inflammatory bowel disease Flashcards
what are examples of inflammatory bowel diseases?
chrons
IC
ulcerative colitis
aetiology of IBD
environmental trigger- role of bacteria, diet
genetically susceptible people
unknown
what ages are affected by ulcerative colitis?
any age
whos more likely to get ulcerative colitis
females
what does ulcerative colitis present with
Bloody diarrhoea
Abdominal pain
Weight loss
what are clinical features of ulcerative colitis?
Markers of a severe attack Stool frequency: >6 stools/day with blood AND Fever: >37.5ºC Tachycardia: >90/min ESR(CRP): raised Anaemia: Hb <10g/dl Albumin: <30g/l Leucocytosis, thrombocytosis
where does ulcerative colitis effect?
colon
whos more likely to get chrons disease?
equal
clinical features of chrons disease
Diarrhoea Abdominal pain Weight loss. Malaise, lethargy, anorexia, N&V, low-grade fever Malabsorption Anaemia, vitamin deficiency
what would you find in the blood with inflammatory indices?
High ESR & CRP High platelet count High WCC Low Hb Low albumin
what would you find in the stools with inflammatory indices?
Calprotectin
<50 Normal
50-200 Equivocal
>200 Elavated
extra-intestinal manifestations of the eyes
uveitis, episcleritis, conjunctivitis
extra-intestinal manifestations of the joints
sacroiliitis, monoarticular arthritis, ankylosing spondylitis
extra-intestinal manifestations of the renal calculi
only in CD
extra-intestinal manifestations of the liver and biliary tree
fatty change, pericholangitis, sclerosing cholangitis, gallstones
extra-intestinal manifestations of the skin
pyoderma gangrenosum, erythema nodosum, vasculitis
differential diagnosis to IBD
Chronic diarrhoeas Malabsorption Malnutrition Ileo-caecal TB Colitis must be distinguished from infective, amoebic and ischaemic colitis
long term complications of colitis
Colonic carcinoma Risk Factors Extent Pancolitis 26 x normal Left colitis 8 x normal Proctitis minimal Duration < 10 yrs minimal risk - 20 yrs 23 x normal - 30 yrs 32 x normal
medical management of IBD in hospital
Steroids Anticoagulation Rest Other Cyclosporin Infliximab Surgery
medical management of IBD in out patients
5ASA Steroids Immunosuppression Azathioprine Mercaptopurine Methotrexate Infliximab
failure of medical therapy
Recurrent courses of steroid Relapse prior to or shortly after stopping therapy Failure to control symptoms Unacceptable complications of steroids: Diabetes Severe osteoporosis Psychosis
poor response to medical therapy
Fistulas
Fibrotic strictures
Peri-anal disease
Severe fulminating disease
surgery for severe colitis
otal colectomy
Rectal preservation
Ileostomy
what is pouch surgery?
mobilise and lengthen small bowel. then contrict pouch
chrons surgical indications
Failure of medical management
Relief of obstructive symptoms (small bowel)
Management of fistulae - e.g. bowel to bladder
Management of intra-abdominal abscess
Management anal conditions
Failure to thrive
