
- transmural inflammation: no
- granulomas: no
- fibrosis: no
- crypt abscesses: yes
What are haustra?
Small pouches of the colon wall between folds
Treatment of IBD in hopsital
- IV hydrocortisone 100mg qds
- heparin to reduce risk of VTE whilst in hospital
Treatment of UC flare up
- first line: mesalazine
-
second line: oral prednisolone
.
if severe: - first line: IV hydrocorisone
- additional options: IV ciclosporin, infliximab or surgery
Maintenance drug treatment of ulcerative colitis
mesalazine first line
azathioprine if M doesn’t work
Surgical options for ulcerative colitis
-
panprotocolectomy - removal of the large bowel + rectum
then: - ileostomy: ileum is brought onto the skin with a spout into stoma bag
- J-pouch: ileum is folded back on itself + fashioned into a larger pouch which attaches to the anus (acting like a rectum)
Treatment of Crohn’s flare up
- first line: oral prednisolone or IV hydrocortisone
- enteral nutrition
- addition of azathioprine, infliximab, metocaptopurine if needed
How does enteral nutrition induce remission in crohn’s?
- treating nutritional deficiencies
- improving gut microbiome
- removing inflammatory foods
maintenance drug treatment of Crohn’s
azathioprine or mercaptopurine
or biologics (first line in perianal or fistulating crohn’s)
Surgical options for Crohn’s
- resecting distal ileum
- treating strictures of fistulas
