Inflammatory bowel disease Flashcards
What is the difference in distribution between Crohn’s and ulcerative colitis?
Crohns can effect mouth to anus
Ulcerative colitis is exclusively colon and rectum
Disease continuity in Crohn’s vs UC?
Crohns- discontinuous (skip lesions)
UC- continuous
Depth of inflammation in Crohn’s vs UC?
Crohns- transmural
UC- mucosal
Biggest risk factor for Crohn’s development?
Smoking
Macroscopic appearance of Crohn’s disease?
Cobblestoning appearing- oedematous islands of mucosa separated by fissures
What consequences can the transmural inflammation in Crohn’s have? (3)
Adhesions to neighbouring structures, sinus formation, fistula formation
Microscopic features of Crohn’s? (2)
Deep fissuring ulcers
Inflammatory cell infiltrates (lymphocytes, non-caseating granulomas)
Disease course of Crohn’s disease?
Chronic with relapses/remissions
Main clinical features of Crohn’s colitis? (5)
Continuous/episodic diarrhoea Abdominal pain Weight loss and malabsorption Features of obstruction Peri-anal disease
Peri-anal disease features in Crohn’s? (6)
Abscess Fistulae Fissures Uleration Strictures Skin tags
Systemic manifestations/associations of Crohn’s? (6)
Anterior uveitis/iritis Ankylosing spondylitis Erythema nodosum Gallstones Primary sclerosis cholangitis Megaloblastic anaemia (if involvement of terminal ileum)
Investigation of suspected Crohn’s?
Full blood count (?anaemia)
CRP
Stool culture
Ileocolonoscopy and biopsy
Medical management of Crohn’s disease?
Induction of remission (prednisolone, 5-ASA e.g. mesalazine)
Maintenance of remission (azathioprine, mercaptopurine)
What should be assessed before offering AZT/mercaptopurine for Crohn’s?
TPMT level
Which antibiotic is sometimes used for isolated peri-anal disease?
Metronidazole
What is the basic principle of surgery for Crohn’s?
Maintenance of bowel length
Bowel complications of Crohn’s? (5)
Strictures causing obstruction Fistulae Perforation Acute dilatation Increased risk of colonic carcinoma
Treatment of perianal fistula?
Seton suture- allows fistula to drain and heal itself
Clinical features of ulcerative colitis?
Diarrhoea + blood/mucus
Abdominal pain
Pyrexia
Increased faecal frequency and urgency
Key investigation in the diagnosis of ulcerative colitis?
Sigmoidoscopy showing red, friable mucosa
What might abdominal X ray show in ulcerative colitis?
Dilated gas filled colon
Mainstays of UC treatment?
Fluid and electrolyte replacement
Nutritional support
Systemic steroids to induce remission
What is Truelove and Witt’s criteria?
System used to identify a severe acute episode of UC
Maintenance therapy for UC?
Aminosalicylates e.g. mesalazine
AZT and mercaptopurine
