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General Surgery > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

What is Crohn’s disease characterised by?

A

Transmural granulomatous inflammation anywhere in the GIT.

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2
Q

Where is Crohn’s disease most common?

A

Terminal ileum.

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3
Q

How does Crohn’s disease present?

A 
Abdo pain.
Abdo tenderness.
Diarrhoea.
Weight loss.
Fever.
Malaise.
Anorexia.
Perianal abscesses.
RIF mass.
Apthous mouth ulcers.
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4
Q

What are some possible complications of Crohn’s disease?

A 
Small bowel obstruction.
Bowel perforation.
Rectal haemorrhage.
Malabsorption of nutrients (e.g. B12 in the terminal ileum --> anaemia).
Fistulae. 
Toxic megacolon (more common in UC).
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5
Q

What is the management for mild attacks of Crohn’s disease (systemically well)?

A

Prednisolone 30mg/day PO for 1 week, then 20mg/day PO for 1 month, then wean off by 5mg every 2-4 weeks.

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6
Q

What is the management for severe attacks of Crohn’s disease (systemic involvement, raised CRP, low albumin, raised temp, raised pulse)?

A

Hydrocortisone 100mg/6hr IV.
Rectal disease can be treated with topical steroids.
Metronidazole 400mg/8hr PO helps too.
If improvement, transfer to oral prednisolone.

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7
Q

What is the long-term management of Crohn’s disease?

A

Azathioprine 2.5mg/kg/day PO.
Methotrexate 25mg/week IM.
Infliximab.

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8
Q

What enzyme is it important to test the levels of before commencing azathioprine and why?

A

TPMT.
Azathioprine is converted to 6-MP by enzyme TPMT in body, different people have different amounts of this enzyme so it is important to test its levels before commencing. Also important to do regular FBCs (myelosuppression) and LFTs (hepatotoxicity).

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9
Q

What age groups are Crohn’s disease and ulcerative colitis most common?

A

Young adults and 60s.

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10
Q

What are some systemic symptoms of Crohn’s disease and ulcerative colitis?

A

Clubbing, erythema nodosum, pyoderma gangrenosum, conjunctivitis, large joint arthritis, ankylosing spondylitis.

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11
Q

What investigations should be performed if Crohn’s disease or ulcerative colitis are suspected?

A

OGD and colonoscopy with biopsy (diagnostic).
Capsule endoscopy.
Bloods - low Hb, high CRP, high WCC, low albumin.
CDT (check for C.Diff).
Stool MC&S.
Faecal calprotectin - rises with inflammation in the bowel but not necessarily IBD as could also be an infection. <50 normal, 50-200 mildly abnormal, >200 highly suggestive of IBD.

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12
Q

What is ulcerative colitis?

A

Chronic relapsing inflammatory disorder of colonic mucosa extending from rectum proximally (never passes ileocaecal valve except in backwash ileitis).

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13
Q

How does ulcerative colitis present?

A 
Gradual onset diarrhoea +/- blood and mucus.
Crampy abdo pain.
Fever.
Malaise.
Anorexia.
Tenesmus.
Urgency.
Weight loss.
Frequency (correlates to disease severity).
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14
Q

What is the management for mild attacks of ulcerative colitis (<4 motions/day, apyrexial)?

A

Prednisolone 20-40mg/day PO + mesalazine + steroid foams PR BD.

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15
Q

What is the management for moderate attacks of ulcerative colitis (4-6 motions/day, temp 37.1-37.8)?

A

Prednisolone 40mg + mesalazine + steroid foams.

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16
Q

What is the management for severe attacks of ulcerative colitis (>6 motions/day, temp >37.8)?

A

Hydrocortisone IV + NBM + maintenance fluids.
If no improvement after 3 days consider cyclosporin, infliximab or surgery.
If improvement step down to oral steroids + mesalazine.

17
Q

What are the indications for surgery in severe ulcerative colitis?

A

Perforation, massive haemorrhage, toxic megacolon, failure to respond to medicine.

18
Q

What are some side effects of cyclosporins?

A

Gingival hyperplasia, hirsuitism, hypergylcaemia, HTN, renal dysfunction, hyperkalaemia, hepatic dysfunction, hyperlipidaemia.

19
Q

How is remission from ulcerative colitis maintained?

A

Oral aminosalicylate e.g. sulfasalazine. If proctitis, offer topical aminosalicylate and if refractory consider azathioprine.

20
Q

What are some side effects of sulfasalazine?

A

Headache, nausea, fever, anorexia, rash, haemolysis, hepatitis.

21
Q

What are some possible complications of ulcerative colitis?

A

Toxic megacolon, colonic cancer, blood loss, perforation, VTE.

General Surgery (37 decks)

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