inflammatory bowel disease Flashcards
what are the features of crohs?
- can affect anywhere from mouth to anus
- skip lsions
- transmural inflammation
- fissuring ulcers
- lymphoid and neutrophil aggregates
- non caseating granulmas
- increased incidence in smokers
what are the features of ulcerative colitis?
- always affects the rectum and extends proximally varying distances
- continuous
- mucosa and sub mucosal inflammation only
- crypt abscesses
- decreased incidence in smokers
what investigations can be done to diagnose IBD in terms of
1) blood tests
2) stool tests
3) simple imaging
4) endoscopy
5) cross sectional imaging
1) blood tests
FBC - for anaemia
U&E - for electrolytes or AKI due to GI losses
CRP - for inflammation
2) stool test
stool culture - excluse infective colitis
faecal calprotectin - raised in active disease and negative in IBD remission or IBS
3) simple imaging
AXR - request if there is a clinical suspicion of toxic megacolon. Also useful to asses for proximal constipation
4) endoscopy
Flexible sigmoidoscopy - safest test in bloody diarrhoea
colonoscopy - needed to look for more proximal disease
capsule endoscopy - useful to view the small bowel muscosa
5) cross sectional imaging
- CT abdomen when looking for acute compliations
- MRI enterography when looking for small bowel crohn’s. fistulas or to map the extent or small bowel crohns
- MRI rectum to image perianal crohns
what is the treatment of IBD?
- steroids, delivered topically or orally (prednisolone, or in small bowel disease, budesonide) or IV (hydrocortisone).
- patient unwell enough to be in hospital, will receive IV hydrocortisone 100mg qds.
- no improvement after 3-4 days, consider escalation
what is used to maintain remission in UC?
Mesalazine (5-ASAs) is used to maintain remission in UC but has no role in Crohn’s.
if this doesn’t work, biologics and azathioprine are used
what is used as maintenance treatment in crohn’s and in patients with UC where mesalazine doesnt work?
Azathioprine and Biologics are used
how do patients with IBD present usually?
with a change in bowel habit, often diarrhoea.
when taking a history, ask
- frequency
- deviation from usual
- changed form
- wakes them up
- blood
- tenesmus
- incontinence/urgency?
- does it flush easily
why do patients admitted to hospital with acute IBD need prophylactic heparin?
because they are at high risk of VTE
what is the rescue therapy for UC after escalation?
ciclosporin, biologics or surgery
what is the rescue therapy for crohns after escalation?
biologics or surgery
what is the maintenance treatment in crohns?
azathioprine and biologics are used as maintenance treatment in crohns
as maintenance treatment in crohns and UC is immunosuppressive, what needs monitoring?
FBC
U&E
LFTs
what is the first choice medication in perianal or fistulating crohns?
biologics
