Inflammatory Bowel Disease Flashcards
name some common upper GI symptoms?
- Reflux/heartburn
- Belching
- Bloating
- Abdominal pain
- Vomiting
- Nausea
- Difficulty swallowing
- Problems in the passage of food
name some common lower GI symptoms?
- Lower abdominal pain
- Stitch
- Flatulence
- Urgency to defecate
- Diarrhoea
- Intestinal bleeding
- Bloating or distension
- Constipation
- Accidental stool leakage or incontinence
- Problems in the passage of food or stool
what are the types of inflammatory bowel disease?
- ulcerative colitis
- Crohn’s disease
- (intermediate colitis)
what is faecal calprotectin and what does its presence suggest?
substance produced by the intestines in response to inflammation. it is a marker of bowel inflammation which is normal in IBS but raised in IBD
where does ulcerative colitis occur?
begins in rectum and extends proximally. doesn’t affect anal canal
describe the disease distribution in Ulcerative Colitis?
abrupt transition between normal and diseased bowel
what are the histological findings in Ulcerative Colitis?
- Most pathological findings limited to mucosa and submucosa
- Muscularis propria-only affected in fulminant disease
- Distorted crypt architecture/crypt abscesses
what is the incidence and prevalence of ulcerative colitis?
Incidence: 2-10 per 100 000
Prevalence: 35-100 per 100 000
what groups have an increased incidence of Ulcerative colitis?
Caucasians Jews Female 15-25 yrs 55-65 yrs
what group has a decreased incidence of ulcerative colitis?
less common in smokers
what are the symptoms of Ulcerative Colitis?
-Diarrhoea
-PR bleeding
-Frequency of small stools with urgency (inflamed rectum loses ability to distend and relax
-Other findings are minimal: fatigue, malaise, weight loss, fever, tachycardia
what classification system can be used to assess the severity of ulcerative colitis?
Truelove and Witts classification
what parameters does Truelove and Witts classification take into consideration?
- bowel movements
- fever
- heart rate
- haemoglobin
- blood in stools
- erythrocyte sedimentation
where does Crohn’s disease affect?
anywhere from mouth to anus
describe the disease distribution of Crohn’s disease?
3 major patterns of disease distribution:
- Ileocaecal disease (40% at presentation)
- Disease confined to small intestine (30% at presentation)
- Disease confined to colon (25% at presentation)
Appears in patches in GI tract (skip lesions)
what are the histological findings in Crohn’s disease?
- Transmural inflammation
- Granulomas (more common in submucosa)
Means more likely to get complications like obstructions, fistulae and have inflamed bowel attached to each other which form masses
what is the incidence and prevalence of Crohn’s disease?
Incidence: 1-6 per 100 000
Prevalence: 10-100 per 100 000
what are the symptoms of Crohn’s disease?
- Diarrhoea
- Abdominal pain
- Weight loss/loss of appetite
- Change in bowel habit
- Bloody stools
- Fatigue secondary to anaemia and inflammatory condition
what are the signs of Crohn’s disease?
- Clubbing
- Pallor
- Nail changes
- Leukonychia due to hypoalbuminaemia
- Red eye symptoms
- Mouth ulcers
- Soft-non tender abdomen
- Palpable masses?
what groups have an increased risk of Crohn’s disease?
Caucasians Jews Female 15-25 yrs 55-65 yrs Family history Those with other inflammatory conditions AND More common in smokers
what classification systems are used to assess Crohn’s disease?
Crohn’s disease activity index
Harvey-Bradshaw index
when is the Crohn’s disease activity index used and what does scoring indicate?
more complex but used in therapeutic trials
- score <150 = quiescent/in remission
- score 150-300= active disease
- score 300 = severe active disease
when is the Harvey-Bradshaw index used and what does scoring indicate?
simpler than Crohn’s disease activity index
- score <4=in remission
- score 5-8=moderate activity
- score >8=severe active disease
what investigations are done for suspected IBD?
- Flexible sigmoidoscopy /colonoscopy and biopsies (upper GI endoscopy occasionally in Crohn’s)
- Radiology
- Plain AXR (thumbprinting)
- CT (including enterography)
- MR enterography
- Small bowel follow through/meal
- Others
- Faecal calprotectin (useful in monitoring)
- Wireless capsule endoscopy (camera pill)
- Labelled white cell scan (rare)
what are the features of ischaemic colitis?
cramping
abdominal pain
what are the risk factors of ischaemic colitis?
smoking history
hypertension
what area is most likely to be affected in ischaemic colitis?
splenic flexure due to it being at the border of regions supplied by different arteries so if there is compromised blood supply it will be there first
what may be seen on X-ray in a patient with ischaemic colitis?
thumbprinting due to mucosal oedema/haemorrhage
Name some classes of drugs that are used in the treatment of IBD?
- aminosalicylates
- corticosteroids
- immunomodulators
- cytokine modulators
other than pharmacological methods what other approaches can be used in the treatment of IBD?
nutrition
surgery
what are aminosalicylates, give some examples and what are the side effects?
5-ASA (mesalazine)
olsalazine, balsalazide, sulphasalazine
reduce relapse by 70-80% and prevent colorectal cancer
side effects: rashes, headaches, diarrhea, interstitial nephritis, reversible infertility
give examples of corticosteroids and what are the side effects?
prednisolone, budesonide, beclomethasone, hydrcortisone
side effects: cushings syndrome, addisons
give examples of immunomodulators?
azathioprine
methotrexate
mycophenolate
ciclosporin
describe the action of azathioprine?
- affects purine synthesis
- decreases T lymphocytes
- upto 30% don’t tolerate dangerous neutrophenia
- (6)-mercaptoprine is an active metabolite of azathiprine
describe the action of methotrexate and its administration?
antifolate (antimetabolite)
induces pulmonary fibrosis
administration is PO or IM
describe the action of mycophenolate?
affects guanine synthesis in B and T lymphocytes
describe the action of ciclosporin, its effectiveness and when it is used?
calcineurin inhibitor and activator of T cells
80% respond but 80% still need colectomy in 6 months
used as rescue therapy in UC
describe the action of cytokine modulators, give examples, adverse effects and indications?
- TNF-alpha inhibitors
- infliximab, adalimumab
- for severe active disease not responding to conventional drugs eg fistulising Crohn’s
- concerns about increased risk of lymphoproliferative disorders
describe the role of surgery in treatment of IBD?
-more common for crohn’s
30% of Crohn’s yet higher rate of disease recurrence after surgery
-last resort
-UC - when toxic megacolon/acute colitis or failure to respond to other therapy. colectomy is curative unless they develop pouchitis
-crohn’s - when there is limited segmental pathology with obstructive symptoms
