Inflammatory bowel disease Flashcards
What is ulcerative colitis
diffuse inflammation of colonic mucosa ( one layer)
only affects rectum and colon
affects variable lengths of colon
continuous inflammation
no known cause
What are risk factors for ulcerative colitis
family history HLA-B27
smoking is protective factor against UC
affects males more than females
bimodal peak - 20-40 and 60
What may someone with UC present with
bloody diarrhoea
rectal bleeding and mucus
abdominal pain and cramps
tenesmus
weight loss
What is the criteria for acute severe colitis
frequency of stool >6
overtly bloody stool
fever > 37.5
tachycardia >90
anaemia Hb <105
Raised ESR >30
What are some extra-intetsinal manifestations of UC
colonic carcinomas
massive rectal haemorrhage
large joint arthritis
primary sclerosing cholangitis
anterior uveitis
aphthous ulceration
What may be seen on examination in someone with UC
anaemic pallor
blood on DRE
abdominal tenderness
What investigations are required
colonoscopy and biopsy
– but if patient has severe colitis flexible sigmoidoscopy is preferred to avoid risk of perforation
abdominal X-ray
- dilated bowel and thumbprinting will be seen
Bloods-
LFTs and FBC
Stool sample
Double contrast barium enema
- loss of haustration
-pseudopolyps
-if chronic , colon is narrow and short
What are typical findings in a patient with UC on colonoscopy and biopsy
red raw mucosa- bleeds easily
no inflammation beyond submucosa
crypt abscesses
pseudopolyps
depletion of goblet cells and mucin
granulomas are infrequent
How is the severity of UC classified
mild - <4 stools a day , small amounts of blood
moderate 4-6 stools a day , no systemic upset , varying amounts of blood
severe >6 bloody stools per day and features of systemic upset
How do you manage mild/moderate UC
Mesalazine - topical/rectal then oral
steroids if remission not achieved
- oral beclamethasone
How do you manage severe ulcerative colitis
IV steroids - hydrocortisone
IV cyclosporine
( immunosuppressant ) if remission not achieved
Add low molecular weight heparin - because those with acute severe UC are at high risk of thromboembolic events - risk of clot> than risk of bleeding
How do you maintain remission following a mild - moderate ulcerative colitis flare
Aminosalicylate ( mesalazine )
How do you maintain remission following a severe UC relapse or >=2 exacerbations in the past year
Immunosuppressants -
oral azathioprine or mercaptopurine
What drug do you give if none of the earlier treatments are working for UC
Infliximab is rescue theory
What is Crohns disease
transmural inflammation of GI tract
can affect anywhere from mouth to anus
skip lesions- tissue is healthy in between
most commonly affects terminal ileum and perianally
Inflammation – ulceration – all layers affected – non caseating granuloma formation
