Inflammatory Bowel Disease Flashcards
what are the two types of IBD? which is most common?
crohns
ulcerative colitis- most common
when do Crohns and UC present?
bimodal peak for crohns: - 15-30 years - 60-80 years
UC mainly 15-25 years. Small peak again 55-65 years
where in the GI tract does Crohns affect? where is the most common site?
can affect any part of GI tract (from mouth to anus)
most common site is the terminal ilieum
describe the inflammation in crohns disease
transmural inflammation (affects all layers of the bowel) produces deep ulcers + fissures - “cobblestone mucosa” discontinuous inflammation - “skip lesions”
non-caseating granulomatous inflammation
Where in the GI tract does UC affect?
large bowel only
- begins in the rectum and extends proximally
describe the inflammation in UC
Continuous inflammation
Affects mucosa only
Crypt abscess formation
Goblet cell hypoplasia
Psuedopolyp formation
outline the histological differences between crohns + UC
how does smoking affect crohns and UC
smoking is a risk factor for crohns but protective against UC
presentation of Crohns
abdominal pain + diarrhoea
weight loss
oral ulcers
perianal features e.g. skin tags, abscesses
presentation of UC
bloody diarrhoea
PR bleeding
Abdo pain - left lower quadrant
Increased frequency/urgency of defecation
tenesmus
fistuals are seen in which type of IBD
Crohns
skin manifestations of IBD
erythema nodosum - tender red/purple nodules on patients shins
pyoderma gangrenosum- erythematous papules that develop into ulcers
primary sclerosing cholangitis is a complication of which condition
UC
- fibrosis of bile ducts
which test has a good sensitivity and specificity for IBD
faecal calprotectin
diagnostic investigation for Crohns
Endoscopy (OGD + colonoscopy) + biopsy
Diagnostic investigation for UC
flexible sigmoidoscopy + biopsy usually sufficient
- full colonoscopy if diagnosis unclear
how many bowel movements per day indicate
- Mild UC
- Mod UC
- Severe UC
mild UC = <4
mod UC = 4-6
sev UC = >6
therapy for inducing remission in mild-moderate UC
- 1st line
- 2nd line
- 3rd line
1st line: rectal mesalazine (aminosalicylate- 5ASA)
2nd line if remission not achieved within 4 weeks: add oral mesalazine
3rd line if remission still not achieved: add rectal / oral predinisolone
therapy for inducing remission in severe UC
need hospital tx with IV hydrocortisone
therapy used to maintain remission in UC
1st line: rectal Mesalazine or combo of rectal + oral mesalazine
2nd line: Azathioprine / infliximab if recurrent episodes (>2 a year)
therapy for inducing remission in Crohns
1st line: prednisolone
2nd line: add mesalazine / azathioprine / methotrexate
therapy for maintaining remission in Crohns
Azathioprine 1st line (mercaptopurine as an alternative)
Methotrexate 2nd line
what surgical procedure can cure UC
Total proctocolectomy
- removes colon + rectum
- patient left with permanent ileostomy or ileo-anal anastamosis (J-pouch)
what surgical procedures might crohns patients require
70-80% of patients will require surgery at some point, however it is not curative
- Ileocaecal resection: removal of terminal ilieum + caecum with primary anatasomosis
- Segmental resections
- Stricturoplasty: division of stricture that is causing bowel obstruction
- Surgery for peri-anal disease e.g. abscess drainage
ulcer at a stoma site in IBD patient is caused by what
pyoderma gangrenosum
