Inflammatory Bowel disease Flashcards
Which part of the colon does Ulcerative collitis affect
Rectum (proctits 50%)
or extend and invlve part of the colon (left-sided colitis 30%)
or the entire colon (pancolitis 20%)
Never spreads proximal to the illoceacal valve.
Causes of UC
Idiopathic
genetic
Which gene is associated with UC
HLADR103
Risk factors of UC
most present aged 15-30
More in non/ex smokers
Appendectomy protects
Risk factors for Crohn’s
More common in smokers
Presentation of UC
Episodic or chronic diarrohoea (+- blood or mucus)
Crampy abdominal discomfort
urgency/tenesmus - rectal UC
systemic symptoms in attacks: fever, malaise, anorexia, weight loss
higher stool frequency compared to Crohns
A 35 year old male presents with weight loss, diarrohoea, and abdominal pain. On examination he has apthous ulcers in the mouth and a palpable mass in the right illiac fossa.
Crohn’s disease
Extraintestinal signs of IBD in the mouth
Apthous ulcers in the mouth
Extraintestinal signs of IBDin the eyes
conjuctivitis
Iritis
Episcliritis
Extraintestinal signs of IBD in the liver
Abscess, fatty change, hepatitis, sclerosing cholangitis
vascular Extraintestinal signs of IBD
Mesenteric, portal or deep vein thrombosis
Extraintestinal signs of IBD in the skin
Erythema nodosum, pyoderma gangrenosum
Extraintestinal signs of IBD in the boins/joints
Metabolic bone disease, sacroiliitis
Mild UC characteristics
<4 motions/day
small rectal bleeding
HR <70
Moderate UC characteristics
4-6 motions/day
medium rectal bleeding
HR 70-90
Severe UC characteristics
> 6 motions/day
severe rectal bleeding
HR >90
Symptoms of crohn’s disease
Diarrhoea/urgency “I get up at 4am and go 5-6 times in the next 45 mins”
Abdominal pain, weight loss, fever, malaise, anorexia.
“I can be fine one minute and deathly the other”
Signs of Crohn’s
Apthous ulcers
Abdominal tenderness/mass
Fistulae
perianal abscess
skin tags
Anal strictures
Investigations for inflammatory bowel disease
FBC - Anaemia
ESR
CRP
Faecal Calprotectin
Stool sample
Blood cultures
Sigmoidoscopy
Endoscopy/ Colonoscopy for biopsy
Radiology
When is ESR elevated
In exacebrations or because of abscess in IBD
What can we benefit from CRP
Helpful in monitoring Crohn’s disease activity
Why would you want a stool sample in IBD?
Help to exclude superimposed infections in exacebrations
What is sigmoidoscopy
Looks at rectum and sigmoid colon.
What can sigmoidoscopy show in UC
Loss of vascular pattern
granularity
Friability
Ulceration
What can sigmoidoscopy show in Crohn’s
Patchy inflammation with discrete, deep ulcers, perianal disease or rectal sparing occurs
Cobble stone appearance
What Radiological investigations can help in IBD investigations
Barium enema - can show ulcers or strictures
CT - colongram
MRI - staging
AXR - dilation of colon, mucosal oedema, perforation
USS - thickened small bowel, stricture in Crohn’s disease.
Surgical treatment of UC
60% of UC will require surgery
Panproctocolectomy with ileostomy or proctocolectomy with ileal–anal pouch anastomosis cures the patient
Surgical treatment of Crohn’s
Operations are often necessary to deal with fistulae, abscesses and perianal disease, or to relieve small or large bowel obstruction
Surgery is not curative compated to UC, and recurrence is a rule
IBD prognosis
Now life expectancy is similar to general population and patients can live normal life
Medical treatment for mild to moderate subacute proctitis or proctosigmoiditis
Topical aminosalicylates (Enema or suppository)
Or
Oral + Topical aminosalicylates
Or Oral alone but must explain that topical or combination is more effective
Medical treatment for mild to moderate subacute left-sided and extensive ulcerative colitis
Offer high dose oral Aminosalicylates
Can Add topical Aminosalicylates or oral beclometasone dipropionate (corticosteroid i think)
Oral predinosolone if aminosalicylates is contraindicated
Inducing remission in acute ulcerative colitis
IV corticosteroid to induce remision
Or IV cyclosporine or surgery if IV corticosteroid is containdicated
Inducing remission in Crohn’s disease
Consider predinosonle or IV hydrocortisone in people with first presentation
Consider budesonide(corticosteroid) if glucocorticoids are contraindicated
If both of above fail/contraindicated consider antisalicylates - explain that it is less effective but has fewer SE
adjunct treatment: azathioprine or mercaptopurine
Influximab and adalimumab
When to consider IV cyclosporine in severe acute Ulcerative colitis
if IV corticosteroid is containdicated
If no impromvement within 72 hours of starting IV corticosteroids
If symptoms persist after IV corticosteroid therapy
When to consider IV cyclosporine in severe acute Ulcerative colitis
if IV corticosteroid is containdicated
If no impromvement within 72 hours of starting IV corticosteroids
If symptoms persist after IV corticosteroid therapy
In a severe or exacebrations Crohn’s disease presentation which of the following medications you should not offer
Budoneside
Antisalicylates
Do not offer these drugs as monotherapy for Crohn’s disease
Axathiopurine mercaptopurine, methetroxate
Maintaining remision in Crohn’s
azathioprine or mercaptopurine
Methotrexate if above is contraindicated
Maintaining remision in mild to moderate subacute proctitis or proctosigmoiditis
same as acute Rx
Maintaining remision in mild to moderate subacute left-sided and extensive ulcerative colitis
Same as acute but lower dose
