Inflammatory Bowel Disease Flashcards
What is Crohn’s disease?
Chronic inflammatory disease affecting any area of the digestive tract
What histiological signs are seen in crohn’s disease?
Mucus/increased goblet cells
Cobblestone appearance
Inflammation from mucosa-serosa/transmural
Non-caseating granulomas
Fissures
Fistulas
What age is crohn’s most likely to occur?
Onset peaks in early adulthood and over 60s
What sex is crohn’s more common in?
F = M
What causes crohn’s?
Idiopathic
Genetic Predisposition/FH
- CARD15
Smoking
How does crohn’s present?
Depends on side affected
Diarrhoea
Abdominal pain
- Right lower quadrant
Weight loss
Malaise
Blood in stool
Malabsorption
- Iron deficiency anaemia
- Vitamin deficiencies
Mouth ulcers
Angular stomatitis
Clubbing
Fever
What investigations are used in crohn’s diagnosis?
>CRP and >ESR
- Severe attacks
Calprotectin
FBC
- >WCC
- >Platelets/Thrombocythemia
- Decreased Hb
Colonoscopy/Sigmoidoscopy with biopsy
Barium swallow
Malabsorption Tests
What is calprotectin?
Protein biomarker, present in faeces, released by inflammed gut mucosa
What barium signs are seen in crohns?
Cobble stone appearance
Rose thorn ulcers
What malabsorption tests are used in crohns monitoring and diagnosis?
B12
Folate
Vitamin D
Ca
What is used in the management of crohns?
Smoking cessation
Steroids/glucocorticoids
5ASA (Aminosalicylates)
Immunosuppression
Biologics
Enteral feeding/elemental diet
Surgery, although this does not cure disease
Name an example of a 5ASA
Mesalazine
Sulphsalazine
Name examples of immunosuppressants used in IBD
Azathioprine
Methotrexate
Name examples of biologics used in IBD managament
Infliximab
Name the classification that determines crohns severity
Montreal classification
What does the Montreal classification take into consideration?
Age
Extent of disease
Severity
Disease behaviour, such as trictures and penetration
Name some complications of chrons?
Anterior uveitis
Episcleritis
Arthritis
Sacroilitis
Erythema nodosum
Pyroderma gangrenosum
Gallstones and renal stones, more common than in UC
Small and large bowel malignancy
Fistulae and perinanal abscess
What is erythema nodosum?
Swollen fat under the skin causing red bumps and patches
What is Pyoderma Gangrenosum?
Rare inflammatory skin disease where painful pustules or nodules become ulcers that progressively grow
Single painful irregular deep ulcer on her right shin, with a pustular surface and a blue overhanging edge
What is Ulcertative Colitis?
Chronic inflammatory condition affecting the large intestine and rectum, forming ulcers along lumen
What histological signs are seen in UC?
Crypt abscesses
Pseudopolyps
Goblet cell mucus depletion
Vascular congestion
Inflammation confined to mucos
What sex is UC most common in?
F>M
What age is UC most likely to occur?
Peak at 15-25 and 55-65
What is the most common inflammatory bowel disease?
UC
What communities is UC most common in?
Caucasians and Jewish community
What causes UC?
Idiopathic
FH
How does UC present?
Bloody diarrhoea
Abdominal pain
- Left lower quadrant
Weight loss
Frequent stools
- >6 a day, severe attack
Anaemia/malbsorption
Clubbing
Tenesmus/feeling of incomplete evacuation
What investigations are used in UC diagnosis?
>CRP and >ESR in severe attacks
Calprotectin
FBC
- >WCC in severe attack
- >Platelets/Thrombocythemia in severe attack
- Decreased Hb
Sigmoidoscopy with biopsy
Barium swallow
pANCA
Stool microscopy/culture
Abdominal X-ray (AXR)
In how many UC patients is pANCA +
>70%
Why is an AXR used in UC?
Rule out toxic dilation
What is the management of UC?
Topical/rectal 5ASA
Oral 5ASA
Corticosteroids
IV steroids
IV Ciclosporin/immunosuppresant
Oral Thiopurines
Surgery
Name some chronic complications of UC
Fistula
Conjunctivitis and Uveitis
Primary sclerosing cholangitis
Sacroiliitis
Erythema nodosum
Venous thrombosis
Pyoderma gangrenosum
Colorectal carcinoma
Fatty liver
Name some acute complications of UC
Haemorrhage
Perforation
Toxic megacolon
What are the side effecrts of Aminosalicylates (5ASA)?
Agranulocytosis
Headache
GI upset
Pancreatitis
Name the side effects of Azathioprine
Leucopenia
Hepatoxicity
Pancreatitis
Lymphoma
Where is the most common site for UC inflammation?
Rectum, as inflammation always starts here
What is the most common extra-intestinal feature of UC and CD?
Arthritis
What is used in acute management of CD if steroids fail?
Biologic treatment
What is first line to induce remission of CD?
Glucocorticoids (prednisilone or IV hydrocortisone)
What is second line to induce remission of CD?
5ASA
What is used as an add on to induce remission of CD?
Azathioprine or methotrexate
What is used for refractory and fistulating CD?
Infliximab/biologics
What is first line for maintaining remission of CD?
Azathioprine
Methotrexate considered in patients where azathioprine is contraindicated
What is used for peri-anal CD (abscess)?
Metrondiazole + Ceftriaxone
What is the management for perianal fistulae?
Drainage for high/trans-sphincteric
Fistulotomy for low/sub-mucosal
Describe mild UC
Less than 4 stools a day
Little blood
Describe moderate UC
4-6 stools a day
Varying amount of blood
No systemic upset
Describe severe UC
More than 6 bloody stools a day
Systemic upset
- Tachycardia
- Pyrexia
- Anaemia
- Raised inflammatory markers
What is first line for maintaining remission in mild-moderate UC?
Topical/rectal 5ASA
(oral if extensive disease)
What is used for maintaining remission in severe UC?
Oral thiopurines
What are the stages in inducing remission for mild-moderate UC?
Topical/Rectal 5ASA
Oral 5ASA
- Add if remission is not achieved in 4 weeks
Corticosteroid
- Add if remission is not achieved after rectal and oral 5ASA
What are the stages for inducing remission in severe UC?
IV Steroids
IV Ciclosporin
- Add if no improvement in 72 hours
What UC sign is seen in bariums swallows?
Lead pipe colon
What should be assessed in patients before initiating Azathioprine?
Thiopurine methyltransferase (TMPT) activity
As this is the enzyme involved in the metabolism of this medication, and so deficiency means the treatment will not work
What surgery is used in UC?
Proctocolectomy
Give differential diagnoses of clubbing
CF
Mesothelioma
Bronchiectasis
Lung fibrosis
Lung carcinoma
Lymphoma
Inflammatory bowel disease
Cirrhosis
Coeliac disease
Cyanotic heart disease
Myxoma
Bacterial endocarditis
