Inflammatory bowel disease Flashcards
When does people typically develop IBD ?
before the age of 30.
What is the pathophysiology of Crohn’s Disease?
Inappropriate immune response against the
gut flora causes Transmural chronic inflammation anywhere in GI tract with rectal sparing. The worse affection is seen at the terminal ilium. The lesion distribution is called skipped lesions as there are unaffected segments between affected. The disease has genetic etiology, but is not fully elucidated.
What is the epidemiology of Crohn’s Disease?
6 / 100,000 cases in Ireland with biomodal distribution one 15 – 35yoa and another 50 – 70yoa.
What are the GI manifestations of Crohn’s disease ?
- Crampy abdominal pain and Watery diarrhoea.
- Bloody diarrhoea may or may not be present.
- Evidence of malabsorption such as B12 deficiency and Steathorroea.
*Aphthous ulcers, Odynophagia and Dysphagia.
What are the Extraintestinal Manifestations of Crohn’s disease ?
– Arthritis
– Uveitis and Episcleritis
– Pyoderma gangrenous
– Erythema nodosum
– Kidney stones
– Gallstones
What are the complications of Crohn’s disease ?
- Intestinal Strictures and fistulas
- Phlegmon which is the acute spreading soft tissue inflammation.
- Perianal abscesses
- Fissures
- Increased risk for colorectal cancer
What is the utility of Calprotectin testing ?
It is a faecal protein marker of intestinal inflammation with low sensitivity and high specificity. It is Generally used to eliminate the likelihood of IBD in a patient presenting with chronic abdominal pain and diarrhoea. A positive test requires endoscopic follow-up
What should be the approach to negative Calprotectin testing ?
If faecal calprotectin is “negative” in a patient
with low risk for IBD, Consider workup and treatment for IBS.
What are the colonoscopy or endoscopic features of Crohn’s disease ?
– Skip lesions
– “Cobblestoning”
What is the CT findings in Crohn’s disease ?
“Fat wrapping” or “Creeping fat sign” .
What are the biopsy findings in Crohn’s disease ?
– Transmural involvement
– Non-caseating granuloma
What is the Crohn’s disease sign in on barium enema?
String sign
What is the algorithm for Crohn’s disease dx ?
https://www.aafp.org/content/dam/brand/aafp/pubs/afp/issues/2018/1201/p661-f1.jpg
What are the four major classes of drugs used in Crohn’s disease ?
1.Oral 5-aminosalicylates (eg, sulfasalazine, mesalamine)
2.Glucocorticoids (eg, prednisone, budesonide)
3.Immunomodulators (eg, azathioprine, 6-mercaptopurine, methotrexate)
4.Biologic therapies (eg, infliximab, adalimumab, certolizumab pegol, natalizumab, vedolizumab,
ustekinumab)
What is the Step-up medical therapy approach in Crohn’s disease ?
- Typically starts with less potent medications associated with fewer side effects
- More potent & potentially more toxic meds are used only if initial therapies ineffective.