Inflammatory bowel disease Flashcards
How does the montreal classification grade crohns and ulcerative colitis on?
crohns - location and behaviour
UC - spread of disease
What are some environmental causes, possibly, of inflammatory bowel disease?
diet, bacteria, vaccines, diet, ethnicity
How does ulcerative colitis present?
bloody diarrhoea, abdominal pain and weight loss
What are the clinical features of severe ulcerative colitis?
> 6 bloody stools per day along with tachycardia, fever, CRP increase, anaemia, albumin and leucocytosis
Clinical features of crohns?
diarrhoea, abdominal pain, weight loss, malaise, malabsorption leading to anaemia and vitamin deficiency
What is calprotectin?
biomarker present in the faeces when there is colon inflammation
List the extra-intestinal manifestations of IBD
eyes - uveitis joints renal calculi liver and biliary tree sclerosis skin - erythema nodosum
What does crohns look like microscopically and in scans which is a differential diagnosis?
ileocaecal TB
What is sclerosing cholangitis?
disease of the bile ducts with multiple strictures progressing to cirrhosis
Why are there regular surveillance colonoscopies in people with prolonged colitis?
increased risk of colonic carcinoma
what are the outpatient medical management of IBD?
5ASA, steroids and immunosuppressants
also biological agents
What do immunosuppressants show an increased risk of?
lymphoma
How are 5ASA beneficial and what effects their route of administration?
better for ulcerative colitis and if the disease is distal can administer rectally
reduce number and severity for relapse due to higher mucosal levels and reduce CRC risk
What are some other treatment methods for IBD (hospital and others)
anticoagulant
antibiotics
elemental feeding
What are some ways in which medical management of IBD fail?
relapse or fail to control disease
adverse effects of steroids eg osteoporosis, diabetes, psychosis
fistulas, peri-anal disease, strictures
What are the acute surgical treatments for severe colitis?
subtotal colectomy with rectal preservation and an ileostomy
Why in acute colitis is an ileostomy used and rectum preserved?
so at a later date the rectum can be connected up and the ileostomy can be taken away but just in acute cases do it quickly
What are the surgical treatment methods for chronic colitis?
pouch procedure - no ileostomy
proctocolectomy - ileostomy
What is the pouch procedure?
Make rectum out of small intestine
What can you do to allow anal crohns to heal?
take out temporary stoma to allow it to heal without the bacteria irritating it more
Triangle for IBD treatment
surgery
biological agents
immunosuppressants
prednisolone (steroids)
5ASA
- with nutritional support
