Inflammatory bowel disease Flashcards
Ulcerative colitis pathophysiology
diffuse mucosal inflammation limited to the colon
What is it called if ulcerative colitis is limited to the rectum?
proctitis
Crohn’s pathophysiology
patchy transmural inflammation (affects all layers, skip lesions present)
Where in the GI tract can Crohn’s affect?
anywhere from mouth to anus
Where is the most common area Crohn’s affects?
ileocaecal area
Where in the GI tract does Crohn’s most affect in children?
upper GI tract
What does abdominal pain and cherry red stool in infants suggest?
intussusception
How is the appendix linked to IBD?
appendicectomy due to appendicitis:
- increases risk of Crohn’s
- protective of UC
Ulcerative colitis presentation
symptoms correlate to extent
frequent bloody diarrhoea
mucus PR
tenesmus (urge to go to the bathroom without being able to go)
abdominal pain
fever
Crohn’s presenting symptoms
depends where in GI tract it affects
fatigue
weight loss
fever
diarrhoea +/- bleeding
pain
vomiting
bloating
fistula
abscess
What history features should be asked for IBD
previous episodes
family history
smoking
appendicectomy
travel
contacts
antibiotics/NSAIDs
extra-intestinal manifestations
IBD signs
pyrexial
tachycardia
dehydrated
pale
tender abdomen
PR
Investigations for IBD
bloods:
- anaemia
- thrombocytosis
- raised ESR/CRP
- hypoalbuminaemia (albumin goes down as inflammation goes up)
microbiology:
- stool culture
- clostridiodes difficile assay
How can C diff present on endoscopy?
pseudomembranous colitis
What is toxic megacolon?
motility through gut impaired
swelling and inflammation of colon
colon dilates
can perforate
What do fluid levels on xray of the abdomen suggest?
bowel obstruction (small or large)
What is pneumoturia?
gas in urine
What does pneumoturia suggest?
fistula between gut and bladder
IBD differential diagnosis
infective:
gastroenteritis/dysentery
clostridiodes difficile
amoebasis
tuberculosis (TB of ileum can mimic Crohn’s)
CMV
yersiniosis
histoplasmosis
non-infective:
appendicitis
diverticulitis
diverticular colitis
carcinoma
ischaemic colitis
lymphoma
endometriosis
carcinoid
What is a phlegmon?
inflammatory mass
Acute severe ulcerative colitis management
steroids (do not delay until stool cultures, cover with IV abx if necessary)
community = prednisolone 40mg OD
inpatient = hydrocortisone 100mg tds-qds/methylprednisolone 60-80mg OD
stool chart
daily abdominal xray if initial dilatation or subsequent deterioration
IV fluids (pt can eat and drink but may be dehydrated)
blood prn
daily bloods
LMWH (even if bleeding, thrombosis higher risk)
discontinue constipating drugs
unprepared flexible sigmoidoscopy
Acute severe Crohn’s disease management
if inflammatory –> steroids
elemental/polymeric diet (all liquids)
Crohn’s colitis —> treat as UC
metronidazole or ciprofloxacin for fistulae
Name some drugs used in IBD
aminosalicylates
corticosteroids (oral/topical - enema/suppository)
thiopurines eg. azathioprine (unlicensed)
methotrexate
ciclosporin
biologics eg. infliximab
What levels should be measured before giving azathioprine?
TPMT
no TPMT = azathioprine will poison
some TPMT = lower dose azathioprine
What are some extraintestinal manifestations of IBD?
episcleritis
mouth ulcers
uveitis
erythema nodosum
pyoderma gangrenosum
arthritis
