inflammatory bowel disease Flashcards
ulcerative colitis presenting featuress
almost all have (bloody) diarrhoea and rectal bleeding
most have abdominal pain
Crohn’s disease presenting features
not always diarrhoea - esp if affecting more upper GI
abdo pain
weight loss + growth failure
usually picked up on blood test
extra-intestinal manifestations of IBD
erythema nodosum
oral changes - ulcers, angular chelitis
perianal changes - tags, fissures
IBD: lab investigation
FBC + ESR: anaemia, thrombocytosis, raised ESR
biochemistry - stool calprotectin, raised CRP, low albumin
microbiology: no stool pathogens
definitive investigations
radiology: MRI, barium meal and follow-through
endoscopy: colonoscopy + upper GI endoscopy
- mucosal biopsy
- capsule enteroscopy
- enteroscopy
aims of treatment
induce and maintain remission
correct nutritional deficiencies
maintain normal growth and development
treatment
medical: anti-inflammatory, immunosupressive, biologicals (infliximab)
nutritional: immune modulation, nutritional supplementation
surgical
treatment order for crohn’s
polymeric diet or oral prednisolone
steroid sparing agents: azathioprine/6MP or methotrexate
biologics: infliximab/adalibumab
surgery
Crohn’s histopathology
granuloma
patchy inflammation
destructive changes
UC histopathology
disordered crypts
pus/abscess in crypts
increased inflammatory cells
adult vs paeds: UC or Crohn’s
adult = more UC kids = more Crohn's
adult vs paeds: M or F
adult: female
kids: male
adult vs paeds: UC
adults: proctitis, L sided colitis
kids: pancolitis
adult vs paeds: crohn’s
adult: isolated ileal
kids: upper GI/panenteric
