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SPM- Gastroenterology > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

What are the macroscopic features of ulcerative colitis?

A

Continuous inflammation from the rectum moving proximally
Only the mucosa is infected
Bloody, mucous diarrhoea
Does not extend beyond the colon

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2
Q

What are the symptoms of UC?

A

GI
Bloody diarrhoea
Abdominal pain
Tenesmus

Systemic
Fatigue
Lethargy
Weight loss
IDA- leading to palpitations
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3
Q

What are some extra-intestinal manifestations of UC?

A 
Seronegative spondyloarthropathy (HLA-B27)
Uveitis
Episcleritis
Erythema nodosum
PSC- (p-ANCA and ANA association)
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4
Q

What are the features of erythema nodosum?

A

Tender red nodules affecting the shins

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5
Q

What are some complications of UC?

A 
Severe GI bleeding
Toxic megacolon
Fulminant colitis 
Strictures
Increased risk of CRC
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6
Q

What are some features of Crohn’s disease?

A

Transmural inflammation- more likely to develop fistulas
Skip lesions
Affects entire GI tract
May see oral ulcers

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7
Q

Where is a common site for Crohn’s to occur? What does this cause?

A

Terminal ileum- this is the site of B12 absorption so may cause megaloblastic anaemia, dorsal column degeneration

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8
Q

What complications are more likely to form in Crohn’s than UC?

A

Fistulas- esp perianal abscess or fistulas

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9
Q

What initial tests might be done to diagnose IBD at primary care level?

A 
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

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10
Q

What would be the work up of IBD in secondary care?

A

Colonoscopy with biopsy to investigate features

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11
Q

What infectious causes could mimic IBD?

A 
These are infections that cause bloody diarrhoea, these include:
Shigella
Salmonella
Yersinia
Campylobacter
E.Coli

Also C.Diff

Also parasites- such as Giardia

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12
Q

What does UC look like on barium X-ray?

A

Lead pipe sign- loss of haustra

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13
Q

What can be done to investigate for late small bowel inflammation?

A

Wireless capsule endoscopy

CT scan

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14
Q

What biopsy findings are there for UC?

A

Limited to mucosa and submucosa
Crypt abscesses and atrophy
Lymphocyte infiltration

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15
Q

What biopsy findings are seen for Crohn’s?

A

Transmural inflammation

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16
Q

What is the general management for UC?

A

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

17
Q

What is a curative treatment for UC?

A

Colectomy- as disease is limited to the colon

18
Q

What rectal therapies may be used for UC?

A

Mesalazine/5-ASA
Steroids

Enemas, Suppositories

19
Q

When can topical (rectal) delivery be used for UC?

A

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

20
Q

As a general rule of thumb what should be used to maintain remission?

A

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)

21
Q

What needs to be ruled out for IBD?

A

Infectious causes of diarrhoea

Shigella
Salmonella
Yersinia
Campylobacter
E.Coli 
Garida
C.Diff
Others
22
Q

What is the management of Crohn’s?

A

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.

23
Q

Can 5-ASA be used for Crohn’s?

A

No it doesn’t work

SPM- Gastroenterology (13 decks)

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