Inflammatory Bowel Disease (IBD) Flashcards
what is crohn’s disease?
a chronic, relapsing-remitting, non-infectious inflammatory disease of the gastrointestinal tract
what are the risk factors for crohn’s disease?
- genetic
- smoking
- NSAIDs
- infectious gastroenteritis
- low-fibre, high-refined sugar diet
what are the symptoms of crohn’s disease?
- RLQ + peri-umbilical pain
- diarrhoea +/- blood or mucus
- perianal pain/itching
- aphthous ulcers
- nausea + vomiting
- fever
- fatigue
- weight loss
what are the findings on examination of crohn’s disease?
- abdominal tenderness/mass
- perianal pain +/- skin tag, fissure, fistula or abscess
- anaemia (e.g. pallor)
- arthralgia
- clubbing
- aphthous ulcers
what does a blood test show for crohn’s disease?
- ↓ Hb
- leucocytosis
- thrombocytosis
- hypoalbuminaemia
- hypocalcaemia
- ↑ ESR/CRP
- ? ↓ iron
- ? ↓ vitamin B12
what is faecal calprotectin used for in gastrointestinal conditions?
- a sensitive marker of gastrointestinal inflammation
- it helps distinguish IBD from non-inflammatory conditions (e.g. IBS)
- it is raised in crohn’s disease + can be used to monitor disease activity
what are the features of crohn’s disease on endoscopy?
- ‘cobblestone’
- ‘skip’ lesions
- oedema
- hyperaemia
- aphthous ulcers
- ‘rose thorn’ ulcers
- non-caseating granulomas
- lymphoid hyperplasia
what imaging may be used for crohn’s disease?
- XR/CT abdomen
- US abdomen
- MRI small bowel/pelvis
what drugs may be used to induce remission in crohn’s disease?
- corticosteroids (e.g. prednisolone/methylprednisolone) - first presentation or a single inflammatory exacerbation in a year
- budesonide
- aminosalicylates (e.g. sulfasalazine/mesalazine)
what drugs may be added to corticosteroids to induce remission in crohn’s disease?
+ thiopurines (e.g. azathioprine/mercaptopurine)
+ methotrexate
+ biologics (e.g. infliximab/adalimumab) - after two or more exacerbations in a year
what drugs may be used to maintain remission in crohn’s disease?
thiopurines (e.g. azathioprine/mercaptopurine)
what is the surgical management of crohn’s disease?
- strictureplasty
- fistulectomy
- abscess drainage
- colectomy/proctocolectomy
- ileostomy/colostomy
- bowel resection
what are the long-term complications of crohn’s disease?
- stricture
- fistula
- perforation
- perianal disease
- anaemia
- malnutrition
- cancer of the small + large intestine
what is ulcerative colitis (UC)?
a chronic, relapsing-remitting, inflammatory disease which affects the large bowel and rectum
how is ulcerative colitis (UC) classified based on location and extent of disease?
- proctitis: rectum
- proctosigmoiditis: rectum + sigmoid colon
- left-sided colitis: rectum, sigmoid colon + descending colon
- extensive colitis: rectum, sigmoid colon, descending colon + transverse colon
- pancolitis: rectum + entire colon
what is the truelove + witts criteria for ulcerative colitis?
used to classify the severity of ulcerative colitis into mild, moderate, or severe based on:
- number of bowel movements per day
- rectal bleeding
- temperature
- HR
- Hb
- ESR
what are the risk factors for UC?
- HLA-B27 positive
- infectious gastroenteritis
- NSAIDs
- smoking cessation
- ashkenazi jewish
what are the symptoms of UC?
- diarrhoea +/- blood or mucus
- urgency
- tenesmus
- lower abdominal pain
- bloating
- fatigue
- weight loss
- malaise
what are the findings on examination of UC?
- lower abdominal pain/tenderness
- distension
- anaemia (e.g. pallor)
- arthralgia
- clubbing
- erythema nodosum
- pyoderma gangrenosum
- uveitis
- episcleritis
what are the features of UC on flexible sigmoidoscopy/colonoscopy?
- continuous, uniformly inflamed mucosa
- erythematous, friable mucosa
- abnormal vascular pattern
- ulceration
- ‘pseudopolyps’
- crypt abscesses
- ↓ goblet cells
what is the 1st-line treatment for inducing + maintaining remission in mild-to-moderate UC?
aminosalicylates (e.g. mesalazine)
what role do corticosteroids play in UC management?
corticosteroids (e.g. prednisolone) are used to induce remission during relapses of UC
what are thiopurines used for in UC + what test is required before starting treatment?
- thiopurines (e.g. azathioprine) are used as steroid-sparing therapy to induce + maintain remission
- patients must have TPMT (thiopurine methyltransferase) activity checked before starting, as low TPMT increases the risk of myelosuppression
when are biologics used in UC treatment?
biologics (e.g. infliximab/ustekinumab) are used when UC is refractory to other treatments
