Inflammatory bowel disease Flashcards
What is the pathology of ulcerative colitis?
It is inappropriate immune response against colonic flora. This leads to continuous inflammation that does not spread proximal to the ileocaecal valve.
What is the nature of the inflammation in ulcerative colitis?
It causes formation of pseudopolyps and punctate ulcers that is not transmural
What are some of the common UC symptoms?
Episodic or chronic diarrhoea (may have blood and mucus), crampy abdominal discomfort, urgency, tenesmus
Also fever, malaise and weight loss
What are some of the extraintestinal signs of UC?
Clubbing
Large joint arthritis
Erythema nodosum
Conjunctivitis
What tests can be done to diagnose UC and rule out other conditions?
Blood tests: FBC, CRP, U and E, LFT, culture
Stool: microscopy and culture and c diff test to rule out salmonella, campylobacter etc.
Faecal calprotectin: sensitive test for GI Inflammation
AXR
Lower GI endoscopy - sigmoidoscopy to assess and biopsy and full colonoscopy to assess disease extent
What abdominal x ray signs will be seen for UC?
No faecal shadows
Mucosal thickenings/Islands
Colonic dilation
What are some acute complications of UC?
Colonic dilation
Perforation
venous thromboembolism - give all patients prophylaxis
What are some of the chronic complications of UC?
Colonic cancer
Colonoscopy every 1-5 yrs depending on risk
multiple random biopsies
How do you treat mild, moderate and severe UC?
Mild give mesalazine which is a 5 aminosalasinic acid (5ASA) plus topical steroid foams or prednisolone retention enemas if needed
Moderate is treated with oral prednisolone 40mg/d for one week then taper. Used with 5asa
Severe - admit for IV hydration/electrolytes, IV steroids e.g. hydrocortisone, thromboembolism prophylaxis
Azathioprine can work but methotrexate only for crohns
When are biologics required in UC?
When patients get flares during steroid tapering or require more than 2 steroid courses in a year
What are the characteristics of lesions in crohns disease?
These are skip lesions
Transmural and granulomatous
What is the cause of crohns disease?
Abnormal immune response against gut flora in genetically susceptible individuals
What are the symptoms of crohns?
Diarhoea, abdo pain, weight loss/failure to thrive
Systemically - fatigue, malaise, anorexia
What are the signs of crohns disease?
Bowel ulceration, abdo tenderness, strictures
Systemically - clubbing, skin, joint and eye problems
What are some of the complications of crohns disease?
Bowel obstruction, toxic dilation, abscess formation, colon cancer
What tests can be done for crohns?
Bloods - fbc, esr, crp, u and e, lft, inr, ferritin
Stool - culture and sensitivity, faecal calprotectin (sensitive to gi inflammation)
Colonoscopy and biopsy
MRI to look at small bowel
What is the treatment for mild-moderate crohns
For flares prednisolone 40mg/d for one week then taper for 7 weeks
If refactory to steroids then start on azathioprine
5-asa only used for uc and has no role in crohns
What is a contra indication to methotrexate?
Female of reproductive age
What is the treatment for severe crohns
Admit for iv fluids and steroids
Hydrocortisone 100mg/6hr IV
Thromboembolism prophylaxis
Monitor and consider need for blood transfusionand nutritional support
Tnf alpha inhibitors such as infliximab and adalimumab are used
How can you differentiate UC from crohns in terms of presentations?
UC usually presents with bloody diarrhoea
Crohns is the only one that causes strictures, these cause pain and are relieved by not eating
