Inflammatory Bowel Disease Flashcards
What does IBD stand for?
Inflammatory Bowel Disease
IBD includes conditions such as ulcerative colitis and Crohn’s disease.
What is the aetiology of IBD?
Unknown, occurs in genetically susceptible individuals with an inappropriate immune response to gut flora. There is an inflammatory response and there is failure of protective mechanisms from the Paneth cells which produce alpha-defensin, mucus production by goblet cells and the intercellular junctions in the intestinal epithelia. IgM, IgA and IgG will be ielevated
Tobacco is a strong risk factor for Crohn’s disease but protective in ulcerative colitis.
What age group is typically affected by IBD?
15 to 30 years old
What are common symptoms of IBD?
Diarrhoea Occurring at night , abdominal pain, tenesmus, tachycardia, anxiety, fever, dehydration
What is a key diagnostic marker for intestinal inflammation in IBD?
Faecal calprotectin which is a marker for increased neutrophils in intestine, pointing to intestinal inflammation
Which imaging techniques are used for diagnosing IBD?
Ultrasound, MRI for fistula, CT scan for perforation, wool obstruction or strictures
What is a colic stricture?
Narrowing of the colon
Describe the inflammation pattern of ulcerative colitis.
Superficial inflammation beginning in the rectum and travels up the sigmoid colon. Onset has a bmiodal pattern between 15-300 and 50-70. There is increased risk with appendectomy prior to age 20. Tobacco is a protective factor.
What is the lead pipe appearance associated with?
Ulcerative colitis due to loss of haustra markings
What is pancolitis?
Inflammation of the entire colon in ulcerative colitis
List some extraintestinal manifestations of ulcerative colitis.
Non-deforming asymmetrical arthritis”
“ Aphthous stomatitis”
* Erythema nodosum”
“* Primary sclerosing cholangitis”, “* Ankylosing spondyloarthropathy”,
Toxic megacolon”]
What is primary sclerosing cholangitis?
bile ducts of liver become scarred which increases the risk of colorectal cancer
What is ankylosing spondylarthropathy?
inflammation of the joints and ligaments of the spine spine, which worsens with rest and is partially bad at night. There may be dyspnoea, fatigue, loss of appetite and weight loss
What is toxic megacolon?
Dilation of colon greater than 6cm due to inflammation that causes thinning of colonic walls and deep ulcers. There is acute trans ray inflammation of colon with necrosis and granulation tissue filled with inflammatory cells. They typically represent with diarrhoea, malaise and abdominal pain and distention. There is a risk of bowel perforation and peritonitis, resulting in fever, abdominal pain, hypotension and confusion
What is used to assess disease severity in UC?
Simple clinical colitis activity index.
What are the criteria for suspecting ulcerative colitis?
[”* Bloody diarrhoea persisting more than 6 weeks”, “* Faecal urgency and/or incontinence”, “* Nocturnal defecation”, “* Tenesmus”, “* Abdominal pain in LEFT LOWER quadrant”, “* Weight loss or delayed puberty in children”]
What are the positive examination findings for Crohn’s disease?
[”* Pallor”, “* Clubbing”, “* Abdominal tenderness”,
Aphthous sotomatitis
Diarrhoea more than 4-6 weeks
Hepatobiliary manifestation with
Jaundice
Nocturnal defaecation
Pain in right LOWER quadrant
Pre-defaecation pain
Gradual onset and periods of remission adn relapse
Worsened by smoking cessation
Worsened by NSAIDs
“* Perianal skin tag/fistula”, “* Signs of malnutrition”]
How does partial bowel obstruction present?
abdominal colicky pain, distention and diarrhoea
How does complete bowel obstruction present?
severe abdominal pain, vomiting, complete constipation and no flatus (wind)
What are the findings for endoscopy in ulcerative colitis?
Endoscopy will show fragile or ganloar mucosa, with loss of vascular pattern and erosions and pseudo polyps
2 Biopsy from at least five different sites of the bowel, including the ileum and rectum
What are the histologies features of ulcerative colitis?
mucus depletion, villous surface irregularity, crypt atrophy and basal plasmocytosis.
What is fulminant colitis?
more than 10stools a day, with continuous bleeding, abdominal pain, distention and fever and weight loss.
What is the typical presentation of Crohn’s disease?
Frequent diarrhoea, faecal urgency, abdominal pain or discomfort
What is the significance of the accordion sign in CT imaging?
Indicates colonic wall thickening Accordion sign is where the contrast appears trapped between the mucosal folds due to colonic wall thickening.
