Inflammatory bowel disease (Crohns & UC) Flashcards
Describe the typical presentation of ulcerative colitis in a child
Teenager (can be young child) with:
Chronic bloody diarrhoea (may be noctural)
Urgency, Tenesmus
Abdominal pain (esp LLQ)
Extra-intestinal features
Describe the typical presentation of crohns in a child
Teenager (can be young child) with:
Weight loss & growth failure
Chronic diarrhoea (usually not bloody)
Lethargy
Abdominal pain
Perianal disease
Extraintestinal features
Compare the presentations of UC and crohns in children
UC has more specific GI symptoms; chronic bloody diarrhoea is key
Crohns has more non-specific symptoms; weight loss, growth failure and abdominal pain are key
Although chronic diarrhoea is also common in crohns
Also crohns has specific stuff like mouth ulcers, masses etc
Crohns is also more common in children
Give an overview of the diagnostic approach to IBD - before investigations are done
History & examination
Intestinal symptoms
Extra-intestinal manifestations
Exclude infection
Family history
Growth & sexual development
Nutritional status
What extra intestinal manifestations would you look for when investigating IBD?
Erythema nodosum - (both but more common in Crohns)
Apthalmous ulcers - (crohns)
Perianal tags & fissures - (crohns)
Arthritis - (both - rare in kids)
Uveitis (more common in UC)
What laboratory investigations are done for IBD?
What results would you expect to see?
Full blood count & ESR:
- anaemia
- thrombocytosis
- raised ESR
Biochemistry:
- Stool calprotectin
- raised CRP
- low albumin
Microbiology:
- no stool pathogens (exclusion)
What is IBDU?
IBD unclassified
How is the distrubution in paediatric UC different from adult UC?
Children tend to have Pancolitis
Whereas adults tend to only have proctitis or L sided colitis
Ie - kids generally have much more serious UC than adults
How is the distribution of paediatric crohns different from that of adults?
Paediatric crohns tends to be Panenteric (thus have Upper GI involvement) or ileocolonic
Adult crohns tends to be ileocolonic or isolated ileal
So - kids tend to have more widespread Crohns at presentation than adults
What are the definitive investigations for IBD in kids
Radiology:
- MRI
- In v young kids - US or Barium meal & follow-through
Endoscopy:
- Ileocolonoscopy & upper GI endoscopy
- Mucosal biopsy
- Sometimes:
- capsule enteroscopy
- balloon enteroscopy
What main features on endoscopy & biopsy (histology) would you see in UC?
Endoscopy:
- red, raw mucosa - bleeds easily
- widespread ulceration & pseudopolyps
Histology:
- mucosal & submucosal inflammation (but not further)
- crypt abscesses
- depletion of goblet cells
- infrequent granulomas
What features on endoscopy & biopsy (histology) would be in keeping with crohns?
Endoscopy:
- Cobble stone appearance
- Skip lesions
- Strictures
Histology:
- non-caseating granulomas
- transmural inflammation
- increased goblet cells
Summarise the whole investigative approach to IBD
1) History & examination etc etc
2) Lab stuff - Bloods & biochem (esp calprotectin)
3) Radiology & endoscopy
What are the aims of treatment of IBD in children
Induce & maintain remission
Correct nutritional deficiencies
Maintain normal growth & development
What are the methods of treatment of IBD in children
Medication:
- anti-inflammatory
- immunosuppressive
- biologics - eg infliximab
Nutritional:
- immune modulation
- nutritional supplementation
Surgical
