Inflammatory Bowel Disease (Crohn's and Ulcerative Collitis) Flashcards
What is UC?
UC is a relapsing and remitiing inflammatory disorder of the colonic mucosa.
- proctits (rectum)
- left sided colitis
- entire colon (pancolitis)
What percentage of UC is limited to the rectum (proctitis)?
50%
What % of UC is left sided colitis?
30%
What % of UC involves the whole colon - pancolitis?
20%
What is the prevalence of UC?
100-200 per 100, 000
what is the male: female ratio of UC?
1:1
at what age does UC present?
15 - 30 yrs
Smoking is a protective risk factor for which IBD condition? crohn’s or UC?
Smoking reduces risk of UC
Smoking increases risk of crohns
What are the symptoms of UC?
- 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.
What are the signs of UC?
- 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
what are the extraintestinal eye signs of UC?
- conjunctivitis
- episcleritis
- iritis
what are the extraintestinal MSK signs of UC?
- large joint arthritis
- sacroiliitis
- ankylosing spondylitis
What tests would you do for UC?
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.
What are the complications of UC?
- Toxic megacolon (colon dilated to >6cm)
- venous thrombosis
What drugs are used to induce remission in mild UC?
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
What drugs are used to induce remission in moderate UC?
- 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
What is classed as severe UC?
unwell and 6+ motions a day
How do we treat severe UC?
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
What are the indications for surgery in UC?
- perforation
- massive haemorrhage
- toxic megacolon
- failed medical therapy
What immunomodulants are used in UC?
- Azathioprine
- methotrexate
- infliximab
- adalimumab
- calcineurin inhibitors e.g. ciclosporin / tacrolimus
What is the dose of azathioprine for UC?
2.5mg /kg/d PO after food
What is crohns disease?
Inflammation of the GI tract that can occur anywhere from mouth to anus. characterised by transmural skip lesions.
What are is affected in 70% of crohn’s?
terminal ileum
what is the prevalence of crohn’s
0.5-1 / 1000 (crohn’s)
1-2/1000 (UC)
