Inflammatory Bowel Disease (IBD) Flashcards
What are the two forms of IBD. (2)
Crohn’s disease.
Ulcerative colitis.
What are the characteristics of Crohn’s disease. (9)
Affects any part of the GIT from mouth to anus. Segmental. Transmural process. Ulceration. Cobblestone appearance. Pseudopolyps. Non-caseating granulomas. Fissures. Fistulae.
What contributes to the development of Crohn’s disease. (3)
Genetic predisposition (NOD2/CARD15).
Smoking.
NSAIDs may exacerbate disease.
What are the symptoms of Crohn’s disease dependent on.
Depends on the site affected.
What are the typical symptoms associated with Crohn’s disease. (5)
Abdominal pain. Diarrhoea/urgency. Weight loss/failure to thrive. PR mucus/pus. Arthritis.
What are the clinical signs of Crohn’s disease. (12)
Fever. Malaise. Anorexia. Anaemia. Palpable inflammatory mass. Perianal abscess/fistulae/skin tags. Anal strictures. Aphthous ulcerations. Abdominal tenderness/mass. Erythema nodosum. Clubbing. Pyoderma gangrenosum.
What is seen on the blood tests of a patient with Crohn’s disease. (4)
Raised CRP.
Raised ESR.
Low Hb.
Low albumin.
What tests should be conducted in a patient suspected of having Crohn’s disease. (7)
Stool microscopy/culture.
Blood tests (CRP, ESR, albumin, WCC, Hb, FBC, UandEs, LFTs, INR, ferritin, TIBC, B12, folate).
Sigmoidoscopy/colonoscopy with biopsies.
Small bowel enema detects ileal disease.
White cell scan.
BaFT.
MRI (can assess pelvic disease and fistulae).
What malabsorption tests should be performed in a patient with Crohn’s. (4)
Vitamin B12.
Folate.
Vitamin D.
Calcium.
What are the complications of Crohn’s disease. (16)
Stricturing. Small bowel obstruction. Perforation. Toxic dilatation (rarer than in UC). Abscess formation. Fistulae. Rectal haemorrhage. Colon cancer. PSC. Cholangiocarcinoma. Renal stones. Osteomalacia. Malnutrition. Amyloidosis. Cholelithiasis. Fatty liver.
What is the treatment for Crohn’s. (9)
Mild attacks: prednisolone 30mg/d PO for 1 week, then 20mg/d for 4 weeks.
Severe attacks: IV steroids, NBM, IVI, hydrocortisone 100mg/6h IV.
Other treatments include: 5-aminosalicylic acid (5-ASA) eg. mesalazine. Antibiotics. Azathioprine/6-mercaptopurine. Methotrexate. Infliximab (anti-TNF alpha). Enteral therapies (elemental diet, TPN). Surgery.
What are the characteristics of UC. (7)
Involves the rectum and extends proximally.
Inflammation confined to mucosa and submucosa.
Distorted crypt architecture.
Cryptitis.
Crypt abscesses.
Inflammatory cell infiltrate.
Vascular congestion.
What contributes to the development of UC. (2)
Genetic predisposition.
Non-smokers.
What are the symptoms of UC. (7)
Episodic or chronic diarrhoea.
PR bleeding and mucus.
Crampy abdominal discomfort.
Systemic symptoms in attacks: Weight loss. Fever. Malaise. Anorexia.
What are the physical signs of UC. (19)
There may be none. In acute, severe UC, there may be: Fever. Tachycardia. Tender distended abdomen.
Extraintestinal signs include: Clubbing. Aphthous oral ulcers. Conjunctivitis. Episcleritis. Iritis. Large joint arthritis. Sacroilitis. Ankylosing spndylitis. Fatty liver. PSC. Cholangiocarcinoma. Nutritional deficits. Amyloidosis. Erythema nodosum. Pyoderma gangrenosum.
What is seen on the blood tests of a patient with UC. (5)
Raised CRP. Raised ESR. Raised platelets. Low albumin. Low Hb.
What are the investigations carried out in a patient suspected of UC. (8)
Blood tests (CRP, ESR, albumin, platelets, Hb, FBC, UandEs, LFTs).
Blood cultures.
Stool microscopy/culture.
AbdoXray (need to rule out toxic dilatation).
Colonoscopy with biopsies.
Erect CXR (to look for perforation).
Barium enema (never do during severe attacks or for diagnosis).
pANCA test.
What percentage of UC patients test positive for pANCA.
70%.
How do you induce remission in UC. (3)
Mild UC: 5-ASA (eg sulfasalazine/mesalazine).
Steroids (prednisolone 20mg/d PO, helps remission induction).
Moderate UC (if 4-6BO/day): prednisolone 40mg/d for 1 week, then 30mg/d for 1 week, then 20mg for 4 more weeks and 5-ASA.
Severe UC (if unwell and >6BO.day): NBM, IV hydration, hydrocortisone 100mg/6h IV, rectal steroids, daily blood tests and physical examinations.
What are the complications of UC. (7)
Haemorrhage. Perforation. Venous thrombosis. Toxic megacolon. Colorectal carcinoma. Fatty liver. Primary sclerosing cholangitis.
