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Year 3 Abdo Conditions > Inflammatory Bowel Disease (Crohn's and Ulcerative Collitis) > Flashcards

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

1
Q

What is UC?

A

UC is a relapsing and remitiing inflammatory disorder of the colonic mucosa.

  • proctits (rectum)
  • left sided colitis
  • entire colon (pancolitis)
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2
Q

What percentage of UC is limited to the rectum (proctitis)?

A

50%

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3
Q

What % of UC is left sided colitis?

A

30%

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4
Q

What % of UC involves the whole colon - pancolitis?

A

20%

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5
Q

What is the prevalence of UC?

A

100-200 per 100, 000

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6
Q

what is the male: female ratio of UC?

A

1:1

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7
Q

at what age does UC present?

A

15 - 30 yrs

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8
Q

Smoking is a protective risk factor for which IBD condition? crohn’s or UC?

A

Smoking reduces risk of UC

Smoking increases risk of crohns

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9
Q

What are the symptoms of UC?

A
  • episodic diarrhoea (with or without blood or mucus)
  • crampy abdo pain
  • increased bowel frequency –> increased severity of UC
  • urgency / tenesmus = rectal UC
  • systemic symptoms during attack : fever, malaise, anorexia, weight loss.
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10
Q

What are the signs of UC?

A
  • may be no signs OR:
  • sever UC - fever, tachycardia, tender distended abdo

Extraintestinal signs

  • clubbing
  • oral ulcers
  • erythema nodosum (red lumps under skin)
  • pyoderma gangrenosum
  • conjuctivitis
  • episcleritis
  • iritis
  • large joint arthritis
  • sacroiliitis
  • ankylosing spondylitis
  • fatty liver
  • cholangiocarcinoma
  • amyloidosis
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11
Q

what are the extraintestinal eye signs of UC?

A
  • conjunctivitis
  • episcleritis
  • iritis
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12
Q

what are the extraintestinal MSK signs of UC?

A
  • large joint arthritis
  • sacroiliitis
  • ankylosing spondylitis
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13
Q

What tests would you do for UC?

A

Bloods:

  • FBC
  • CRP / ESR
  • U&E
  • LFT
  • blood culture

Stools to exclude:

  • campylobacter
  • c.diff
  • salmonella
  • shigella
  • E.coli
  • amoebae

AXR:

  • no faecal shadows
  • mucosal thickening
  • colonic dilatation (toxic mega colon)

Chest Xray:
-perforation

Colonoscopy:

  • biopsy
  • Histology : look for inflammation, goblet cell depletion, glandular distortion, mucosal ulcer, crypt abscesses.
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14
Q

What are the complications of UC?

A
  • Toxic megacolon (colon dilated to >6cm)

- venous thrombosis

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15
Q

What drugs are used to induce remission in mild UC?

A

1) 5-ASA e.g. sulfasalazine or mesalazine.
2) Steroids e.g. prednisolone 20mg PO twice daily OR PR foams e.g. hydrocortisone OR prednisolone retention enema 20mg.

**if improving after 2 weeks reduce steroids slowly

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16
Q

What drugs are used to induce remission in moderate UC?

A
  • Oral prednisolone (40mg/d for 1 wk), then 30mg/d for 1 wk then 20mg/d for 4 more wks.
  • AND a 5ASA
  • AND twice daily steroid enemas

**decrease steroids gradually if improving

17
Q

What is classed as severe UC?

A

unwell and 6+ motions a day

18
Q

How do we treat severe UC?

A

1) admit for nil by mouth and IV hydration
2) IV Steroids : Hydorcortisone 100mg/6h IV
3) Rectal steroids (hydrocortisone 100mg in 100ml 0.9% Nacl every 12 hrs
4) monitor bp, pulse, temperature, stool freq/character
5) If not improving then either colectomy surgery OR rescue infliximab / ciclosporin

19
Q

What are the indications for surgery in UC?

A
  • perforation
  • massive haemorrhage
  • toxic megacolon
  • failed medical therapy
20
Q

What immunomodulants are used in UC?

A
  • Azathioprine
  • methotrexate
  • infliximab
  • adalimumab
  • calcineurin inhibitors e.g. ciclosporin / tacrolimus
21
Q

What is the dose of azathioprine for UC?

A

2.5mg /kg/d PO after food

22
Q

What is crohns disease?

A

Inflammation of the GI tract that can occur anywhere from mouth to anus. characterised by transmural skip lesions.

23
Q

What are is affected in 70% of crohn’s?

A

terminal ileum

24
Q

what is the prevalence of crohn’s

A

0.5-1 / 1000 (crohn’s)

1-2/1000 (UC)

25
Q

What age does crohn’s present at?

A

20 - 40s

26
Q

what increases the risk of crohn’s?

A
  • smoking increases risk by 3-4X

- NSAIDs exacerbate disease

27
Q

What are the symptoms of crohns?

A
  • Diarrhoea
  • urgency
  • abdo pain
  • weight loss
  • fatigue
  • fever, malaise, anorexia
28
Q

What are the signs of crohns?

A
  • oral ulcers
  • abdo tenderness/ mass
  • perianal abscess
  • fistulae
  • skin tags
  • anal strictures

-clubbing, skin, joint, eye problems (same as UC)

29
Q

What are the complications of crohns?

A
  • small bowl obstruction
  • toxic megacolon
  • abscess formation
  • fistulae
  • perforation
  • rectal haemorrhage
  • colon cancer
  • fatty liver
  • primary sclerosing cholangitis
  • cholangiocarcinoma
  • renal stones
  • osteomalacia
  • malnuitrition
  • amyloidosis
30
Q

What tests are done for crohn’s disease?

A

Blood:
-FBC, ESR, CRP, U&E, LFTs, INR, Ferritin, B12, Folate

Stool to exclude:
C.diff, campylobacter, salmonella, e.coli

Colonoscopy and rectal biopsy

Small bowel enema (detects ileal disease)

Capsule endoscopy

Barium enema

MRI to assess pelvic disease and fistulae

31
Q

What is the treatment for mild crohn’s attacks?

A

1) Prednisolone 30mg/d for 1 week, then reduce to 20mg/d for 4 weeks.

(if symptoms resolve decrease predisolone by 5mg every 2-4 weeks)

32
Q

What is the treatment for sever crohn’s attacks?

A
  • admit for IV steroids (hydrocortisone 100mg/6h IV)
  • ## IV fluids
33
Q

What is the treatment for perianal disase (50%) in crohns?

A

Assess via MRI.

treat with oral abx, immunosuppressant therapy +/- infliximab

Year 3 Abdo Conditions (24 decks)

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