Inflammatory Bowel Disease Flashcards
What is the likelihood a parent with IBD passes it on to their children?
What are the types of genes affected?
10%
Epithelial barrier, immune response and bacterial handling gene mutations can cause IBD
Describe the relationship of bacteria in the colon in a person with IBD. Effect of this?
The bacteria is in “dysbiosis” (imbalanced)
This causes chronic inflammation of the gut
Symptoms of ulcerative colitis?
Bloody diarrhoea Abdominal pain Weight loss Tiredness / fatigue Rectal bleeding
Investigations for suspected ulcerative colitis?
Bloods (markers of inflammation - CRP/ESR/low albumin) Stool culture (to rule out infection) Faecal calprotectin (>200microg/g) Colonoscopy + colon mucosal biopsy pANCA
Where is UC localized? How does it spread?
It is localized in the colon
Starts at rectum and spread proximally
Do many UC patients require colectomy?
20-30% require colectomy within 10 years of diagnosis
Signs that UC is severe?
Blood in stools >6 stools per day Anaemia Abdominal tenderness or dilatation Increased temp/HR
What is proctitis?
How is it treated?
Inflammation of the lining of the rectum
Anti-inflammatories / Corticosteroids
Symptoms of proctitis?
Frequency Urgency/tenesmus Incontinence Mucus + blood in stool Constipation
What is acute severe colitis?
An acute exacerbation of ulcerative colitis
Characterized by: >6 bloody stools/day Increased HR + Temperature Anaemia Raised CRP/ESR
Necessary interventions within first 24 hours of acute severe colitis?
LMWH
IV glucocorticoids
Abdominal X-Ray (dilatation? Oedema? Faecal loading?)
IV hydration & correction of electrolytes (low K/Mg can precipitate toxic megacolon)
How is Crohn’s localized? How does it present?
Anywhere from mouth to anus - patchy disease with skip lesions between affected areas
Clinical features depend on affected area
Clinical features of Crohn’s?
Diarrhoea Abdominal pain Weight loss Malabsorption (anaemia/vit deficiency) Mouth ulceration Malaise/lethargy/anorexia/nausea & vomiting/low-grade fever
Investigations for Crohn’s disease?
Bloods (inflammation markers)
Stool culture (rule out infection)
Faecal calprotectin (>200, won’t be elevated in small bowel disease)
Colonoscopy + biopsy
MRI small bowel
Capsule endoscopy
CT scan (if acutely unwell - want to rule out abscessed)
Histological differences between Crohn’s and UC?
Crohn’s gut will have granulomas, UC won’t
Goblet cells are depleted in UC
Crypt abscesses in UC > Crohn’s
Transmural inflammation in CD, Mucosal in UC
Symptoms and investigations for perianal Crohn’s disease?
Perianal pain
Pus Secretion
Inability to sit down
MRI pelvis
Clinical examination under anaesthetic
Treatment of perianal Crohn’s disease?
Surgery to drain the abscess
Antibiotics if infected
What are some things that commonly occur in perianal Crohn’s disease?
Ulceration
Fistula’s
External openings (can become inflamed)
How often are colonoscopies given to patients with colitis?
Depends on severity of colitis
Low risk colitis - every 5 years
Intermediate risk - every 3 years
Higher risk - every 1 year
Drugs used to treat IBD? (step up approach)
- 5-ASA or sulfasalazine
- Prednisone or budesonide
- Immunomodulators (AZA or 6-MP or MTX)
- Biologic agents
- Surgery
How do aminosalicylates (5-ASA) work? When are they indicated?
Block prostaglandins and leukotrienes
1st line therapy for mild-moderate UC
Used to be used for maintenance of Crohn’s remission but not anymore
When are steroids indicated in IBD cases? Examples of steroids?
They are used to induce remission in CD & UC
- Prednisolone
- Budenoside (less effective, only used in ileal & asc. colon disease - better side effect profile though)
Examples of immunomodulators for UC and Crohn’s? When are they indicated?
Indicated to maintain UC & Crohn’s - stop exacerbation/progression
Azathioprine
Methotrexate (CD)
Side effects of Azathioprine (6-Mercaptopurine)?
Leucopenia (low WBC)
Hepatotoxicity (requires blood monitoring every 8 weeks)
Pancreatitis
Possible lymphoma and melanoma risk
What are the biologic agent drugs? Examples?
They are monoclonal antibodies
Infliximab
Adulimumab
Vedolizumab
Often have to be administered at x weekly intervals (eg. once every 6 weeks)
What non-pharmacological intervention can be effective in managing IBD?
Elemental feeding (ingestion/IV administration of liquid nutrients in an easily assimilated form)
More efficacious in children, can be as effective as steroids
Surgical options for drug resistant IBD?
Partial colectomy
Total proctocolectomy + ileostomy
Total colectomy + pouch procedure
What is an ileostomy?
Surgical procedure that can be necessary after a colectomy + proctectomy
In an ileostomy the small intestine is diverted through an opening in the abdomen
What is a pouch procedure?
Procedure that involves the lengthening and folding of the small intestine into a pouch and then attaching it to the rectum
Done when colon needs to be removed but rectum can be salvaged
What is a proctectomy?
Surgery to remove all or part of the rectum