What part of the GIT does Crohn’s disease affect.
Any part from mouth to anus.
What part of the GIT does UC affect.
Affects large bowel only.
What are the typical endoscopic findings in Crohn’s disease. (3)
Rectum frequently spared.
Some areas of healthy bowel between diseased segments (skip lesions).
Bowel wall is thickened and has a cobblestone’ appearance due to deep ulceration.
What are the typical endoscopic findings in UC.
Bowel wall is thin and featureless in severe disease.
What are the typical histological findings in Crohn’s disease. (2)
Granuloma is the characteristic finding. Transmural inflammation (extends all the way through the bowel wall).
What are the typical histological findings in UC.
Inflammation usually confined to mucosa.
What are the common radiological findings in Crohn’s disease. (4)
Strictures, fissures and fistulae are common.
Asymmetrical inflammation.
What are the common radiological findings in UC. (2)
Symmetrical inflammation.
Uncommon to find strictures, fissures and fistulae.
Which IBD is commonly associated with smokers.
Crohn’s disease.
Predicts a worse course of disease.
Increases risk of surgery and future surgery.
Which IBD is commonly associated with non-smokers or ex-smokers.
UC.
What is Crohn’s disease.
A chronic inflammatory GI disease characterized by transmural granulomatous inflammation affecting any part of the gut from mouth to anus.
What part of the GIT is most often affected in Crohn’s. (2)
Terminal ileum is affected in 70% of cases.
Proximal colon.
What are ‘skip lesions’. (2)
Areas of unaffected bowel between areas of active disease.
Seen in Crohn’s disease.
What is the prevalence of Crohn’s disease.
0.5-1/100,000.
What is the incidence of Crohn’s disease.
5-10/100,000/year.
What is the typical age of presentation of Crohn’s disease.
Peaks 20-30 and 60-70.
Where might abscesses form in Crohn’s. (3)
Abdominal.
Pelvic.
Ischio-rectal.
What percentage of patient’s with Crohn’s have fistulae.
10%.
What is seen on a barium enema of a patient with Crohn’s. (3)
Cobblestoning.
‘Rose thorn’ ulcers.
Colon strictures.
What is the preferred investigation to assess disease extent.
Colonoscopy.
What percentage of patient’s with Crohn’s develop perianal disease.
50%.
What indicates a poor prognosis in patients with Crohn’s. (4)
Age
What are some other causes of erythema nodosum. (5)
Crohn's disease. Streptococci. TB. Sarcoidosis. Drugs.
What is the prevalence of UC.
100-200/100,000.
What is the incidence of UC.
10-20/100,000.
What is the male:female ratio for UC.
1:1.
What is the typical age of presentation of UC.
15-30.
What is UC.
UC is a relapsing and remitting inflammatory disorder of the colonic mucosa.
What parts of the GIT does UC most commonly affect. (3)
Just the rectum (proctitis in 50%).
Extends to involve parts of the colon (left sided colitis in 30%).
It may involve the entire colon (pancolitis in 20%).
Where does UC not spread beyond.
UC never spreads proximal to the ileocaecal valve.
What are the pathological features of UC. (4)
Hyperaemic/haemorrhagic granular colonic mucosa.
There may be pesudopolyps formed by inflammation.
Punctate ulcers may extend deep into the lamina propria - inflammation is normally not transmural.
What differentiates Crohn’s from UC.
Mucosal extent of the disease.
What are the extraintestinal signs of UC. (15)
Clubbing. Aphthous oral ulcers. Conjunctivitis. Episcleritis. Iritis. Large joint arthritis. Sacroilitis. Ankylosing spndylitis. Fatty liver. PSC. Cholangiocarcinoma. Nutritional deficits. Amyloidosis. Erythema nodosum. Pyoderma gangrenosum.
What are the topical therapies that can be used for UC (proctitis). (3)
Suppositories: prednisolone 5mg or mesalazine).
5-ASAs work better than topical steroids.
What are the indications for surgery in UC. (4)
Perforation.
Massive haemorrhage.
Toxic dilatation.
Failed medical therapy.
What percentage of UC cases will eventually need surgery.
20%.
What is the indication for immunomodulation in UC.
If there is no remission on steroids.
What can you use for immunomodulation in UC.
Azathioprine/6-mercaptopurine.
What is the relapse rate for UC once remission has been achieved.
All 5-ASAs reduce relapse rate from 80% to 20% at 1 year.
What may be seen on AXR in UC. (3)
No faecal shadows.
Mucosal thickening/islands.
Colonic dilatation.
What should you look for in colonoscopy in UC. (5)
Inflammatory infiltrate. Goblet cell depletion. Glandular distortion. Mucosal ulcers. Crypt abscesses.
Summarise the treatment options available for UC. (5)
5-ASA. Corticosteroids. Azathioprine. Biological therapy (anti-TNF). Colectomy is curative.
Summarise the treatment options for Crohn’s disease. (7)
Corticosteroids. Azathioprine. Methotrexate. Biological therapy (anti-TNF). Nutritional therapy. Surgery for complications is not curative. 5-ASA is not effective.
