Inflammatory Bowel Disease Flashcards
what is IBD?
chronic inflammatory disease of bowel
class of IBD?
Crohn’s and UC
epidemiology of IBD?
identification in young= severe disease
genetic aetiology of IBD?
chromosome 16q12 or NOD2
immunological aetiology of IBD?
impaired mucosal immunity
environmental factors that inc risk of IBD?
smoking & NSAIDs
site of UC?
colon/rectum
site of crohn’s?
anywhere in GI tract
so what is Crohn’s?
chronic transmural inflammation and ulcerating condition of GI tract that can affect anywhere from mouth anus
what is the handy pneumonic for Crohn’s?
N- no blood in faeces E- entire GI tract S- skip lesions on endoscopy T- terminal ileum most affected and transmural (full thickness) inflammation S- smoking is a risk factor
what else is commonly found with Crohn’s?
fistulas, strictures and wt loss
what mutated gene may cause Crohn’s?
chromosome 16
true/false…
young males in northern europe have higher chance of having Crohn’s?
true
symptoms of Crohn’s affecting small intestine?
abdominal cramps, diarrhoea
symptoms of Crohn’s affecting colon?
cramps, diarrhoea w blood
symptoms of Crohn’s affecting mouth?
ulcers, swollen lips, angular chelitis
symptoms of Crohn’s affecting anus?
anal pain, abscess
signs of Crohn’s?
RIF mass, peri-anal signs e.g. fistula
clinical course of crohn’s?
chronic OR exacerbations & remission- unpredictable response to therapy
ix for Crohn’s
endoscopy w mucosal biopsy, Ba imaging, bloods (CRP, albumin, FBCs, B12)
what are common findings on endoscopy for Crohn’s?
cobblestone appearance, pseudo polyps, fissures, non-caseating granuloma, transmural inflammation, skip areas
tx for Crohn’s?
lifestyle- no smoking
drugs- steroids, immunosuppressants, anti-TNF therapy
surgery- resection, stricturoplasty, fistula repair (non-curative !!)
what drug is given to maintain remission for Crohn’s?
azathioprine
what emergency surgery is done for Crohn’s?
colectomy
complications of Crohn’s?
fistula*, SBS, anal disease, bowel obstruction, perforation, malabsorption, amyloidosis
what is UC?
chronic inflammatory disorder confined to colon and rectum which involves inflammation of mucosal and submucosal layers (superficial)
what is the acronym for UC?
C- continuous inflammation L- limited to colon and rectum O- only affects superficial mucosa S- smoking is protective E- excretes blood & mucous U- use aminosalicyclates as tx P- primary sclerosis cholangitis
is the epidemiology of UC same as that of Crohn’s?
yes- young males mostly affected
symptoms of UC?
diarrhoea w blood/exudate, lower abdominal cramps, inc bowel frequency, tenesmus, incontinence
what are the 5Ps of UC?
pyrexia pseudopolyps lead-piping appearance poo proctitis
systemic signs of UC?
uveitis
mouth- stomatitis, ulcers
skin- erythema nodosum
ix for UC?
endoscopy with mucosal biopsy, bloods (albumin, CRP etc), AXR to rule out toxic megacolon
what criteria is used to assess severity of UC?
truelove & Witt’s criteria
what does Truelove & Witt’s criteria state?
> 6 blood stools +
fever/ tachy/anaemia/ elevated ESR (erythrocyte sedimentation ratio)
what histological findings on biopsy may be found in a pt with UC?
many inflammatory cells, crypt distortion (irregularly shaped), mucosal ulceration with fibrinopurulent exudate, NO GRANULOMA
Rx for UC?
inducing remission: 1st line= 5-ASAs, 2nd line= steroids, immunosuppressants & anti-TNF therapy
severe: IV corticosteroids, 2nd line= IV cyclosporin (immunosuppressant)
what Rx is given to maintain remission in UC?
aminosalicyclates
what is the non-emergency surgical tx for UC?
protocolectomy - pouch given
CURATIVE
what is the emergency surgical tx for UC?
sub-total colectomy
complications for UC?
toxic megacolon, intractable disease, colorectal carcinoma, anal fissures
recap: Crohn’s…
1. occurs only in colon & rectum
2. has skip lesions on endoscopy
3. transmural inflammation as opposed to superficial
4. non-granulomatous inflammation
5. fistulas present
6. extra GI complications/ symptoms
7. cancer risk low
- NO- anywhere in GI tract
- YES
- YES
- NO- has granulomatous inflammation
- YES
- NO- extra GI common in UC
- YES
cure for fistula?
seton or surgery
SNAP: sepsis, nutrition, anatomy, plan