Inflammatory Bowel Disease Flashcards
What 2 conditions come under Inflammatory Bowel Disease?
- Crohn’s Disease
- Ulcerative Colitis
What is Crohn’s Disease?
- Disorder characterised by transmural inflammation of GI tract
- The transmural inflammation leads to fibrosis and eventual intestinal obstruction
- Presents as skip lesions
What are the risk factors of Crohn’s Disease?
- Smoking
- White ancestory
- Age 15-40 or 60-80
- Family history
- Drugs - NSAIDs
What clinical features are specific to Crohn’s Disease?
- Weight loss
- Mouth to anus skip lesions
- Mouth ulcers
- Perianal disease
- Gallstones
- Inflammation of all layers of the GI tract. Goblet cells, granulomas increased in number
- Abdominal pain (most common presentation in children)
- Non bloody diarrhoea (most common presentation in adults)
- Bowel obstruction
What causes Crohn’s disease?
Inappropriate immune response against gut flora in a genetically susceptible individual
What is the differential diagnosis of Crohn’s Disease?
- Ulcerative Colitis
- Diverticular Disease
- Acute Appendicitis
- Ectopic Pregnancy
What are the main regions affected in Crohn’s Disease?
- Ileum of small intestine (last part of small intestine)
- Caecum of large intestine
What are the complications of Crohn’s Disease?
- Obstruction due to stenosis
- Fistulas
- Abscess formation
What are the investigations in suspected Crohn’s Disease?
=> Bloods
Elevated CRP correlating with disease
Increased faecal calprotectin - 1st line
=> Endoscopy
- Colonoscopy is investigation of choice, features suggestive of Crohn’s Disease are skip lesions
=> Histology
- Inflammation in all layers from mucosa to serosa
=> Small bowel enema -investigation which uses barium to view inside
- Rose thorn ulcers
- Fistulae
- Strictures (Kantor’s string sign)
- Proximal bowel dilation
What is the management of Crohn’s Disease?
=> General advice: stop smoking
=> Inducing remission:
- First line - glucocorticoids
- Enteral feeding
- Second line - 5-ASA (Mesalazine)
- Azathioprine or Mercaptopurine used as add on medication not for monotherapy
=> Maintaining remission:
- First line - Azathioprine or Mercaptopurine
- Second line - Methotrexate
- 5-ASA if the patient has had previous surgery
=> Surgery
What is Ulcerative colitis?
Form of inflammatory bowel disease thats starts in the rectum and moves proximally up the colon, but does not pass the ileocaecal valve. Inflammation does not spread past the submucosa
What are the risk factors of Ulcerative Colitis?
- Family History of IBD
- HLA-B27
- Smoking
- NSAIDs
- Infection
What are the clinical features specific to Ulcerative Colitis?
- Uveitis
- Primary sclerosing cholangitis
- No inflammation beyond submucosa
- Continuos disease, not past ileocaecal valce
- Risk of Colorectal cancer (more so in UC but can be seen in Crohn’s)
- Bloody diarrhoea
What is the differential diagnosis of Ulcerative Colitis?
- Crohn’s Disease
- Diverticulitis
- IBS
What is the differential diagnosis of bloody diarrhoea?
- Inflammatory Bowel Disease
- Infection
- GI bleeding
- Medication - NSAIDs
What are the common features of Ulcerative Colitis and Crohn’s Disease?
- Diarrhoea
- Arthritis
- Erythema Nodosum
- Pyoderma gangrenosum
What is the investigation in suspected Ulcerative Colitis?
=> Bloods
- Faecal-calprotentin
=> Endoscopy
Reveals continuos disease
How is Ulcerative Colitis categorised in terms of location?
Affecting only rectum - Proctitis (most common site)
Affecting the descending colon - Left sided Colitis
Affecting the transverse colon - Extensive colitis
How is Ulcerative colitis categorised in terms of severity?
=> Mild
- < 4 stools a day
- Small amount of blood
=> Moderate
- 4-6 stools a day
- Varying amount of blood
- No systemic symptoms
=> Severe
- > 6 stools a day
- Systemic symptoms (fever, tachycardia, anaemia, hypoalbuminaemia, abdominal tenderness, reduced bowel sounds, distension)
What is the management of Ulcerative Colitis
=> Management is focussed on inducing and maintaining remission
- Management route depends on location and severity of the UC
What is the management in terms of inducing remission of Ulcerative Colitis?
=> Mild to moderate
PROCTITIS:
- Rectal Aminosalicylate
- After 4 weeks, + PO Aminosalicylate
- Topical or PO Corticosteroids
LEFT SIDED COLITIS:
- Rectal Aminosalicylate
- PO Aminosalicylate or PO Aminosalicylate + Topical Corticosteroid
- PO Aminosalicylate + PO Corticosteroids
EXTENSIVE COLITIS:
- Rectal Aminosalicylate + PO Aminosalcylate
- Stop rectal treatments, give PO Aminosalicylate + PO Corticosteroids
=> Severe Colitis:
- Treated in hospital
- First line - IV steroids (IV Ciclosporin used if steroids contraindicated)
- If no improvement after 72 hours: IV Steroids + IV Ciclosporin or surgery
What is the management in terms of maintaining remission of Ulcerative Colitis?
=> Mild to moderate
PROCTITIS: - Rectal Aminosalicylate alone or - Rectal Aminosalicylate + PO Aminosalicylate or - PO Aminosalicylate alone
LEFT SIDED COLITIS & EXTENSIVE COLITIS:
- Low maintenance dose of PO Aminosalicylate
=> Severe Colitis
- PO Azathioprine or PO Mercaptopurine (used when there have been more than 2 exacerbations in the past year)
