Inflammatory Bowel Diseases Flashcards
What patients are more likely to have inflammatory bowel diseases
20-25 and 50-80 year olds
Crohn’s - male > female
Ulcerative colitis - female > male
White > black
What are common causes of inflammatory bowel diseases
Food intolerance
Persisting viral infection/immune activation
Smoking
Genetic
Where does Crohn’s disease affect
Can affect any part of the GI tract
Popular site is the ileocaecal region
What area does ulcerative colitis affect
Starts at the distal part of the bowel and can move continuously forward through the large intestine
Will always be present in the rectum then extend upwards
Describe the features of ulcerative colitis
Disease continuous Rectum always involved Anal fissures in 25% of cases Ileum involved in 10% of cases Mucosa granulus with ulcers Vascular Serosa not affected
Describe the features of Crohn’s disease
Discontinuous Rectum involved in 50% of cases Anal fissures in 75% of cases Ileum involved in 30% of cases Mucosa has cobbled appearance with fissures Non-vascular Serosa inflammed
Describe the microscopic features of ulcerative colitis
Vascular appearance
Inflammatory change in mucosa
Mucosal abscesses present
Describe the microscopic features of Crohn’s disease
Transmural
Oedema due to blockage of lymphatics caused by granulomas - giant cells - which are occupying the lymphatic draining channels
How does Crohn’s disease present endoscopically
Cobblestone surface
Areas of tissue oedema separated by fibrous bands which are effectively producing a quilted effect
How does Crohn’s disease present on the skin
Perianal tissue where there is mucosal tagging, growth of the mucosa and inflammatory changes
Same things around the mouth
How does ulcerative colitis present endoscopically
Erythematous inflammatory area present in multiple parts of the bowel, continuous from the rectum
What are the symptoms of ulcerative colitis
Diarrhoea
Abdominal pain
PR bleeding
What are the symptoms of Crohn’s disease
Same as UC if in the large intestine
Small bowel - pain, malabsorption, obstruction, anal disease
Mouth - orofacial granulomatosis
What investigations are carried out in inflammatory bowel diseases
Blood tests - anaemia, CRP, ESR
Faecal Calprotectin
Endoscopy
Why are anaemia tests useful for inflammatory bowel conditions
Will tell whether there is much blood loss or bleeding over time
Give examples of inflammatory markers and explain why they are useful for inflammatory bowel diseases
C reactive protein and erythrocyte sedimentation rate
Helpful for looking at whether there is a general inflammatory process underway in the body
What is faecal calprotectin
A test which can be carried out on the stool looking for an inflammatory protein calprotectin
If there is inflammation within the bowel, calprotectin secretion from epithelial cells into the bowel will increase
Why is faecal calprotectin used
To monitor activity in inflammatory bowel disease as it will often rise before the patient develops symptoms and treatment can be tailored to the patients needs
What is the disadvantage of using an endoscope for inflammatory bowel diseases
Sometime difficult to get the scope through the bowel
What can be carried out instead of an endoscopy
Leukocyte scan - leukocytes sent to inflammatory area and then monitored by a detector
Barium meal
Bullet endoscopy - camera will photograph the bowel as it passes through
What are the complications with inflammatory bowel diseases
Over years of inflammatory change, can develop a carcinoma
How is the carcinoma risk of ulcerative colitis dealt with
Take surveillance of the bowel and if the patients symptoms are controlled it saves them an operation and a colostomy
What different medical treatments are available for inflammatory bowel disease
Systemic steroids - prednisolone
Local steroids - rectal administered
Anti inflammatory drugs - 5ASA based drugs
Non steroid immunosuppressants
Anti TNFa therapy - infliximab, adalimumab
Give examples of 5ASA drugs
Pentasa
Mesalazine
Sulphasalazine
