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Inflammatory Bowel Disease Flashcards

1
Q

What 2 conditions come under Inflammatory Bowel Disease?

A
  • Crohn’s Disease

- Ulcerative Colitis

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2
Q

What is Crohn’s Disease?

A
  • Disorder characterised by transmural inflammation of GI tract
  • The transmural inflammation leads to fibrosis and eventual intestinal obstruction
  • Presents as skip lesions
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3
Q

What are the risk factors of Crohn’s Disease?

A
  • Smoking
  • White ancestory
  • Age 15-40 or 60-80
  • Family history
  • Drugs - NSAIDs
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4
Q

What clinical features are specific to Crohn’s Disease?

A
  • 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
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5
Q

What causes Crohn’s disease?

A

Inappropriate immune response against gut flora in a genetically susceptible individual

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6
Q

What is the differential diagnosis of Crohn’s Disease?

A
  • Ulcerative Colitis
  • Diverticular Disease
  • Acute Appendicitis
  • Ectopic Pregnancy
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7
Q

What are the main regions affected in Crohn’s Disease?

A
  • Ileum of small intestine (last part of small intestine)

- Caecum of large intestine

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8
Q

What are the complications of Crohn’s Disease?

A
  • Obstruction due to stenosis
  • Fistulas
  • Abscess formation
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9
Q

What are the investigations in suspected Crohn’s Disease?

A

=> 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
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10
Q

What is the management of Crohn’s Disease?

A

=> 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

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11
Q

What is Ulcerative colitis?

A

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

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12
Q

What are the risk factors of Ulcerative Colitis?

A
  • Family History of IBD
  • HLA-B27
  • Smoking
  • NSAIDs
  • Infection
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13
Q

What are the clinical features specific to Ulcerative Colitis?

A
  • 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
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14
Q

What is the differential diagnosis of Ulcerative Colitis?

A
  • Crohn’s Disease
  • Diverticulitis
  • IBS
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15
Q

What is the differential diagnosis of bloody diarrhoea?

A
  • Inflammatory Bowel Disease
  • Infection
  • GI bleeding
  • Medication - NSAIDs
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16
Q

What are the common features of Ulcerative Colitis and Crohn’s Disease?

A
  • Diarrhoea
  • Arthritis
  • Erythema Nodosum
  • Pyoderma gangrenosum
17
Q

What is the investigation in suspected Ulcerative Colitis?

A

=> Bloods
- Faecal-calprotentin

=> Endoscopy
Reveals continuos disease

18
Q

How is Ulcerative Colitis categorised in terms of location?

A

Affecting only rectum - Proctitis (most common site)
Affecting the descending colon - Left sided Colitis
Affecting the transverse colon - Extensive colitis

19
Q

How is Ulcerative colitis categorised in terms of severity?

A

=> 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)
20
Q

What is the management of Ulcerative Colitis

A

=> Management is focussed on inducing and maintaining remission

  • Management route depends on location and severity of the UC
21
Q

What is the management in terms of inducing remission of Ulcerative Colitis?

A

=> Mild to moderate

PROCTITIS:

  1. Rectal Aminosalicylate
  2. After 4 weeks, + PO Aminosalicylate
  3. Topical or PO Corticosteroids

LEFT SIDED COLITIS:

  1. Rectal Aminosalicylate
  2. PO Aminosalicylate or PO Aminosalicylate + Topical Corticosteroid
  3. PO Aminosalicylate + PO Corticosteroids

EXTENSIVE COLITIS:

  1. Rectal Aminosalicylate + PO Aminosalcylate
  2. 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
22
Q

What is the management in terms of maintaining remission of Ulcerative Colitis?

A

=> 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)

GI (23 decks)

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