Inflammatory Bowel Disease Flashcards
Define inflammatory bowel disease
Chronic relapsing inflammatory conditions of the bowel
What classification is used to classify the type of colotis?
Montreal
Name two main types of IBD
Crohn’s disease and ulcerative colitis
What is the aetiology of IBD?
Unknown, but there is definitely an environmental trigger and the genetic susceptibility of patients
What are the alarm symptoms of ulcerative colitis?
- Bloody diarrhoea
- Abdominal pain
- Weight loss
What are the features of UC?
Continuous inflammation which begins at the rectum and progresses proximally – only in the large bowel (can affect as far as the caecum)
What are the signs of ulcerative colitis?
Markers of sever attack: • Stool frequency: >6/day with blood AND: • Fever >37.5 • Tachycardia >90 • ESR (CRP) –raised • Anaemia: Hb <10g/dl • Albumin <30g/l • Leucocytosis, thrombcytosis
Describe the features of CD?
Patchy disease:
• Mouth to anus
• Skip lesions
• Clinical features depend on regions involved
What are the alarm symptoms of CD?
- Diarrhoea
- Abdominal pain
- Weight loss
- Malaise, lethargy, anorexia, nausea and vomiting, low grade fever
- Malabsorption: anaemia, vitamin deficiency
What are the markers in the blood of IBD?
- High ESR & CRP
- High platelet count
- High WC count
- Low Hb
- Low albumin
What are the markers in the stool of IBD?
Calprotectin
• <50 normal
• 50-200 equivocal
• >200 elevated
What is CRP?
Inflammatory marker
What is the difference in histology between CD and UC?
- Only crohn’s disease contains granulomas
- Goblet cells are depleted in UC
- Crypt abscesses: UC > CD
What is the difference in features between CD and UC?
Crohn’s can develop fistulas and peri-anal disease
What are extra-intestinal manifestations of IBD?
- Eyes: conjunctivitis
- Joints: ankylosing spondylitis
- Renal calculi: only in CD
- Liver and biliary tree: fatty change, gallstones, sclerosing cholangitis
- Skin: erythema nodosum, vasculitis
What is sclerosing cholangitis?
Disease of the bile ducts which causes multiple strictures and can lead to cirrhosis
What screening is available of IBD?
Colonoscopy:
• 8-20yrs -> 3yrs colonoscopy
• 30-40yrs -> 2yr
• 40+ yrs -> annually
Quadrantic biopsies every 10cm
What is the aim of medical management of IBD?
Initially to reduce inflammation in the gut to relieve symptoms. Then once under control, drugs are given to maintain remission and prevent relapse
What is the step up approach for treatment of IBD?
- 5ASA
- Steroids
- Immunomodulators
- Biologic agents
- Surgery
What is the first line therapy for treatment of IBD?
Aminosalicylates (5ASA) - induces remission and then given for maintenance of remission
What are two types of 5ASA?
- Mesalaxine
* Ethylcelluose microgranules
What types of steroids are used?
Prednisolone and budenoside
What drugs are used for immunosuppression of IBD?
Methotrexate and infliximab
What are thiopurine drugs?
Class of drug that is used to suppress the normal activity of the body’s immune system (Azathioprine, Mercaptopurine) to prevent autoimmune inflammation
What are side effects of thiopurine?
- Leucopenia
- Hepatoxicity
- Pancreatitis
When is surgery indicated?
Failure of medical therapy:
• Relapse
• Failure to control symptoms
• Complications: diabetes, sever osteoporosis, psychosis
What surgeries are used to treat severe colitis?
- Total colectomy
- Rectal preservation
- Ileostomy
What are the indications for surgery for CD?
- Failure of medical management
- Relief of obstructive symptoms
- Management of fistulae, intra-abdominal abscess, anal conditions
- Failure to thrive
