Inflammatory Bowel Disease Flashcards
What conditions make up the bulk of IBD?
Crohn’s disease
Ulcerative colitis
How is IBD classified?
Montreal classification
When does incidence peak in UC?
20-40 years
Over 60
How does UC present?
Bloody diarrhoea
Abdominal pain
Weight loss
How does UC affect the body?
Continuous inflammation in the colon, with variable distribution and severity
What are the clinical features of severe ulcerative colitis attack?
>6 stools/day + blood Fever Tachycardia Raised CRP Anaemia Low alb
How does Crohns disease affect the body?
Patchy skip lesions from mouth to anus
What are the clinical features of Crohns disease?
Diarrhoea Abdominal pain Weight loss Malabsorption -> Malaise, anorexia, lethargy
When is calprotectin raised in the stool?
> 200
When colon is inflamed
Inflammatory indices for IBD
High ESR, CRP High platelets High WCC Low Hb Low Alb High Calprotectin
How does the histology of UC differ from CD?
CD - granulomas
UC - Goblet cell depletion, more crypt abscesses
What features present in Crohn’s disease but not Ulcerative colitis?
Fistulae
Peri-anal disease
Renal calculi are an additional manifestation of what?
Crohn’s disease
Extra-intestinal manifestations of IBD are seen where?
Renal (CD) Eyes Joints Liver/biliary Skin
Differential diagnosis for IBD
Chronic diarrhoea
Ileo-caecal TB
Infective/amoebic/ischaemic colitis
Which liver disease is associated with IBD?
Sclerosing Cholangitis
What is Sclerosing Cholangitis?
IBD associated bile duct disease
Multiple strictures
Slowly progressive to cirrhosis
To what degree does colitis increase risks of colonic carcinoma?
Pancolitis 26x normal
Left colitis 8x normal
20yrs 20x normal
30yrs 30x normal
What are the surveillance colonoscopy guidelines for extensive colitis?
8-20yrs - 3 yearly
30-40yrs - 2 yearly
+40yrs - yearly
What drugs are indicated for management of IBD?
Aminosalicylates (5ASA) Steroids Thiopurines Methotrexate Immunosuppressants Biologics
What is the role of aminosalicylates in UC?
Induce and maintain remission
Which steroids are indicated in IBD?
Prednisolone
Budenoside
What is the role of thiopurines in IBD?
Induction and Maintenance of remission
What are the significant side effects of thiopurines?
Leucopenia
Hepatotoxicity
Pancreatitis
Intolerance
Adv/disadv of elemental feeding
As effective as steroids
More effective in kids
Compliance is difficult
Which antibiotic is indicated for IBD, and how?
Metronidazole
Crohns, peri-anal
SI bacterial overgrowth
What are the unacceptable complications of steroid use?
Diabetes
Osteoporosis
Psychosis
When is drug therapy considered to have failed?
Recurrent courses of steroids
Relapse prior to/short after stopping therapy
Failure to control symptoms
Surgical indications for Crohn’s
Failure of medical management
Relief of obstructive symptoms
Manage fistulae, abscesses, anal conditions
Failure to thrive
How many patients need further surgery in IBD?
50%
What is the sequence of therapies for IBD?
5-ASA Steroids Immunomodulators Biologics Surgery
