Inflammatory Bowel Disease Flashcards
what 2 main diseases does this encompass
crohn’s and UC
what is causes
genetic (stronger in crohns)
impaired mucosal immunity
environmental (smoking causes crohn’s but makes UC better)
genes linked to IBD
NOD2/CARD15 on chromosome 16
how is it diagnosed
increased CRP decreased Hb and albumin stool microscopy/culture malabsorption deficiencies (vit B12) AXR in UC to query toxic megacolon
how are they treated
5-ASA (mesalazine - mostly UC) steroids (prednisolone/budesonide) immunosuppression (azathioprine/methotrexate) anti-TNF (IV infliximab) surgery
difference in location
crohns - anywhere
UC - colon and rectum
difference in skip lesions
crohns - common
UC - rarely skips
difference in bowel wall
crohns - thickened bowel and stricture
UC - mucosal ulceration and thin wall
difference in inflammation
crohns - transmural
UC - superficial
difference in granulomas
crohns - present
UC - none
difference in fistula
crohns - common
UC - rare
difference in cancer risk
crohns - moderate
UC - high
what is pathological appearance of crohns
cobblestone appearance pseudopolyps fissures non-caseting granuloma in 50% TH1 mediated
age range of crohns
most in 20s and male
symptoms of crohns
abdominal cramps diarrhoea weight loss bleeding PR anaemia painful ulcers abscesses
how is crohns diagnosed
endoscopy - patchy, segmental disease with skip lesions and cobblestone appearance
mucosal biopsy - transmural inflammation, deep knife like fissuring ulcers, patchy
surgery used in crohns
resection
stricturoplasty
fistula repair
what are complications of crohns
malabsorption short bowel syndrome vitamin deficiencies - anaemia fistulas bowel obstruction perforation malignancy amyloidosis
pathology of UC
distorted crypt architecture (crypt abscesses)
inflammatory cell infiltrate
TH1 and TH2 mediated
age range for UC
20-40 year olds but variable
symptoms for UC
diarrhoea + bleeding + mucus increased bowel frequency urgency tenesmus incontinence night rising LIF pain weight loss
how to define severe UC
> 6 bloody stools/day and 1 of fever, tachycardia or anaemia
how is UC diagnosed
endoscopy - diffuse continuous disease
biopsy - diffuse mucosal colitis, inflammatory cells, basal lymphoplasmatic infiltrate with irregular shaped branching crypts (may become abscesses)
what surgery used to treat UC
proctocolectomy (remove colon and rectum) with end ileostomy / with ileorectal anastomosis / with pouch
what are complications of UC
toxic megacolon (persistent inflammation causes loss of muscle tone leading to distension)
primary sclerosing cholangitis
extra-intestinal manifestations
colorectal cancer
