Inflammatory Bowel Disease Flashcards
What is IBD?
A term used to describe two chronic GI inflammatory conditions
- Ulcerative colitis
- Chron’s disease
What is the prevalence of Chron’s?
Prevalence 50/100,000 (M=F)
Incidence peaks at 15-30 AND in 60s
What are the risk factors for Chron’s?
Poor diet
FH
Smoking
Altered immune states
What is the underlying pathophysiology of Chron’s?
Inflammation can affect any part of GI tract
-most commonly terminal ileum/ascending colon
-skip lesions present
-narrowed bowel, thickened wall
-deep ulcers (Rose thorn, cobblestone appearance on CT)
Inflammation throughout all layers of bowel
-fistulae/stenosis common
What are the clinical features of Chron’s?
Abdo pain
Diarrhoea (steatorrhoea in ileal disease, bloody in colonic)
Wt loss
Severe apthous ulceration of mouth (early sign)
Anal complications
Extra GI manifestations
Acute RIF pain/mass
What are the anal complications of Chron’s?
Fissure Fistula Haemorrhoids Skin tags Abscesses
What is the prevalence of UC?
100-200/100,000
Peaks at 15-30yrs AND at 60yrs
F>M
What effect does smoking have on UC?
Protective
What is the underlying pathophysiology of UC?
Inflammation starts in rectum, extends proximally along colon
-proctitis if affects rectum only
Inflammation of distal terminal ileum (backwash ileitis)
Inflammation only affects mucosa (excessively ulcerate)
-adjacent mucosa looks like inflam polyps
What are the clinical features of UC?
Crampy lower abdo discomfort
Gradual onset diarrhoea (often bloody)
Urgency/tenesmus (if disease confined to rectum)
Extra-GI sx
What is the histological difference b/w UC & Chron’s?
Chron’s - transmural inflammation, lymphoid hyperplasia, granulomas
UC - mucosal inflammation, crypt abscesses, goblet cell depletion
What is indeterminate inflammatory colitis?
Diagnosis given when biopsy taken in acute phase, not always possible to distinguish UC/Chron’s
What is fulminant IBD?
Most of mucosa lost, leaving only a few islands of normal tissue
Toxic dilatation can occur
What investigations are appropriate in suspected IBD?
Bloods - FBC, U&Es, CRP/ESR, LFTs, Fe/B12
Stool studies - stool chart, MCS x3, calprotectin
AXR/CXR/CT
Endoscopy (+/- biopsy)
What medical therapy is available for a mild acute Chron’s flare?
SYMPTOMATIC BUT SYSTEMICALLY WELL
- oral prednisolone
- tapered steroids
What medical therapy is available for a severe acute Chron’s flare?
SYMPTOMATIC AND SYSTEMICALLY UNWELL
- admission (if raised temp, pulse, CPR/ESR, low albumin)
- IV hydrocortisone 100mg/6h
- make pt NBM w/ parenteral nutrition)
- high level monitoring
- thiopurines
- infliximab (if refractory)
- transfer to oral prednisolone
What medical therapy is available for Chron’s maintenance?
1st Line = Thiopurines (azathiopurine/6-mercaptopurine) 2nd Line = Methotrexate Oral metronidazole (if anal disease)
What screening should always be done before prescribing Thiopurines?
TPMT deficiency
-unable to metabolise thiopurine
What medical therapy is available for a mild/mod acute UC flare?
<6 MOTIONS/DAY, SYSTEMICALLY WELL
- topical aminosalicylate +/- oral mesalazine (proctitis/proctosigmoiditis)
- loading dose oral mesalazine +/- oral beclometasone/topical mesalazine (extensive disease)
- 2nd line = oral pred (if 4wks of sx)
- 3rd line = tacrolimus (after 2-4 more wks)
- 4th line = biological agents (specialist)
What medical therapy is available for acute severe/fulminating UC?
MDT management (consider surgical intervention)
IV corticosteroids
SC heparin
Avoid anti-motility drugs (including opioids)
2nd line = IV ciclosporin (if sx worsen/no improvement w/i 72hrs steroids)
3rd line = biological agents (specialist)
What are the indications for surgical treatment of acute severe/fulminating UC?
>8motions/day Pyrexia Tachycardia Colonic dilatation Low albumin Low Hb CRP >45
What medical therapy is available for UC maintenance?
1st line = 5-ASA derivatives (topical for proctosigmoiditis, oral if left-sided
-sulfasaslazine, mesalazine
2nd line = oral thiopurines
-azathioprine/mercaptopurine
What monitoring do UC pts require?
Monitoring appropriate to specific drug
Bone health monitoring
What are the general complications of IBD?
Bowel perforation
Lower GI haemorrhage
Toxic dilatation (most common in UC)
Colonic carcinoma
