Inflammatory bowel disease Flashcards

1
Q

How common is IBD?

A

In the West, the incidence of ulcerative colitis is stable at 10–20 per 100 000, with a prevalence of 100–200 per 100 000, while the incidence of Crohn’s disease is increasing and is now 5–10 per 100 000, with a prevalence of 50–100 per 100 000.

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2
Q

Who is affected by IBD?

A

UC - M=F, any ethnic group

CD - M

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3
Q

What causes IBD?

A
  • Has both environmental and genetic components
  • Genetic variants that predispose to Crohn’s disease may have undergone positive selection by protecting against infectious diseases, including tuberculosis.
  • It is thought that IBD develops because these genetically susceptible individuals mount an abnormal inflammatory response to environmental triggers, such as intestinal bacteria.
  • This leads to inflammation of the intestine with release of inflammatory mediators, including TNF, IL-12 and IL-23, which cause tissue damage.
  • In both diseases, the intestinal wall is infiltrated with acute and chronic inflammatory cells but there are important differences between the conditions in the distribution of lesions and in histological features.
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4
Q

What are the risk factors for UC?

A
  • non-smoker or ex-smoker status
  • commensal gut bacteria dysbiosis
  • ?breastfeeding exposure
  • ?dietary fibre
  • ?Abx exposure
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5
Q

What are the risk factors for CD?

A
  • smoker status
  • commensal gut bacteria dysbiosis
  • Western diet (low residue, high sugar)
  • ?breastfeeding exposure
  • ?dietary fibre
  • ?Abx exposure
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6
Q

What is the presentation of UC?

A
  • Rectal bleeding with passage of mucous and bloody diarrhoea
  • Extra-intestinal manifestations
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7
Q

What is the presentation of CD?

A
  • Diarrhoea
  • Abdominal pain
  • Weight loss
  • Constitutional symptoms (malaise, lethargy, anorexia, nausea, vomiting, low fever)
  • Some patients may have no GI symptoms
  • Symptoms depend on segment of bowel affected e.g. bloody diarrhoea in colonic disease and seatorrhoea in small bowel disease
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8
Q

What are the musculoskeletal extra-intestinal manifestations of IBD?

A
  • seronegative spondyloarthropaties
  • peripheral arthritis
  • axial arthopathies (sacroiliitis, ankylosing spondylitis)
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9
Q

What are the dermatological extra-intestinal manifestations of IBD?

A
  • erythema nodosum
  • pyoderma gangrenosum
  • apthous stomatitis
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10
Q

What are the ocular extra-intestinal manifestations of IBD?

A
  • episcleritis
  • scleritis
  • uveitis
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11
Q

What are the hepatobiliary extra-intestinal manifestations of IBD?

A
  • sclerosing cholangitis
  • fatty liver
  • chronic hepatitis
  • cirrhosis
  • gallstones
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12
Q

What are the signs of UC on examination?

A
  • Generally no specific signs
  • Abdominal distention and/or temderness
  • Tachycardia and pyrexia (in severe colitis)
  • PR will usually show blood
  • Ridgid sigmoidoscopy is usually abnormal, showing inflamed, bleeding and friable mucosa
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13
Q

What are the signs of CD on examination?

A
  • Weight loss
  • Signs of malnutrition
  • Aphthous ulceration of the mouth
  • Abdominal tenderness and/or right iliac fossa mass
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14
Q

What are the differential diagnoses for IBD?

A
Anorexia Nervosa
Appendicitis
Bacterial Gastroenteritis
Bulimia Nervosa
Celiac Disease (Sprue)
Clostridium Difficile Colitis
Collagenous and Lymphocytic Colitis
Colorectal malignancy
Cytomegalovirus (CMV)
Cytomegalovirus Colitis
Diverticulitis
Eosinophilic Gastroenteritis
Food Poisoning
Giardiasis
Intestinal Motility Disorders
Intestinal Radiation Injury
Irritable Bowel Syndrome
Lactose Intolerance
Salmonella Infection (Salmonellosis)
Viral Gastroenteritis
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15
Q

What are the ano/perianal complications of CD?

A
Fissure in ano
Haemorrhoids
Skin tags
Perianal abcess
Ischiorectal abcess
Fistula in ano
Anorectal fistulae
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16
Q

What investigations would you perform in suspected CD?

A

Bloods:

  • FBC: normocytic, normochromic anaemia, Fe/folate deficiency
  • Raised ESR and CRP