INFLAMMATORY BOWEL DISEASE Flashcards
What is Crohn’s disease?
A chronic inflammatory GI disease characterised by transmural granulomatous inflammation affecting any part of the gut from mouth to anus.
What is ulcerative colitis?
A relapsing and remitting inflammatory disorder of the colonic mucosa primarily affecting the colon and rectum.
What are the two main parts of the GI tract affected by Crohn’s?
The terminal ileum and the proximal colon.
What is the difference between ulcerative colitis and Crohn’s in terms of the spread of disease within the GIT?
Ulcerative colitis starts in the rectum and spreads proximally. Crohn’s can develop anywhere in the GIT and diseased areas are separated by areas of unaffected GIT (skip lesions).
Which form of IBD is more associated with bloody diarrhoea? Crohn’s or ulcerative colitis?
Ulcerative colitis
In ulcerative colitis, what might be mixed with the patient’s stool along with blood?
Mucus
How might someone with suspected Crohn’s disease present? (Name at least 4 symptoms)
Abdominal pain Diarrhoea Urgency to go to the loo Foul smelling diarrhoea Weight loss Vomiting Fever Malaise Anorexia Mouth ulcers
On examination, what are some of the signs associated with Crohn’s?
Clubbing Tenderness Mouth uclers Right iliac fossa pain Anaemia Anal and perianal complications
Extragastro-intestinal features associated with CD: Uveitis Conjunctivitis Athropathy Arthralgia Ankylosing spondylitis Inflammatory back pain Erythema nodosum Pyoderma gangrenosum
What do we call inflammatory bowel disease that cannot be definitively classified as either ulcerative colitis or Crohn’s disease?
Colitis of undetermined type and etiology (CUTE)
In terms of epidemiology, what ethnic group is most prone to IBD?
Jewish people
Which sex is more often affected by IBD?
Females
How is age related to severity of inflammatory bowel disease?
It is thought that those who develop symptoms earlier in life will experience more aggressive and extensive disease
What is the largest independent risk factor for development of IBD?
Having a family member with the disease
How is hygiene related to Crohn’s disease?
Good domestic hygiene has been shown to be a risk factor for CD. A ‘clean’ environment may not expose the intestinal immune system to pathogenic or non-pathogenic mircoorganisms such as helminths which seems to alter the balance between effector and regulatory immune responses.
How is smoking related to ulcerative colitis?
Smoking has been shown to be protective against ulcerative colitis. Non- and ex-smokers are more at risks of developing ulcerative colitis, whereas one trial has actually shown that nicotine can be an effective treatment.
How is smoking related to Crohn’s disease?
Smoking is a risk factor for CD, and sufferers are more likely to be smokers. Smoking increases the risk of disease recurrence after surgery.
How are NSAIDs related to inflammatory bowel disease?
NSAID ingestion is associated with both the onset of IBD and flares of disease.
What psychological factors may be associated with inflammatory bowel disease?
Chronic stress and depression seem to increase relapses in patients with quiescent disease.
How is a previous appendectomy related to the development of Crohn’s and ulcerative colitis?
Appendectomy may be protective for the development of UC. In contrast, appendectomy may increase the risk of development of CD.
What do we call ulcerative colitis that affects only the rectum?
Proctitis
What are the histological differences between inflammation and ulceration in Crohn’s disease and ulcerative colitis?
Inflammation is transmural in CD, whereas only the mucosa is affected in UC.
Are granulomas more associated with Crohn’s disease or ulcerative colitis?
Crohn’s disease
Are goblet cells more affected by Crohn’s disease or ulcerative colitis?
Goblet cells are depleted in ulcerative colitis
Are crypt abscesses more associated with Crohn’s disease or ulcerative colitis?
They are seen in both but are more present in ulcerative colitis
What type of polyp is associated with inflammatory bowel disease?
Inflammatory polyps or pseudopolyps. They are in general benign with no cancer potential.
Are the granulomas associated with Crohn’s disease caseating or non-caseating?
Non-caseating epitheloid cell aggregates
Are anti-neutrophil cytoplasmic antibodies (ANCA) more associated with Crohn’s disease or ulcerative colitis?
Ulcerative colitis
Are anti-Sacchoromyces cerevisiae antibodies (ASCA) more associated with Crohn’s disease or ulcerative colitis?
Crohn’s disease
What should form the rest of your differential diagnosis when presented with someone displaying the signs and symptoms of inflammatory bowel disease?
Infective causes of diarrhoea (eg C. difficile) Behcet's disease Diverticular disease Ischaemic colitis Gastrointestinal lymphoma Carcinoma of the bowel Irritable bowel syndrome Ileocolonic TB is common in developing countries which makes a diagnosis of CD difficult.
What are the extragastrointestinal manifestations of inflammatory bowel disease which affect the eyes?
Uveitis
Conjunctivitis
Episcleritis
What are the extragastrointestinal manifestations of inflammatory bowel disease which affect the joints?
Type I (pauciarticular) arthropathy Type II (polyarticular) arthropathy Arthralgia Ankylosing spondylitis Inflammatory back pain
What are the extragastrointestinal manifestations of inflammatory bowel disease which affect the skin?
Erythema nodosum
Pyoderma gangrenosum
What are the extragastrointestinal manifestations of inflammatory bowel disease which affect the biliary tree and liver?
Sclerosing cholangitis Fatty liver Chronic hepatitis Cirrhosis Gallstones
What are the anal and perianal complications of Crohn’s disease?
Fissure in ano Haemorrhoids Skin tags Ischiorectal abscess Fistula in ano (bladder, vagina) Anorectal fistulae
What investigations should be undertaken into someone with suspected Crohn’s disease?
Bloods tests (FBC, ESR, CRP, LFTs, pANCA) Blood cultures Stool cultures Colonscopy Upper GI endoscopy Capsule endoscopy Abdominal CT Perianal MRI or Endoanal US
What might blood tests in someone with Crohn’s reveal?
Anaemia - maybe normochromic/normocytic but can also be caused by iron or folate deficiency due to malabsorption. Interestingly B12 deficiency is rarely seen.
Raised ERS Raised CRP Raised WCC Raised platelets Hypoalbuminaemia Liver biochemistry may be abnormal pANCA will be negative
When should colonoscopy not be performed in Crohn’s patients?
When colonic involvement is not suspected
In those presenting with severe disease
What may be seen during colonoscopy of someone with Crohn’s disease with colonic involvement?
Vary from patchy superficial apthous ulceration to more widespread larger and deeper ulcers producing a cobblestone appearance.
What may be seen in small bowel imaging of someone with Crohn’s disease?
Asymmetrical alteration in the mucosal pattern with deep ulceration and areas of narrowing or stricturing.
What is toxic megacolon?
Look this up
