Inflammatory Bowel Disease Flashcards
What are the features of ulcerative colitis?
Starts at rectum - bloody diarrhoea, urgency, tenesmus, abdominal pain (particularly LLQ), extra-intestinal features
What are the investigations for suspected IBD?
Faecal calprotectin - 90% sensitivity,
Anti-TTG and IgA (to exclude coaliac’s disease from differential list.)
FBC, U&Es, LFTs, CRP, TFTs.
Stool culture and microscopy to rule out infective cause.
Colonoscopy with multiple biopsies
What are the typical findings on colonoscopy and biopsy for UC?
Colonoscopy - raw mucosa, bleeds easily, limited to submucosa, psudopolyps due to widespread inflammation.
Biopsy - Inflammatory cell infiltrate, crypt abscess, depletion of goblet cells, NO granulomas.
What are the features of ulcerative colitis on a barium enema?
Loss of haustrations, superfical ulceration, pseudopolyps and drainpipe colon if disease is long standing
What are the conditions associated with ulcerative colitis?
Arthritis,
Erythema nodosum,
Episcleritis,
Osteoporosis,
Uveitis,
Pyoderma gangrenosum,
Clubbing
Primary sclerosing cholangitis
What are some factors which can lead to a flare of UC?
Stress,
Medications - NSAIDs/antibiotics,
Cessation of smoking
What is the classification of UC flares?
Mild - <4 stools per day with tiny amounts of blood.
Moderate - 4 to 6 stools per day and mild amount of blood but no systemic upset.
Severe - >6 stools per day, visible blood and systemic upset. Should be admited to hospital
What is the management of proctitis and proctosigmoiditis flares in UC?
- Topical ASA,
- If remission not achieved within 4 weeks then add oral aminosalicylate.
- If remission still not achieved then add topical/oral steroid.
- If steroids do not help then consider adding tacrolimus
What is the management of extensive flares in UC disease?
- Rectal aminosalicylate and a high dose oral aminosalicylate.
- If remission not achieved then add oral corticosteroid
What is the management of severe colitis?
- IV steroids in hospital (if contraindicated then use ciclosporin)
- After 72hr if no improvement then add IV ciclosporin or consider surgery
How can you maintain remission in proctitis/proctosigmoiditis in UC?
Topical aminosalicylate alone or with oral aminosalicylate.
How do you maintain remission in left-sided and extensive disease in UC?
Oral aminosalicylate
What medication should be added if UC patient has severe relapse of >2 exacerbations in a year?
Oral azathioprine or oral mercaptopurine
What are the clinical features of Crohn’s disease?
Weight loss and lethargy,
Diarrhoea (can be bloody),
Abdominal pain,
Perianal disease (ulcers or sikin tags)
Mouth ulcers
Extra-inteestinal features
What are the investigations for suspected Crohn’s disease?
Bloods - CRP, fecal calprotectin, FBC, UEs, LFTs, B12 and folate (due to terminal ileum affected)
Endoscopy and biopsy - Deep ulcers and skip lesions.
Small bowel enema
What are the histology and enema findings for crohns disease?
Histology - Granulomas, goblet cells, transmural thickness affected.
Small bowel enema - Strictures (String sign of Kantor), rose thorn ulcers, fistulae, proximal bowel dilation
What are the complications of Ulcerative colitis?
Short term - Toxic megacolon, massive lower GI bleed.
Long term - colorectal cancer, cholangiocarcinoma, colonic strictures.
Variable term - Primary sclerosing cholangitis, inflammatory pseudopolyps
What is the treatment for inducing remission in Crohn’s disease?
1st line - Glucocorticoids (oral, topical or IV)
2nd line - Aminosalicylates (mesalazine) but not as affective.
Additions: Azathioprine, mercaptopurine or methotrexate.
What treatment is used to maintain remission in Crohn’s disease?
1st - Azathioprine or mercaptopurine (must check TPMT activity before).
2nd line - methotrexate
Describe features of perianal fistulae, investigations and treatment
Connection between anal canal and perianal skin.
Investigations - MRI
Treatment - Metronidazole +/- anti -TNF agents. May need drainage seaton if complex.
Describe features of perianal abscess
Requires incision and drainage + antibiotics.
May need seaton drainage if tract is identified
What are the complications of Crohn’s disease?
Small bowel cancer,
Colorectal cancer,
Osteoporosis
What is Primary sclerosing cholangitis?
Inflammation and fibrosis of intra and extra-hepatic bile ducts. Mainly associated with UC but also Crohn’s and HIV
What are the features of PSC?
Cholestasis (jaundice, raised bilirubin and ALP),
RUQ pain as backpressure of bile causes hepatitis which can lead to cirrhosis,
Fatigue
What are the investigations for PSC?
Main - ERCP/MRCP which shows beads on string appearence.
Will also be pANCA positive.
What are the complications and management of PSC?
Complications - Cholangiocarcinoma and colorectal cancer.
Management - liver transplant, colesytramine for pruritis relief
What are the features of primary biliary cholangitis?
Autoimmune condition causing interlobular bile duct inflammation which causes progressive cholestasis -> cirrhosis. Classic presentation is a middle ages woman with itching.
What are the clinical features of PBC?
Fatigue,
Pruritis.
Cholestatic jaundice,
Hyperpigmentation,
RUQ pain,
Xantholomata,
Clubbing,
Hepatosplenomegaly
May progress to liver failure
What are the investigations of PBC?
Anti-mitochondrial antibodies, raised serum IgM.
MRCP - to exclude obstruction
What is the management of PBC?
1st line - ursodeoxycholic acid
Pruritis relief - colestyramine
Fat soluble vitamin supplements
Liver transplant (reoccurrence in graft isn’t normally a problem)
What drug can be used in Crohn’s following a bowel resecction?
Cholestyramide. Can reduce absorption of fat soluble vitamins and can cause abdo cramps/constipation
