Inflammatory Bowel Disease Flashcards
What are the macroscopic features of ulcerative colitis?
Continuous inflammation from the rectum moving proximally
Only the mucosa is infected
Bloody, mucous diarrhoea
Does not extend beyond the colon
What are the symptoms of UC?
GI
Bloody diarrhoea
Abdominal pain
Tenesmus
Systemic Fatigue Lethargy Weight loss IDA- leading to palpitations
What are some extra-intestinal manifestations of UC?
Seronegative spondyloarthropathy (HLA-B27) Uveitis Episcleritis Erythema nodosum PSC- (p-ANCA and ANA association)
What are the features of erythema nodosum?
Tender red nodules affecting the shins
What are some complications of UC?
Severe GI bleeding Toxic megacolon Fulminant colitis Strictures Increased risk of CRC
What are some features of Crohn’s disease?
Transmural inflammation- more likely to develop fistulas
Skip lesions
Affects entire GI tract
May see oral ulcers
Where is a common site for Crohn’s to occur? What does this cause?
Terminal ileum- this is the site of B12 absorption so may cause megaloblastic anaemia, dorsal column degeneration
What complications are more likely to form in Crohn’s than UC?
Fistulas- esp perianal abscess or fistulas
What initial tests might be done to diagnose IBD at primary care level?
Bloods FBC (IDA due GI bleeding and anaemia of chronic disease, Raised WCC) B12 and Folate ESR, CRP U&Es ALT/AST
Stool
Faecal calprotectin- marker of inflammation of the GI tract
Rule out infectious causes- MC and S, C.Diff Toxin, Parasite tests
What would be the work up of IBD in secondary care?
Colonoscopy with biopsy to investigate features
What infectious causes could mimic IBD?
These are infections that cause bloody diarrhoea, these include: Shigella Salmonella Yersinia Campylobacter E.Coli
Also C.Diff
Also parasites- such as Giardia
What does UC look like on barium X-ray?
Lead pipe sign- loss of haustra
What can be done to investigate for late small bowel inflammation?
Wireless capsule endoscopy
CT scan
What biopsy findings are there for UC?
Limited to mucosa and submucosa
Crypt abscesses and atrophy
Lymphocyte infiltration
What biopsy findings are seen for Crohn’s?
Transmural inflammation
What is the general management for UC?
5-ASA (Mesalazine)- Rectal, Enema, Oral
Steroids for flares, try to avoid in long term due to side effect profile. May be topical, PR, oral or IV (If severe flare)
Steroid Sparing Immunosuppressants- Cyclophosphamide Cyclosporin Anti TNF Alpha- Infliximab Note Methotrexate is not recommended for UC but is for Crohn's
If evidence of infection metronidazole may be given.
Surgery- Colectomy is curative
What is a curative treatment for UC?
Colectomy- as disease is limited to the colon
What rectal therapies may be used for UC?
Mesalazine/5-ASA
Steroids
Enemas, Suppositories
When can topical (rectal) delivery be used for UC?
For distal disease that is limited to rectum/sigmoid
Agents used include:
Mesalazine (5-ASA)
Steroids (of various potencies)
Oral medication is needed for more proximal disease
As a general rule of thumb what should be used to maintain remission?
Whatever induced remission
Buuuutttt
Generally best to avoid steroids in the long term so consider agents such as cyclophosphamide, cyclosporin, methotrexate, mycophenolate mofetil and biologics such as rituximab (anti B-cell) and infliximab (anti TNF alpha)
What needs to be ruled out for IBD?
Infectious causes of diarrhoea
Shigella Salmonella Yersinia Campylobacter E.Coli Garida C.Diff Others
What is the management of Crohn’s?
Similar to UC but topical rectal preparations will not be very helpful
Manage flares- Steroids
Maintain remission- Steroid sparing agents- azathioprine, cyclophosphamide, cyclospin, methotrexate, monoclonals such as infliximab (anti TNF Alpha)
Step up and down as appropriate.
Surgery for strictures and fistulas.
Can 5-ASA be used for Crohn’s?
No it doesn’t work
