Inflammatory Bowel Disease Flashcards
Symptoms (DWARF)
Diarrhoea Weight loss Abdo pain Rectal bleeding/Bloody stools Fatigue
Crohn’s pathophysiology
Can affect the entire GI tract from mouth to anus
- skip lesions
- commonly distal ideal involvement
- transmural inflammation
- can cause strictures and fistulas
- granuloma formation
- rose thorn ulcers - seen on barium swallow
- increased goblet cells
Pathophysiology of UC
- Affects rectum and continues proximally
- Always affects large bowel and can sometimes affect the caecum or ilium
- Submucosal inflammation
- Continuous
Risk factors of Crohn’s disease
Age 15 - 30
Jewish > white > black
Smoking increases risk
FHx
UC risk factors
15 - 30 yo
Jewish > white > black
FHx
HLA- B27
How does smoking effect UC
Stopping smoking exacerbates UC
Presentation specific to Crohns
Aphthous ulcers Arthritis Erythema nodosum Pyoderma gangrenosum Toxic megacolon - due to fistula/ structure causing obstruction
UC specific presentation
Arthritis Ankylosing spondylitis Fever Erythema nodosum Pyoderma gangrenosum Episcleritis/ uveitis Bloody diarrhoea Tenesmus
Fistula complications
Palpable mass
Increase risk of UTI
Abscess formation
Passage of gas/ faeces through vagina/ skin
Investigations for IBD
Bloods - FBC, Fe, B12, CRP, LFTs, U+Es Stool sample testing - faecal calprotectin Colonoscopy with biopsy Abdo XR with contrast CT/MRI of abdo pelvis
Crohns specific investigation
Yersinia enterocolitica serology - rule out infection as can cause acute ileitis
Colonoscopy appearance for crohns
Cobblestone appearance
Strictures
Fistulas
X-ray appearance
Crohns
- skip lesions
- Kantor’s string sign
UC:
- lead pipe appearance
Biopsy findings for UC
Ulceration Crypt distortion Crypt abscesses Pseudopolyps Infiltration and inflammation Loss of haustra
Management of Crohn’s disease for remission
Supportive:
- smoking cessation
Remission:
- prednisolone/ budesonide
- aminosalicylate - if prednisolone contraindicated
- azathioprine/ mercaptopurine + prednisolone
- methotrexate + prednisolone - if ATP not tolerated
- monoclonal antibodies - infliximab
Crohns maintenance
Maintenance:
- Azathioprine/ mercaptopurine
- Methotrexate
Surgery:
- if limited to distal ileum
When is azathioprine or mercaptopurine used?
2+ episodes in 1 year
UC remission management
- Topical aminosalicylate - mesalazine
- Oral aminosalicylate (after 4 weeks)
- Topical/Oral corticosteroid
- Immunomodulative therapies
- anti TNFalpha - infliximab
- anti integrin
- Janus kinase inhibitor
UC maintenance management
- Topical aminosalicylate Or + Oral aminosalicylate
2. Oral azathioprine/ mercaptopurine
Acute severe admission management UC
- IV corticosteroid - hydrocortisone
- cyclosporin 2nd line IV
- fluid resuscitation if needed
- Surgical intervention
When is surgery indicated
If no response to steroids in 24 - 48 hrs or infliximab in 3 days
Fulminant colitis presentation
Fever
Tachycardia
Abdominal distension
Peritonitis
Fulminant colitis endoscopy
Should be avoided due to risk of toxic megacolon or perforation
Complications of Crohn’s
- Intestinal obstruction
- Sinus tracts (like fistula)
- Toxic megacolon (less risk)
Chronic:
- anaemia
- short bowel syndrome and malabsorption
- miscarriage due to methotrexate
- gallstones
- colorectal cancer
