Inflammatory Bowel Disease Flashcards
chrons disease symptoms
abdominal pain
diarrhoea
fever
weight loss
IBD aetiology
possible environmental trigger
genetically susceptible people
Environmental triggers to IBD
role of bacteria
diet
vaccination history
social factors
ethnicity
ulcerative colitis presents with
bloody diarrhoea
abdominal pain
weight loss
what is ulcerative colitis?
continuous inflammation with variable distribution and severity
clinical features of ulcerative colitis
more than 6 stools a day
fever
tachycardia
CRP raised
Anaemia
leucocytosis
thrombocytosis
chron’s disease is a patchy disease that presents with
skip lesions
chron’s disease clinical features
diarrhoea
abdominal pain
weight loss
malaise, lethargy, anorexia, N+V, low-grade fever
malabsorption (anaemia, vitamin deficiency)
CRP
C-reactive protein
test for inflammation
IBD tests that show inflammatory indices
High WCC
High ESR + CRP
High platelet count
Low Hb
Low albumin
ESR
erythrocyte sedimentation rate
test for inflammation - its a marker
Histology of ulcerative colitis
goblet cells are depleted
histology of chron’s disease
granulomas
Chron’s disease includes conditions such as
fistulae
peri- anal symptoms
IBD: Extra-intestinal manifestations
Eyes
uvetitis
conjunctivits
IBD: Extra-intestinal manifestations
joints
sacroilititis
arthritis
IBD: Extra-intestinal manifestations
liver and biliary tree
fatty change
gallstones
pericholangitis
cholestasis
a decrease in bile flow due to impaired secretion by hepatocytes or to obstruction of bile flow through intra-or extrahepatic bile ducts
Sclerosing cholangitis is an Associated liver disease of IBD. what is it?
disease of the bile ducts
multiple strictures
slowly and progressively can lead to cirrhosis
medical management of IBD
out patient
5ASA
steriods
immunosuppression
medical management of IBD
hospital
steriods
anticoagulation
rest
(occasionally surgery)
Aminosalicylates (5ASA)
group of anti-inflammatory drugs used to treat chrons and ulcerative colitis
5ASA in UC results in
reduced numer and severity of relapses
higher mucosal levels = greater benefit
5ASA treatment in UC leads to a reduced risk of
CRC
colorectal carcinoma
CRC
colorectal carcinoma
steroids used include
prednisolone
budenoside
immunosuppressants (3)
ciclosporin (salvage therapy for refractory UC)
mycophenolate
tacrolimus
exclusive elemental feeding can be as effective as
steroids
Failure of medical therapy can lead to…
recurrent courses of steroids
relapse after therapy stops
failure to control symptoms
Poor response to medicine leads to
fistulas
fibrotic strictures
peri-anal disease
severe fulminating disease
surgery for severe colitis
total colectomy
rectal preservation
ileostomy
ileostomy
is a stoma (surgical opening) constructed by bringing the end or loop of small intestine (the ileum) out onto the surface of the skin, or the surgical procedure which creates this opening
colectomy
removing all or part of the colon
after a total colectomy the patient will end up with an
end ileostomy and a rectal stump
chronic UC can be treated surgically either by….. or…..
pouch procedure (no ileostomy)
protocolectomy (ileostomy)
pouch procedure
the ileum is attached to the anus after the rectum has been removed
surgical options for chron’s disease
small intestine
ileocaecal area
colon and rectum
anus symptoms in chrons can be
fissures
abscesses
fistulas
skin tags
chrons surgical indications
failure of medicine
to receive obstructive symptoms (small bowel)
fistula
intra-abdominal abscess
anal conditions
failure to thrive
order of treatment for IBD
5ASA
prednisone or budesonide
immunomodulators
biologic agents
surgery
biologic agents used to treat IBD include:
anti-TNFalpha antibodies
alpha4b7 intern blockers
IL12/IL23 blockers
