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13. GI and Liver > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

What are the 2 types of inflammatory bowel disease?

A

Ulcerative colitis

Crohn’s disease

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2
Q

What are the 4 types of ulcerative colitis?

A

Proctitis (rectum only)
Left sided colitis (rectum to splenic flexure)
Extensive colitis (rectum to hepatic flexure)
Pancolitis (whole colon)

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3
Q

What causes IBD?

A

Unknown

Genetic predisposition

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4
Q

Describe the symptoms of chronic UC. (5)

A 
Episodic/chronic diarrhoea
Crampy abdominal discomfort
Increased bowel frequency
Urgency of bowel motions
Tenesmus
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5
Q

Describe the signs of chronic UC. Consider:

a) Intestinal signs (1)
b) Extra-intestinal signs (7)

A

INTESTINAL:
May be none

EXTRA-INTESTINAL:
Finger clubbing
Mouth ulcers
Erythema nodosum
Pyoderma grangrenosum
Eye problems
Joint problems
Fatty liver
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6
Q

List 4 complications of UC.

A

Perforation
Toxic megacolon
Venous thrombosis
Colonic cancer

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7
Q

How would you define toxic megacolon?

A

Colon diameter: 6+ cm

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8
Q

Describe the symptoms of Crohn’s disease. (6)

A 
Diarrhoea/urgency
Abdominal pain
Weight loss
Fever
Malaise
Anorexia
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9
Q

Describe the signs O/E of Crohn’s disease. Consider:

a) GI signs (5)
b) Extra-intestinal signs (7)

A 
INTESTINAL:
Ulcerations
Abdominal tenderness
Abdominal mass
Perianal symptoms (fistula, abscess, skin tags)
Anal stricture
EXTRA-INTESTINAL:
Finger clubbing
Mouth ulcers
Erythema nodosum
Pyoderma grangrenosum
Eye problems (e.g. uveitis)
Joint problems
Fatty liver
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10
Q

List 7 complications of Crohn’s disease.

A 
Small bowel obstruction
Toxic megacolon
Abscess formation
Fistula formation
Rectal haemorrhage
Colon cancer
Fatty liver
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11
Q

Describe the signs (3) and symptoms (4) of an acute exacerbation of UC.

A

SIGNS:
Fever
Tachycardia
Tender, distended abdomen

SYMPTOMS:
Fever
Malaise
Anorexia
Weight loss
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12
Q

What investigations would you do for IBD? (8)

A 
Clinical history
Examination
Bloods
Stool samples
Abdominal x-ray (AXR)
Chest x-ray (CXR)
Colonoscopy
Biopsy
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13
Q

Which blood tests would you do for IBD? (6)

A 
FBC
CRP/ESR
U&Es
LFTs
Ferritin
Blood cultures
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14
Q

Which tests would you do on stool samples in IBD? (3)

A

Stool cultures
C. difficile toxin
Faecal calprotectin

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15
Q

What would you see on an AXR in IBD? (3)

A

No faecal shadows
Mucosal thickening
Colonic dilation

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16
Q

Why would you do a CXR in IBD?

A

Exclude perforation

17
Q

Describe the appearance of the intestine on colonoscopy in:

a) Ulcerative colitis
b) Crohn’s disease

A

ULCERATIVE COLITIS:
Granular mucosa
Pus formation
Contact bleeding

CROHN’S DISEASE:
Fissuring ulcers
Cobblestoning
Colon strictures

18
Q

Describe the histological features found on biopsy in IBD. (6)

How would you differentiate between UC and Crohn’s?

A 
Inflammatory infiltrate
Goblet cell depletion
Glandular distortion
Mucosal ulcers
Crypt abscesses
Non-necrotising granulomas (Crohn's)

UC: inflammation limited to mucosa/submucosa
Crohn’s: transmural inflammation; granulomas

19
Q

Which other type of imaging could you do for Crohn’s disease?

Why?

A

MRI

Assess pelvic fistulas

20
Q

List 2 examples of 5-ASAs (aminosalicylates).

A

Sulphasalazine

Mesalazine

21
Q

List 2 side effects of 5-ASAs (aminosalicylates).

A 
Intolerance
Renal impairment (rare)
22
Q

How would you treat mild UC? (2)

How would you treat moderate UC? (3)

A

MILD:

  1. Sulphasalazine/mesalazine
  2. Steroids (reduce dose if improvement seen; treat as moderate UC if not)

MODERATE:

  1. Sulphasalazine/mesalazine
  2. Oral steroids
  3. Twice daily steroid enemas
23
Q

How would you treat severe UC? (5)

A
  1. Admission: nil by mouth and IV fluids
  2. Monitoring:
    a. Observations
    b. Stool chart
    c. Twice daily examination
    d. Daily bloods
    e. Consider daily AXR
  3. Steroids:
    a. IV hydrocortisone
    b. Rectal steroids
  4. Blood transfusion (if low Hb)
  5. Rescue therapy:
    a. Ciclosporin
    b. Infliximab
24
Q

What would you use as maintenance therapy in UC?

A
  1. Lifelong 5-ASA (e.g. sulphasalazine

2. Thiopurines (e.g. azathioprine)

25
Q

When would you use surgery in UC? (4)

What types of surgery would you do? (2)

A 
INDICATIONS:
Perforation
Massive haemorrhage
Toxic megacolon
Drug failure

METHODS:
Proctolectomy
Terminal ileostomy

26
Q

How would you treat mild Crohn’s? (2)

A
  1. Oral prednisolone (step down weekly)

2. 3 weekly follow ups in clinic (if improvement: stop steroids; if not, step up treatment)

27
Q

How would you treat severe Crohn’s?

A
  1. Admission: nil by mouth and IV fluids
  2. Monitoring:
    a. Observations
    b. Stool chart
    c. Daily physical examination
    d. Daily bloods
    e. Daily AXR
  3. IV hydrocortisone
  4. IV metronidazole
  5. Topical hydrocortisone
  6. Other treatments if needed:
    a. Blood transfusion
    b. Parenteral nutrition
    c. Oral azathioprine
    d. TNF alpha inhibitors
    e. Methotrexate
28
Q

When would you use surgery in Crohn’s? (5)

A 
INDICATIONS:
Drug failure
GI obstruction from stricture
Perforation
Fistulae
Abscesses
29
Q

List 3 side effects of biologic anti-TNF alpha drugs.

Give 2 examples.

A

Infliximab
Adalumimab

SIDE EFFECTS:

  • Increased risk of infection
  • Neurological problems
  • Increased risk of lymphoma

13. GI and Liver (9 decks)

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