Inflammatory Bowel Disease Flashcards
What are features of Crohn’s?
Crohn’s (crows NESTS)
N – No blood or mucus (less common)
E – Entire GI tract
S – “Skip lesions” on endoscopy
T – Terminal ileum most affected and Transmural (full thickness) inflammation
S – Smoking is a risk factor (don’t set the nest on fire)
Crohn’s is also associated with weight loss, strictures and fistulas.
What are features of Ulcerative Colitis?
Ulcerative Colitis (remember U – C – CLOSEUP)
C – Continuous inflammation
L – Limited to colon and rectum
O – Only superficial mucosa affected
S – Smoking is protective
E – Excrete blood and mucus
U – Use aminosalicylates
P – Primary Sclerosing Cholangitis
How does IBD present?
Presentation •Diarrhoea •Abdominal pain •Passing blood •Weight loss
Investigations for IBD
Routine bloods for anaemia, infection, thyroid, kidney and liver function
•CRP indicates inflammation and active disease
•Faecal calprotectin (released by the intestines when inflamed) is a useful screening test (> 90% sensitive and specific to IBD in adults)
•Endoscopy (OGD and colonoscopy) with biopsy is diagnostic
•Imaging with ultrasound, CT and MRI can be used to look for complications such as fistulas, abscesses and strictures.
How to manage Crohn’s? (remission induction)
Inducing Remission
•First line: Steroids (e.g. oral prednisolone or IV hydrocortisone)
If steroids alone don’t work, consider adding immunosuppressant medication under specialist guidance: •Azathioprine •Mercaptopurine •Methotrexate •Infliximab •Adalimumab
How to maintain remission in Crohn’s?
Tailored to individual patients based on risks, side effects, nature of the disease and patient’s wishes. It is reasonable not to take any medications whilst well.
First line:
•Azathioprine
•Mercaptopurine
Alternatives:
•Methotrexate
•Infliximab
•Adalimumab
What surgical interventions are there for Crohn’s?
When the disease only affects the distal ileum it is possible to surgically resect this area and prevent further flares of the disease. Crohns typically involves the entire GI tract
Surgery can also be used to treat strictures and fistulas secondary to Crohns disease.
Inducing remission in UC?
Mild to moderate disease
•First line: aminosalicylate (e.g. mesalazine oral or rectal)
•Second line: corticosteroids (e.g. prednisolone)
Severe disease
•First line: IV corticosteroids (e.g. hydrocortisone)
•Second line: IV ciclosporin
Maintaining remission
Aminosalicylate (e.g. mesalazine oral or rectal)
•Azathioprine
•Mercaptopurine
Surgical options for UC?`
Ulcerative colitis typically only affects the colon and rectum.
Therefore, removing the colon and rectum (panproctocolectomy) will remove the disease.
left with either a permanent ileostomy or something called an J-pouch
What is a J-pouch
ileo-anal anastomosis (J-pouch).
the ileum is folded back in itself and fashioned into a larger pouch that functions a bit like a rectum. This “J-pouch” which is then attached to the anus and collects stools prior to the person passing the motion
