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)
What age does crohn’s present at?
20 - 40s
what increases the risk of crohn’s?
- smoking increases risk by 3-4X
- NSAIDs exacerbate disease
What are the symptoms of crohns?
- Diarrhoea
- urgency
- abdo pain
- weight loss
- fatigue
- fever, malaise, anorexia
What are the signs of crohns?
- oral ulcers
- abdo tenderness/ mass
- perianal abscess
- fistulae
- skin tags
- anal strictures
-clubbing, skin, joint, eye problems (same as UC)
What are the complications of crohns?
- small bowl obstruction
- toxic megacolon
- abscess formation
- fistulae
- perforation
- rectal haemorrhage
- colon cancer
- fatty liver
- primary sclerosing cholangitis
- cholangiocarcinoma
- renal stones
- osteomalacia
- malnuitrition
- amyloidosis
What tests are done for crohn’s disease?
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
What is the treatment for mild crohn’s attacks?
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)
What is the treatment for sever crohn’s attacks?
- admit for IV steroids (hydrocortisone 100mg/6h IV)
- ## IV fluids
What is the treatment for perianal disase (50%) in crohns?
Assess via MRI.
treat with oral abx, immunosuppressant therapy +/- infliximab
