Inflammatory Bowel Disease (LM) Flashcards
Inflammatory bowel dsease?
- IBD is a group of idiopathic chronic, relapsing-remitting inflammatory intestinal conditions
- Disrupts the body’s ability to digest food, absorb nutrition and eliminate waste
Types of inflammatory bowel disease?
- Crohns
- Ulcerative colitis
Ulcerative colitis?
- Disease is limited to the large intestine (colon) and the rectum
- The inflammation occurs only in the innermost layer of the intestinal lining,
Spread of ulcerative colitis?
Usually begins in the rectum and the lower colon but may also spread continuously to involve the entire colon; but may spread continuously to involve the entire colon.
Truelove and Witts severity index for ulcerative colitis?
THE MHB
1. Temperature
2. Heart rate
3. ESR
4. Movements/day (bowel movements)
5. Hb
6. Blood in stool
Mild UC?
T - apyrexia
HR <70/min
ESR<30
Movements<4
Hb>11g/dl
Blood in stool - none or small
Moderate UC?
T - 37.1-37.8
HR - 70-90/min
ESR<30
Movements - 4-6
Hb - 10.5-11g/dl
Blood in stool - moderate
Severe UC?
T>37.8
HR>90/min
ESR>30
Movements - 7-6
Hb <10.5g/dl
Blood in stool - large
Crohns disease?
There is transmural inflammation of the GI mucosa which can affect any part of the GI tract
Spread of Crohns disease?
- Most commonly affects the terminal ileum and colon
- Skip lesions present (affects some areas of the GI tract while leaving other sections completely untouched)
- prone to strictures, fistulas and adhesions
Why is CD associated with strictures?
inflammation occurs in all layers down to the serosa
UC vs CD?
CD - skip lesions
UC - continuous colonic involvement beginning in rectum
Indeterminate colitis?
- In some, it is difficult to determine whether their symptoms are due to Crohn’s disease or ulcerative colitis.
- There is no evidence of small bowel involvement, fistula or perianal disease. There is no diagnostic criteria for CD or UC by microscopy.
Epidemiology?
The peak age of onset of UC and CD is 15 to 30 years.
Second peak 60 to 80
Male:female UC 1:1 and CD 1.1:1.8
Smoking is associated with a two-fold increased risk of CD
If one has IBD the lifetime risk that a first degree relative will be affected is 10%.
More common in white people than in African or Asians ; higher risk in Jews- Ashkenazi jews have higher risk than Sephardic jews
Risk factors in IBD?
- Smoking associated with earlier age of onset of disease and more frequent need for immunosuppression among women with Crohn’s disease but not men
- Smoking cessation is associated with an increased risk of ulcerative colitis.
Etiology of IBD?
- genetic predisposition
- mucosal immune system immuno-regulatory defect
- environmental triggers
- luminal bacteria
- infcetion
- NSAIDs
- smoking
Causes of IBD?
- Diet
- fat intake, fast food, milk and fiber consumption - Infection
- CD: mycobacterium paratuberculosis UC after episodes of infective diarrhoea
Enteric microflora is altered in IBD - Genetics
- HLA, first degree relatives and monozygotic twins - Antibiotics
- Cigarette smoking
- Appendectomy
- Stress
UC symptoms?
- altered bowel movements
- increased stool frequency
- decreased stool frequency - abdominal pain
- LLQ cramping, relieved with defecation
- tenesmus - hematochezia
CD symptoms?
- altered bowel movements
- chronic or nocturnal diarrhea - abdominal pain
- postprandial RLQ abdominal pain
- distension - weight loss
- fever
Clinical features of UC?
- colon only
- rectal involvement
- muscosal disease
- diffuse ulceration, granularity, friability, bleeding, exudate
- no fistulas or granulomas
Clinical features of CD?
- any segment
- rectal sparing
- skip lesions
- transmural
- apthous ulcers, serpiginous ulcers, cobble stoning
- fistulae
- granulomas
Extraintestinal manifestations of UC?
- joint pain or arthralgia
- aphthous ulcer
- ankylosing spondylitis
- pyoderma gangronesum
- erythema nodosum
- iritis
- uveitis
Extraintestinal manifestations of CD?
- joint pain or arthralgia
- inflammatory peripheral arthritis
- ankylosing spondylitis
- Sweets syndrome
- iridocyclitis
- espiscleritis
- uveitis
- pyoderma gangronesum
- erythema nodosum
Extra-intestinal manifestations of IBD?
A PIE SAC
1. Aphthous ulcers
2. Pyoderma gangrenosum
3. Iritis
4. Erythema nodosum
5. Sclerosing cholangitis
6. Arthritis
7. Clubbing of fingertips
Complications of UC?
- massive bleeding
- late hose pipe appearance fibrosis
- rare to have perforation
- rare to have penetration that develops to a fistula
- malignant change
Complications of CD?
- usually non-massive bleeding
- early obstruction
- perforation
- penetration leading to fistula
- rare to have malignant change
