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#passmed 2022 > Inflammatory Bowel Disease (Crohn's and Ulcerative Colitis) > Flashcards

Inflammatory Bowel Disease (Crohn's and Ulcerative Colitis) Flashcards

1
Q

What is IBD?

A

Umbrella term for 2 diseases causing inflamm of GI Tract

  1. Ulcerative Colitis
  2. Crohn’s
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2
Q

What acronyms tell you the difference between Crohn’s & UC?

A

Crohn’s: crows NESTS

UC: u - c - CLOSEUP

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3
Q

What is the Pathophysiology of Crohn’s?

A

Cause unknown, but strong genetic link

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4
Q

Where does Crohn’s most commonly affect? (2 things)

A
  1. Terminal ileum
  2. Colon

(But can be anywhere from mouth to anus)

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5
Q

What is the Pathophysiology of UC?

A

Inapprop immune response vs abn colonic flora in genetically susceptibile individuals

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6
Q

Why are Crohn’s patients prone to strictures n fistulas n adhesions?

A

Bc inflamm occurs in all layers down to serosa

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7
Q

What is the acronym that tells you how Crohn’s is different to UC?

A

crows NESTS

N - No blood / mucus

E - Entire GI tract

S - “Skip lesions” on endoscopy

T - Terminal ileum most affected + Transmural (full thickness) Inflamm

S - Smoking = risk actor (don’t set the nest on fire)

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8
Q

What is the acronym that tells you how UC is different to Crohn’s?

A

u - c - CLOSEUP

C – Continuous inflamm

L – Limited to colon + rectum

O – Only superficial mucosa affected

S – Smoking is PROTECTIVE lol

E – Excrete blood + mucus

U – Use aminosalicylates

P – Primary Sclerosing Cholangitis

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9
Q

What are the CF of Crohn’s? (7 things)

A
  1. Fever (low grade)
  2. Fatigue
  3. Abd pain (crampy) (most common in kids) / tenderness / mass
  4. Bowel ulceration
  5. Perianal abscess / fistula
  6. Diarrhoea (most common in adults)
  7. Weight loss
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10
Q

What are the CF of UC? (4 + 7 things)

A
  1. Abd pain (crampy) (esp LIF)
  2. Urgency
  3. Tenesmus (feeling like u gotta poo)
  4. Bloody diarrhoea

Extraintestinal signs:

  1. Fever (low grade)
  2. Iritis (swelling of iris)
  3. Oral ulcers
  4. Tachycardia
  5. Clubbing
  6. Primary Sclerosing Cholangitis
  7. Erythema nodosum (swollen red nodules under shin skin)
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11
Q

What investigations should you do for sus Crohn’s? (5 things)

A
  1. Bloods
  2. Stool studies
  3. Colonoscopy w Biopsy (even if mucosa looks normal)
  4. CT / MRI / XR w barium swallow
  5. Small bowel enema
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12
Q

What Bloods should you do for sus Crohn’s? (8 things)

A
  1. FBC
  2. ESR
  3. CRP
  4. UnE
  5. LFT
  6. INR
  7. Ferritin
  8. B12
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13
Q

What will a FBC show in Crohn’s? (3 things)

A
  1. Anaemia
  2. Leucocytosis
  3. Thrombocytosis

(same as UC)

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14
Q

What will the ESR n CRP be in Crohn’s?

A

Both raised

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15
Q

What will the iron and vit B in bloods of Crohn’s be?

A

Deficient in both

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16
Q

Why is it important to do UnE in Crohn’s?

A

Chronic diarrhoea can cause elec imb

(same as in UC)

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17
Q

Why are stool studies done in sus Crohn’s? (3 things)

A
  1. To exclude other causes of inflamm diarrhoea (e.g infection)
  2. C. difficile toxin studies (if recent abx use)
  3. Maybe traces of blood in stool (less common in Crohn’s)
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18
Q

What are the Colonoscopy findings for Crohn’s? (3 things)

A
  1. Skip Lesions (usually spare the rectum)
  2. Deep ulcers + fistulas –> Cobblestone appearance
  3. Transmural (all layers) inflamm
19
Q

What is the use of CT / MRI / XR w barium swallow in sus Crohn’s? (4 things)

A
  1. Assessing extent / severity of disease
  2. Seeing complications (e.g perforation / fistulas / abscess / stenosis)
  3. Seeing signs of inflamm (wall thickening)
  4. Seeing ulcers (Cobblestone appearance)
20
Q

What investigations should you do for sus UC? (5 things)

A
  1. Bloods
  2. Stool studies
  3. Faecal calprotectin
  4. AXR
  5. Lower GI endoscopy
21
Q

What Bloods should you do for sus UC? (6 things)

A
  1. FBC
  2. ESR
  3. CRP
  4. UnEs
  5. LFT
  6. Blood culture
22
Q

What will a FBC show in UC? (3 things)

A
  1. Anaemia
  2. Leucocytosis
  3. Thrombocytosis

(same as Crohn’s)

23
Q

What will the ESR be in UC?

