Inflammatory Bowel Disease Flashcards
diarrohoea
more than three episode of loose stool within 24 hours
IBD
2 idiopathic chronic inflammatory diseases
ulcerative colitis
crohns disease
IBD - commonalities
epidemiology
clinical
therapeutic characteristics
IBD - differences
clinical -
abdominal pain and peri-anal disease = crohns
diarrhoea and bleeding = ulcerative colitis
pathology
pathogenesis of IBD
genetic predisposition
environmental triggers
mucosal immune system
NOD2/CARD15 (IBD-1)
disease susceptibility gene located on chromosome 16q12
mutated form of NOD2 found in 10-20% of Caucasian patients with crohns disease
homozygotes - 20-40
heterozygotes - 2-4
encodes a protein involved in bacterial recognition
gut flora
indispensible to the development of animal models of colitis
antibiotics effective in the treatment of peri-anal crohns disease
diverting faecal stream helps crohns
altered bacterial flora in colons with UC
crohns immunological factors
Th1 mediated disease
ulcerative colitis immunological factors
mixed Th1/Th2 mediated disease
environmental factors
smoking - aggravates crohns disease but protects against ulcerative colitis
NSAIDS
UC
peaking incidence in 20-30s
affects rectum extending proximally
procitis, left-sided colitis, pancolitis
UC - symptoms
diarrhoea and bleeding
increased bowel frequency urgency tenesmus incontinence night rising lower abdominal pain
proctitis can cause constipation
UC -history
recent travel antibiotics NSAIDS family history smoking skin, eyes, joints
get multiple stool samples
UC - severity
> 6 bloody stools in 24 hours
plus fever tachycardia anaemia elevated ESR
bloods
CRP
albumin
plain AXR
endoscopy
histology
plain AXR
stool distribution - absent in inflammed colon
mucosal oedema/’thumb-printing’
patient is at risk of developing toxic megacolon
endoscopy
define extent
confluent inflammation extending proximally from anal margin to a transition zone
loss of vessel pattern
granular mucosa
contact bleeding
pseudopolyps in UC
might disappear once inflammation calms down
never extends past mucosal layer
UC longterm complication
increased risk of colorectal cancer
determined by severity of inflammation duration of disease
disease extent
UC - extra-intestinal maifestations
skin joints eyes deranged LFTs oxalate renal stones
primary sclerosis cholangitis
chronic inflammatory disease of biliary tree
distribution of Crohns disease
can affect any region of GI tract from mouth to anus
transmural inflammation
colonic crohns increasing in incidence
peri-anal disease
recurrent abscess formatoin
pain
can lead to fistula with persistent leakage
damaged sphincters
crohns symptoms
small intestine abdominal cramps (peri-umbilical), diarrhoea, weight loss
colon abdominal cramps (lower abdomen), diarrhoea with blood, weight loss
mouth
painful ulcers, swollen lips, angular chielitis
anus
peri-anal pain, abscess
crohns further assessment
clinical exam
evidence of weight loss, RIF mass, peri-anal signs
bloods
CRP, albumin, platelets, B12 (t, ileum), ferritin
stage disease extent
colonoscopy - save to have bowel prep
small bowel assessment
barium follow-through
small bowel MRI
technetium-labelled white cell scan
IBD clinical summary
common conditions
known differences between UC and cronhs
know how to assess severity of acute flare
further reading required
