Inflammatory Bowel Disease Flashcards
Name the inflammatory bowel diseases.
Ulcerative Colitis
Crohn’s disease
Which part of the bowel does Ulcerative Colitis affect?
The colon only (including the rectum)
Which part of the bowel does Crohn’s affect?
Anywhere from the mouth to anus
When does IBD usually present?
Usually teens and twenties, but not always
What 3 factors contribute to the development of IBD?
- Genetic susceptibility
- Environmental factors such as smoking, stress
- Host immune response
What is the pathogenesis of the immune system in IBD?
IBD is an autoimmune condition
The immune system produces an abnormal response to antigens usually found in the lumen
Effector T cells overpower regulatory T cells
Pro-inflammatory cytokines stimulate release of TNF
Activation of mast cells, neutrophils, eosinophils
All of these lead to cell damage
In UC, is the inflammation patchy or widespread?
Widespread, the inflammation begins at the rectum and gradually travels up the colon
You see distinct cut of points between healthy and affected colon
Continuous: no ‘skip lesions’ - bits of the bowel that are skipped and left unaffected
In Crohn’s is the inflammation patchy or widespread?
Patchy
Skip lesions
In UC what layers of the bowel wall are affected?
Mucosa only
In Crohn’s what layers of the bowel wall are affected?
The whole wall can be affected
Trans-mural
Which features granulomas? UC or Crohn’s?
Crohn’s, but only in 50% of patients
What is the effect of smoking on the risk of developing UC and Crohn’s?
Increases risk of getting Crohn’s
Decreases risk of getting UC
What would you see looking down a microscope at some bowel affected with UC?
No granulomata
Goblet cell depletion
Crypt damage:
- distortion
- abscesses
- cryptitis
What would you see looking down a microscope at some bowel affected with Crohn’s?
Granulomata
Trans-mural inflammation
What would you see during an endoscopy of a person with UC?
Loss of vascular appearance
Erythema, bleeding
Ulcers
Pseudopolyps
What would you see during an endoscopy of a person with Crohn’s?
Cobblestone appearance
Deep ulcers
Fissures: split in bowel wall, does not go all the way through though
Thickened bowel wall: fibrosis
What are the clinical features of UC?
Episodic or chronic diarrhoea
Containing blood + mucus
Cramps, bloating, distension
Tenesmus
Systemic symptoms: fever, malaise, anorexia, weight loss
What are the clinical features of Crohn’s?
Urgent, frequent diarrhoea, bleeding
Abdominal pain
Vomiting
Systemic: fever, malaise, anorexia, weight loss
Perforation of bowel
Obstruction of bowel
What is tenesmus?
A continual, recurrent inclination to evacuate the bowels
What problems can occur in the anus in Crohn’s?
Anal fissure, fistula, skin tags
What is a fistula?
An abnormal passage between a hollow or tubular organ and the body surface, or between two hollow or tubular organs.
IE. between the anus and the skin around the anus
What are some complications of UC?
Liver: fatty change
Colon: toxic dilatation, colorectal cancer
Joints: ankylosing spondylitis
Eyes: uveitis, episcleritis
Skin: Erythema nodosum (red nodules), pyoderma gangrenosum
What are some complications of Crohn’s?
Malabsorption
Colorectal cancer
Amyloidosis
What is amyloidosis?
Deposits of abnormal amyloid proteins in the body which disturbs function of organs + tissues
Investigations for IBD?
Blood tests:
- FBC look for anaemia
- ESR + CRP raised
- LFT sometimes abnormal
Stool sample:
- Exclude infectious causes
Endoscopy:
- distinguish between the two
Rectal biopsy:
- mucosa only or trans-mural inflammation?
X-ray:
- look for wall thickening, dilatation
IBD is a disease that has periods of active disease and periods of remission.
True or false?
True
The aim is to get them into remission and keep them there
Management of IBD.
Drugs: oral or topical (in mouth + anus)
- steroids
- DMARDs
- Biologics, anti-TNF
Liquid enteral nutrition to treat malabsorption
Surgery:
- removal of affected bowel
- colostomy + ileostomy
