Inflammatory Bowel Disease Flashcards
What is Inflammatory Bowel Disease (IBD)?
Chronic relapsing inflammatory conditions of the bowel
What do most cases of inflammatory conditions fall into?
A spectrum between Crohn’s Disease (CD) & Ulcerative Colitis (UC)
When can UC affect someone and in what sex is it more prominent?
Any age
More common in females
What does UC present with?
Bloody diarrhoea
Abdominal pain
Weight loss
What is specific about the inflammation in UC?
It is continuous (only affecting the colon) and always start at the rectum and works it way distally from the rectum
Variable distribution and severity
What is the cure for UC and what happens to the mucosa in UC?
Surgical removal
Mucosa goes from healthy to inflamed
What indicates a severe UC attack?
Stools frequency >6 stools/day with blood Fever ESR is raised Tachycardia Anaemia Albumin
What cells are depleted in UC?
Goblet cells
Are there more crypt abscesses in UC or Crohn’s?
UC
When is Crohn’s most common in people and in what sex?
Early adulthood and over 60s
More common in females
What type of disease is Crohn’s and what is indicative of it?
Patchy disease
Skip lesions from the mouth to the anus
Classically it is spread along the bowel
Clinical features related to where the disease is situated
What are the clinical features of CD? (9)
Diarrhoea Weight loss Abdominal pain Fever Malaise Lethargy Anorexia N&V Malabsorption - Unusual presentation
What is CD like histologically?
Granulomas
Affects the whole thickness of the colon
What is UC like histologically?
No granulomas
Only affects the inner lining of the colon
What is found in CD?
Fitulae
Peri-anal disease
What are the extra-intestinal manifestations of IBD?
Eyes Joints Renal calculi Liver and biliary tree Skin
What are the differential diagnoses for IBD?
Chronic diarrhoea
Ileo-caecal TB
Colitis - Infective/Ameobic/Ischaemic
What classification is used for IBD?
Montreal
What are in indices for IBD inflammation?
High ESR & CRP High platelet count High WCC Low Hb Low albumin
What drops during active inflammation?
Albumin
What investigations should be done for IBD?
Colonoscopy
Medical management – Outpatient and Hospital
How often should colonoscopies be done in patients with IBD?
Extensive colitis for 8-20 years = Once every 3 years
Extensive colitis for 30-40 years = Once every 2 years
Extensive colitis for 40+ years = Annually
What drugs are aminosalicylates (5ASA) and give an example?
Mesalazine - Acrylic resin
Prodrugs - Sulfasalazine
What does 5ASA help to control?
Moderate UC flare-ups within 2-3 weeks
Can be used in the long term
How is it best to distribute 5ASA in distal and more extensive disease?
Rectally
Patients may be on this till the end of their life
What is the first line therapy in the induction and maintenance of remission of mild-moderate UC?
5ASA
For what use are 5ASA’s used in CD?
Mildly active ileocolonic disease and in the maintenance of remission for post small bowel resection
What two steroids are used to treat IBD?
Prednisolone - Optimal dose is 40mg/day and tapering reduction over 4 weeks
Budesonide - Slightly less effective than Prednisolone but it has a better side effect profile
What thiopurine is used in the treatment of IBD?
Azathioprine - Steroid sparing
What are the significant side effects of thiopurines?
Leucopenia Hepatoxicity Pancreatitis Possible long term lymphoma risk 28% of people are intolerant
What percentage of people are intolerant of Methotrexate and what is its main side effect?
10-18%
Stops women having children
What immunosuppressants are used in the treatment of IBD and what is their risk?
Ciclosporin
Mycophenolate
Tacrolimus
Risk of infection
What biologics are used in the treatment of IBD?
Infliximab
Adulimumab
Anti-TNFα-antibodies
When is Metronidazole used?
Crohn’s peri-anal disease with small bowel over growth
What are the advantages and disadvantages of elemental feeding?
Advantages - Can be as effective as steroids with it being more efficacious in children
Disadvantages - Compliance can be difficult
What are unacceptable complications of steroids?
Diabetes
Severe osteoporosis
Psychosis
What occurs when there are poor responses to Medical Rx?
Fistulas
Fibrotic strictures
Peri-anal disease
Severe fulminating disease
Is surgery for IBD done electively or in an emergency?
Both
What does Acutely Ill result in?
Total Colectomy or Rectal preservation or Ileostomy
How does the colon appear in severe colitis?
Paper thin and very inflammed
What is pouch surgery?
Happens in a total colectomy with the colon being removed so the small bowel must be mobilised and lengthened to create a pouch
UC - What does the pouch procedure not have?
No ileostomy
What is a proctocolectomy?
When the colon and rectum are removed but it has an ileostomy
What are the surgical indications for Crohns? (6)
Failure of medical management Relief or obstructive symptoms Management of fistulae - Bowel to bladder Management of inta-abdominal mass Management of anal conditions Failure to thrive
What is sclerosing cholangitis?
Disease of the bile ducts, multiple strictures and it is slowly progressive which can lead to cirrhosis
What is the long-term complication of colitits?
Colonic carcinoma
How does anal CD vary?
It can be non-ulcerating or severely ulcerated
