Inflammatory bowel disease Flashcards
What are the different types of IBD
- ) Ulcerative Colitis
2. ) Crohn’s disease
What are the characteristics of ulcerative colitis
- Inflammatory disorder affecting the mucosa of the large colon
- Onset: bimodal 20-30 and 50
- suggested genetic component
- M:F 1:1
- White superficial ulcers
Describe the pathophysiology of UC
-Exaggerated mucosal T cell response to host microbiota and/or external stimulae in context of genetically receptive host
What are the symptoms of UC
- Rectal bleeding
- Diarrhoea
- Urgency
How is UC diagnosed?
- ) Blood tests
- Raised CRP/ESR
- Anaemia
- Low albumin - ) Faecal calprotectin
- ) Endoscopy
- gold standard
What is faecal calprotectin
-Substance that is released into the intestines in excess when there is any inflammation there
How can we classify UC
- Proctitis
- Left-sided colitis
- Pancolitis
Usually moves more distally so progresses from proctitis to pancolitis
What is pancolitis
- refers to the dfegree of UC
- The whole of the LI is affected
- full name is pan-UC
- sometimes referred to as total colitis or universal colitis
How can we treat UC
1.) steroids: prednisolone
2.) Aminosalicylates(oral and rectal)- mesavat,octasa
3.)Immunosuppressants- azathioprine, methotrexate
4.) Biologics: anti-TNF-infliximab, salimumab
anti-integrin-vedolizumab
5.) Surgery-up to 15% over lifetime
What is subtotal colectomy?
- Removing part of the colon
- Partial colectomy
Define total colectomy
-Removing all of the colon
Define hemicolectomy
Removing the right or left portion of the colon
Define proctocolectomy
Removing both the colon(total/partial) & the rectum
Outline the use of pouches in UC, including it’s complications
- If your UC inflammation and symptoms haven’t been controlled by medications, your doctor may have recommended a common type of surgery to construct an ileal pouch anal anastomosis, or (IPAA). It involves removing the colon and rectum to form a j-pouch.
- pouchitis: bacteria population the ileum(normally sterile) so you get this low level inflammation—> some patients will have to have the pouch removed & have a permanent stoma after that
What are the complications of J pouches
-frequent/urgent trips to the loo
-in women there is a high risk of inferitlity after
-
What a stoma?
A stoma is where a section of bowel is brought out through an opening on your stomach area (abdomen). Your bowel movements (poo) are collected in a pouch or bag attached to the skin around your stoma.
What is a colostomy ?
a stoma formed by bringing part of your colon (large bowel) out on to the surface of your abdomen. The waste from a colostomy is usually more formed than from an ileostomy, as it has had some of the water removed on its way around the bowel.
What is the trulove & witt criteria
- In practice we now use CRP as this is more accurate
- helps us to decide whether to admit an IBD pt
- Factors include: motions per day; rectal bleeding; temp; pulse rate; haemoglobin; ESR
- Split into mild, moderate & severe
How can we assess an IBD pt
- ) Examination: dehydration, abdominal tenderness, bowel sounds
- ) Blood tests: FBC, U&Es, LFTs, CRP
- ) Imagining-CXR & AXR
- ) Stool tests- MC& S, C.diff
- ) Sigmoidoscopy to exclude CMV superadded infection
What is toxic megacolon
a potentially lethal complication of inflammatory bowel disease (IBD) or infectious colitis that is characterized by total or segmental nonobstructive colonic dilatation plus systemic toxicity
What is leadpipe colon
The lead pipe appearance of colon is the classical barium enema(an X-ray exam) finding in chronic ulcerative colitis. There is complete loss of haustral markings in the diseased section of colon, and the organ appears smooth-walled and cylindrical
What are the characteritsics of Crohn’s disease?
- Chronic inflammatory trans-mural inflammation
- M:F: 1:1
- Peak onset age 20-30
Outline the aetiology of Crohn’s disease
- Exaggerated T cell inflammatory response to environmental factors in presence of genetically susceptible host
- Microbiota: ‘hygiene hypothesis’
- Genetics-58% monozygotic twins
Outline the hygeine hypothesis for Crohn’s disease
multiple childhood exposures to enteric pathogens protect an individual from developing Crohn’s disease later in life, while individuals raised in a more sanitary environment are more likely to develop Crohn’s disease.
Outline the disease distribution for Crohn’s disease
- Ileo-colonic
- Ileal
- Colonic
- Perianal
- Upper GI
What are the symptoms of Crohn’s disease
- Diarrhoea
- Rectal bleeding
- Abdominal pain
- Weight loss(more prominent cos it’s a small bowel disease)
- Perianal abscess
- Oral ulceration
What are the signs of Crohn’s disease
- Cachexia( weakness and wasting of the body due to severe chronic illness)
- Scars
- Stomas (often 2-3)
- Parenteral nutrition (i.v administration of nutrition)
Why do we avoid operating on pts with Crohn’s disease
- Cos surgery is never a cure for this
- Minimise invasion and risks eg of infection
How can we diagnose Crohn’s disease?
- ) Blood tests: anaemia, low B12, folate, ferritin, low albumin
- ) Faecal calprotectin
- ) Endoscopy &histology
- ) Imaging- MRI small bowel, MRI pelvis and small bowel USS
Outline the treatment options for Crohn’s disease
- ) Steroids: prednisolone, budesonide
- ) Antibiotics: ciprofloxacin, metronidazole
- ) Immunosuppressants: azathioprine, mercaptopurin, methotrexate
- )Biologics: infliximab, adalimumab, golimumab, vedolizumab, ustekinumab
- ) Modulen-anti-inflammatory properties. Esp useful in paediatric and pre-surgery
- ) Surgery
1&2 are particularly useful short term treatments
Outline use of surgery in Crohn’s disease
- Up to 70% will have surgery in their lifetime
- Examination under anaesthetic ( EUA)- perianal abscess/fistula
- Stricturoplasty: removal of small bowel stricture
- Colectomy
- Diverting colostomy
State the differences between UC and Crohn’s disease
- ) Distribution: UC=only colon ; CD= mouth->anus
- )Inflammation depth: UC=mucosal inflammation only CD=transmural inflammation
- ) Presence of fistulas= only present in CD
- ) Presence of strictures= only present in CD
- ) Histology: UC= crypt abcesses and mucosal inflammation CD= granulomas & transmural inflammation
- ) Smoking= protective in UC ; detrimental= CD
What is key in treatment of acute colitis
Steroids
-Day 3 assessment to decide on rescue therapy or surgery
What should we ensure about drug and ab levels when treating IBD
-That we manipulate them to optimise medical treatment
