Inflammatory Bowel Disease Flashcards
What are the 2 main IBD?
Crohn’s disease
Ulcerative colitis
What do the 2 IBD diseases share (have in common)?
Epidemiology
Clinical therapeutic characertisitcs
What do the 2 IBD diseases differ in?
Clinical presentation
Pathology
What are the 3 pathogenesis of IBD?
Genetic predisposition
Mucosal immune system
Environmental triggers
Describe some evenidence for genetics in IBD?
There is a risk in first degree relative of 2.2-16.2%
There is a risk of twins getting CD (36%) and UC (16%)
Postive famiyl history best established risk factor for disease development
What mediated disease is Crohns?
Th1 meditated disease
What mediated disease is UC?
Mixed Th1/Th2 mediated disease/ NKTC
Describe a rough theory of IBD pathogenesis?
Pathogenic bacteria
Abnormal microbial composition
Defective host contaminant of commensal bacteria
Defect host immunoregulation
What does smoking do in Crohns and UC?
Crohns - aggravates
UC - protects
What is the aetiology of UC?
Inflammation of colon of unknown cause
Peak incidence 20-30s
Relapsing course
Affects rectum extending proximally
Describe the UC disease extent?
Just rectum etc - 36%
Left sided colitis - 27%
Pan colitis (whole colon) - 37%
What are the symptoms of UC?
Diarrhoea and bleeding Increased bowel frequency Urgency Tenesmus Incontinence Night rising Lower abdo pain (LIF)
What things must you remember to ask in the history?
Recent travel Antibiotics NSAID’s Family history Smoking Skin, eyes, joints
How would you determine the severity of UC?
Truelove and Witt criteria
Sever UC - 30% of colectomy
> 6 bloody stools/24 hrs
Plus - 1 of more of….
Fever
Tachycardia
Anaemia
Elevated ESR
What other assessments of UC would you do?
Bloods - CRP, albumin (negative acute phase reactant)
Plain AXR
Endoscopy
Histology
What might you see on a plain AXR in UC?
Stool distribution:
- Absent in inflammed colon
Mucosal oedema / ‘thumb-printing’
Toxic megacolon:
Transverse >5.5cm
Caecum >9cm
What might you see on a endoscopy of UC?
Confluent inflammation extending proximally from anal margin to a ‘transition zone’:
Loss of vessel pattern
Granular mucosa
Contact bleeding
(UC is restricted to just the mucosa)
What might you see histologically in UC?
Absence of goblet cells
Crypt distortion and abscess
Affects only mucosal layer
What are some longterm complications of UC?
Increased risk of colorectal cancer
(determined by, the severity of inflammation, duration of disease, disease extent)
Extensive colitis (to beyond splenic flexure) - at risk and require surveillance after 10 years of disease
What are some extra-intestinal manifestation of UC?
Skin - erythema nodusum, pyoderma grangroenosum
Joints - spondylitis, sacrolitis, peripheral arthritis
Eyes - uveitis
Deranged LFTs
Oxalate renal stones
What is primary sclerosing cholangitis?
Chronic inflammatory disease of the biliary tree
(80% have associated IBD)
Most asymptomatic OR itch, riggers
Cholestatic LFTs
Describe the aetiology of crohns?
diagnose mean age 27
Can affect any region of GI tract from mouth to anus
What are some characteristic features of crohns?
Skip lesions
Transmural inflammation
Describe peri-anal disease?
Recurrent abscess formation
Pain
Can lead to fistula with persistent leakage
Damaged sphincters
What are some symptoms of crohns diseases?
Small intestine Abdominal cramps (peri-umbilical) Diarrhoea, weight loss
Colon
Abdominal cramps (lower abdomen)
Diarrhoea with blood
Wt loss
Mouth
Painful ulcers, swollen lips, angular chielitis
Anus
peri-anal pain, abscess
What would you see in crohns vs UC on the mucosa…?
Crohns - cobble stoning, thickened wall, fissure
UC - ulceration, surviving mucosa (pseudopolyps), loss of haustra, crypt distortion