A

Raised

(same as Crohn’s)

24
Q

Why is it important to do UnE in UC?

A

Chronic diarrhoea can cause elec imb

(same as in Crohn’s)

25
Q

Why are stool studies done in sus UC? (2 things)

A
  1. To exclude other causes of inflamm diarrhoea (e.g infection)
  2. Maybe traces of blood in stool (more common in UC)
26
Q

What is Faecal calprotectin? (3 things)

A
  1. Simple non-invasive test for GI inflamm
  2. High sensitivity
  3. Done for UC
27
Q

What will be seen in a AXR of a UC pt? (3 things)

A
  1. No faecal shadows
  2. Mucosal thickening / islands
  3. Colonic dilatation (complication)
28
Q

What Lower GI endoscopy should you do for ACUTE UC?

Why? (2 things)

A

Limited flexible sigmoidoscopy

  1. To assess
  2. To biopsy
29
Q

What Lower GI endoscopy should you do for UC once it’s CONTROLLED?

Why?

A

Full colonoscopy

To define disease extent

30
Q

What does the treatment of UC depend on?

A

Severity

31
Q

How do you determine the severity of UC?

A

Truelove & Witts Criteria (mod. to include CRP)

32
Q

What are the Truelove & Witts Criteria for MILD UC? (6 things)

A
  1. Apyrexial (no fever)
  2. Resting pulse = less than 70bpm
  3. Hb = 110+
  4. ESR less than 30
  5. Less than 4 poos (motions) a day
  6. SMALL rectal bleeding
33
Q

What are the Truelove & Witts Criteria for MODERATE UC? (6 things)

A
  1. 37.1 - 37.8 C
  2. Resting pulse = 70 - 90 bpm
  3. Hb = 105-110
  4. ESR: n/a
  5. 5 poos (motions) a day
  6. MODERATE rectal bleeding
34
Q

What are the Truelove & Witts Criteria for SEVERE UC? (6 things)

A
  1. 37.8+ C
  2. Resting pulse = 90+ bpm
  3. Hb = less than 105
  4. ESR: 30+
  5. 6+ poos (motions) a day
  6. LARGE rectal bleeding
35
Q

What is the aim of treatment for UC?

A

Inducing + maintaining remission

36
Q

How do you induce remission for MILD + MODERATE UC? (1st + 2nd line)

A

1st line = Aminosalicylate (e.g. mesalazine oral / rectal)

2nd line = corticosteroids (e.g prednisolone)

37
Q

How do you induce remission for SEVERE UC? (1st + 2nd line)

A

1st line = IV corticosteroids (e.g. hydrocortisone)

2nd line = IV ciclosporin (calcineurin inhibitor aka immunosuppressant)

38
Q

How do you maintain remission in UC? (3 things)

A
  1. Aminosalicylate (e.g. mesalazine oral / rectal)
  2. Azathioprine
  3. Mercaptopurine
39
Q

What is the SURGICAL management option for UC? (2 things)

A
  1. Panproctocolectomy (colon + rectum removal , bc UC only fx colon + rectum)
  2. Then permanent ileostomy (pouch)
40
Q

How do you induce remission for Crohn’s? (1st + 2nd line)

A

1st line = Steroids (oral prednisolone / IV hydrocortisone)

2nd line = Add Immunosuppressant (Azathioprine / Mercaptopurine / Methotrexate)

41
Q

How do you maintain remission in Crohn’s? (1st line + alternatives)

A

1st line = Azathioprine / Mercaptopurine

Alternatives = Methotrexate / Infliximab / Adalimumab

Tailored to pt needs, e.g individual risks, side fx etc.

42
Q

What is the surgical management option for Crohn’s?

A

When disease ONLY fx small area = remove dis area

BUT, Crohn’s usually fx whole GI tract, + recurrence rate is high so small section resections aren’t rly advocated

43
Q

What are the complications of Crohn’s? (6 things)

A
  1. Small bowel obst
  2. Abscess
  3. Fistulae
  4. Perforation
  5. Colon cancer
  6. Malnutrition
44
Q

What are the complications of UC? (4 things)

A
  1. Toxic dilatation of colon (+ risk of perforation)
  2. Venous thromboembolism
  3. Colon cancer
  4. Large bowel obst

#passmed 2022 (27 decks)

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