inflammatory bowel disease Flashcards
How does ulcerative colitis present
Bloody diarrhoea
abdo pain
weight loss
fatigue
Describe proctitis
Inflammation of the rectum
Small volume muscus and blood
Can have constipation and only responds to topical therapy
Can be caused by IBD or STIs
What bloods are seen in IBD
Increased - CRP, WCC, platelets
Decreased - albumin
What investigations are done for IBD
Bloods
Stool culture to rule out infection
Faecal calprotectin to show proof of inflammation
Colonoscopy plus biopsy
What is faecal calprotectin
Biomarker released when there is inflammation of the colon
How does Crohns disease present
Darrohea
abdo pain
weight loss
malaise, lethargy, N&V, anorexia
Malabsorption such as anaemia
Describe histological difference between UC and CD
CD - granulomas
UC - Depleted goblet cells
UC>CD - crypt abscesses
CD - transmural inflammation
UC - limited to mucosa
What are the extra intestinal manifestations of IBD
Mouth ulcers
Skin rashes - erythema nodosa
MSK
eyes - episcleritis, scleritis
Primary scleroising cholangitis
What is the treatment ladder fo IBD
5ASAs or sulfasalazine first line - 5ASAs only for UC
second line - prednisone or budesonide
third line - immunomodulators such as azathioprine
4th line - biologics
Surgery
What surgeries for acute severe colitis
Subtotal colectomy - the whole colon is removed apart from the rectal stump and the rectum is preserved – the ileum is then used as a stoma
When should IBD be operated on
Emergency complications such as acute severe colitis which is not responding to steroids
Perforation, obstruction or abscess
Frequent relapses
intolerant to medical therapies
steroid dependant
patient choice
When is pouch surgery not done
CD as it can recur and cause lot of issues
