inflammatory bowel disease in children Flashcards
presenting features of Crohn’s
diarrhoea ++
rectal bleeding ++
abdo pain +++
fever +
weight loss ++++
growth failure ++++
arthritis ++
mass ++
presenting features of UC
diarrhoea +++++ (> a few weeks)
rectal bleeding +++++
abdo pain +++
fever +
weight loss +
growth failure +
arthritis +
mass -
diagnosis of IBD
hx and examination - red flag for colitis = nocturnal diarrhoea, bloody diarrhoea
intestinal sx
extra-intestinal manifestations - ulcers, skin rashes, arthrits, erythema nodosum
exclude infection
FHx
growth and sexual development - delayed in Crohn’s
nutritional status
investigations
what is this and when is it seen
erythema nodosum
extra-intestinal manifestation
seen more commonly in CD rather than UC
improves w/ IBD
oral changes in IBD
angular chelitis
mouth ulcers - in the sulci, tongue
- rolled edge ulcers
extra-intestinal manifestations in IBD
erythema nodosum
oral changes - ulcers
perianal changes - tags
investigations for IBD
FBC and ESR - anaemia, thrombocytosis, raised ESR
biochemistry - stool calprotectin, raised CRP (acute severe colitis, toxic megacolon), low albumin (crohn’s - protein losing enteropathy)
microbiology - no stool pathogens
differences between adult and paeds IBD - IBDU/UC/CD, M vs F
adults: IBDU (unclassified) < CD < UC
F>M
paeds: IBDU < UC < CD
M>F
- disease tends to be more severe and extensive
- greater proportion are IBDU than in adults
differences between adult and paeds UC - proctitis
adults: 40%
paeds: 4% <5y/o, 17% 5-17y/o
differences between adult and paeds UC - L sided colitis
adults - 40%
paeds - 14%
differences between adult and paeds UC - pancolitis
adults - 20%
paeds - >60%
differences between adult and paeds CD - isolated ileal disease
adult - 36%
paeds - 6%
differences between adult and paeds CD - ileocolonic disease
adult - 50%
paeds - 45%
differences between adult and paeds CD - upper GI/panenteric
adult - % - if there are largely lower GI Sx, upper GI endoscopy won’t be done
paeds - 51%, typical presentation in children
definitive investigations for diagnosing IBD
radiology (esp CD) - MRI, barium meal and follow through (younger kids)
endoscopy - colonoscopy and upper GI endoscopy, mucosal biopsy, capsule enteroscopy, enteroscopy
what is this condition
UC
what is this condition
CD
what is this condition
mixed picture therefore IBDU
what is this condition
granuloma therefore CD
what is this condition
crypts and pus therefore UC
aims of treatment in IBD
induce and maintain remission
correct nutritional deficiencies
maintain normal growth and development
methods of treatment for IBD
medical: anti-inflammatory, immunosuppressive, biologicals (infliximab)
nutritional: immune modulation, nutritional supplementation
surgical
bottom up treatment for Crohn’s
surgical treatment for Crohn’s
small segment of disease that is affecting growth but not causing a lot of symptoms - resection and end to end anastomosis can work very well
