Inflammatory Bowel Disease Flashcards
What is the two aetiologies of IBD
Environmental triggers
(bacteria, diet, vaccinations, social, ethnicy)
and
Genetic susceptibility
What is the two most common forms of Inflammatory bowel disease
Crohns disease
Ulcerative colitis
What is the symptoms of Ulcerative colitis
Bloody diarrohea
abdominal pain
weight loss
What is the signs of a severe attack of ulcer colitis
> 6 stools a day with blood
Fever
Tachycardia
Raised CRP
Anemia
Low Albumin
Leucocytosis
What is the pathology of Ulcerative colitis
Continous inflammation starting from the rectum and only affecting the colon
What is variable in Ulcerative colitis
Distribution and Severity
What is the management of Ulcerative colitis
Surgical removal - colectomy
needs to be controlled within 7 days
Why is Crohns disease called a patchy disease
Mouth to anus, called a patchy disease due to skipped lesions
What is the complications of Crohns disease
Inflammation
Stricture
Fistula
What does the clinical feature sypmtoms of crohns disease depend upon
the regions involved - therefore gives a wide variety of symptoms
What is the symptoms of crowns disease
Diarrhoea abdominal pain Weight loss Malise Lethargy Anorexia Malabsorption: Anemia Vitamine deficiency
What are the blood markers for Crohns disease
High ESR High platelet count High WBC Low Hb Low Albumin
What is investigated in stool samples for Crohns disease, why?
Calcoprotein,
Is a white cell protein found in the bowels, when bowels become inflammation there is an increase in cal protein in stool sample
What differential diagnosis but be checked for crowns disease
TB
What are the other causes of Irritable bowel disorder
Lymphocytic colitis
Collagenous colitis
Microscopic colitis
Where can extra manifestations occur in IBD
Eyes
Inflammation/conjunctivitis
Joint
inflammation/ arthritis
Renal calculi
Liver and Billary tree
Skin
What are the manifestation of IBD that can be seen on the skin
Pyroderma gangrenosum
Erythema nosdum
Vasculitis
What are the manifestations of IBD occurring in the liver and biliary tress
Fatty change
Pericholangitis
Sclerosing cholangitis
Gallstones
What form of Irritable bowel disease manifest to renal calculi
Crohns disease
What is the differential diagnosis of IBD
Chronic diarrhoea
- malabsorption
- malnutrition
Illeo-caecal TB
Different collitis:
- infective
- amoebic
- ischaemic
What is the long term complication of IBD
Colonic carcinoma
What is the risk factors for colonic carcinoma
The extent of IBD
and the duration of IBD
How is the potentially development of colonic cancer monitored
Surveillance colonoscopy - biopsy
What is the problems of Surveillance colonoscopy
Cancers do not always arise from dysplastic mucosa
May be difficult to interpret
What is the steps of medical management in IB
5-ASA or sulfasalazine
Steroids:
Predisolone /Budenoside
Immunosuppressants
Biologics
Elemental feeding
antibiotics
Surgery
What are aminosalicylates (5ASA) drugs purpose
Reduces inflammation of the inning of the intestine
When are 5-ASA or sulfasalazine used in the treatment of IBD
1st line therapy used in the induction and maintenance of remission
How is 5ASA administrated
> 3g per day tablet
Rectal 5ASA
What is the purpose of rectal 5ASA
Treats distal and more extensive disease
What is the overall benefit of 5ASA as 1st line therapy
Greater and quicker clinical improvement
Reduced number and severity of relapse
Reduced colorectal cancer risk
(>2g per day life long)
Higher mucosal levels gives greater benefit
How is Predisolone administrated in IBD
Optimal dose 40mg per day with tapering reduction over a minimum of 4 weeks
(longer to reach colon and control inflammation)
How does Budenoside steroid treatment compare to prednosiolone steroid treatment
Slightly less effective than Prednisolone but better side effect profile
What does Budenoside specifically treat
Illeal and ascending colon disease
What are examples of
immunosuppressants used in the treatment of IBD
Azathioprone Methotrexate Ciclosporin Mycocphenolate Tacrolimus
When is azathioprine (AZA/6MP) used in the treatment of IBD
Induction and maintenance of remission
What is the benefit of azathioprine
Is steroid sparing
=lower the dose of steroids needed and thus spare some of the undesirable side effects of steroid therapy
What is the potential side effect of azathioprine
Leucopenia Hepatoxcity Pancreatits Possible long term lymphoma risk Intoleracne
What is essential when managing the side effect of azathioprine
Blood monitoring for the side effect of hepatoxicity
- For 8 weeks
- Then every 8 weeks
- patients must see GP if throat sore/infection
What does methotextrate (MTX) specifically treat, and when is it administrated
Unlicensed use to treat Crohns disease
Used in the Induction and maintenance of remission
What is methotextrate dependant upon
Steriods
When is the immunosuppressant ciclosporin used
Final option for treating refractory Ulcerative colitis
Or used 3-6months as a bridge to azathioprine treatment
What are examples of the biologics used to treat IBD
(Anti TNF alpha antibodies)
MONOCLONAL ANTIBODIES
- Infliximab
- Adulimunab
BLOCKERS
Alpha 4B7 integrin blockers
-Vedolizumab
IL12/IL23 Blockers
- Ustekinumab
Define Biologic therapy
Treatment manufactured in living system
eg monolocalantibodies
How is biologics administrated
IV infusion - 8 weekly
Subcutaneous Injection - 2 weekly
What do biologics increase the risk of
Cancer
What is elemental feeding just as effective as
Steroid treatment
Who is elementary feeding more effective in and why?
Children as are more complaint to the treatment
tastes disgusting so adults less complaint
What is the antibiotic used in IBD
Metronidazole
What does the antibiotic metronidazole treat specifically in IBD
Crohns peri-anal disease
Small bowel bacterial growth
What are examples that show the failure of medical therapy in IBD treatment
Recurrent courses of steroids
Relapse priori to shortly stopping therapy
Failure to control symptoms
Complications of steroids
What are some of the complications of steroids that indicate medial failure in the therapy of iBD
Diabetes
severe Osteopororisis
Psychosis
What are conditions that have a poor response to medical therapy for IBD
Fistulas
Fibrotic strictures
Peri-anal disease
Severe fulminating disease
(new disease)
What are the therapies used in the hospital to treat IBD
Steroids Anticoagulation rest surgery Cyclosporin - immunosuppressant Infliximab - monoclonal antibody
What therapies are used for out patients with IBD
5ASA
Steroids
Immunosuppression
When would emergency surgery rather than elective be performed on a patient with IBD
If they have had 5 day of medical treatment with still no improvement
What is the surgery option if a patent with severe colitis forms acutely ill
total colectomy
Rectal preservation
illeostomy
What are the two procedure for rectal preservation
Protectomy
or
Pouch procedure
Define proctectomy
Remove all part of the rectum
What happens in a pouch procedure
Small bowel is mobilised and lengthened
from Ileum to distal anal canal to construct pouch and stapled together creating a false rectum
Define an illeostomy
Ileum cut into and diverted to an artificial opening in the abdominal wall
creating a stoma bag
What problems arising in the anus due to Crohns may need surgical intervention
Fissures
abscesses
Fistulas
Skin tags
What is the surgical indication for crohns disease
Failure of medical management
Relief of obstructive symptoms (small bowel)
Management of fistulae
Management of intra-abdominal abscess
Management anal conditions
Failure to thrive
