Inflammatory Bowel Diseases Flashcards
define Crohn’s Disease (CD)
a chronic relapsing inflammatory bowel disease characterised by transmural granulomatous inflammation of the GI tract
describe characteristics of CD
no blood or mucous everywhere in GI tract skip lesions (intermittent lesions) terminal ileum most affected and transmural inflammation smoking IS a risk factor
risk factors of CD
familial history of IBD
smoking
previous infectious gastroenteritis
NSAID usage
clinical features of CD
persistent diarrhoea
abdominal pain/discomfort
weight loss
fatigue/malaise
extra-intestinal manifestations of CD
erythema nodosum
anaemia
fever
differentials of CD
UC coeliac disease acute appendicitis IBS malignancy
gold standard investigation of CD
OGD and colonoscopy with biopsy
common examination findings in those with CD
abdominal tenderness/mass in RLQ
perianal pain/tenderness
anal/perianal skin tags, fissures, fistulas or abscess
signs of malnutrition/absorption
blood test investigations and common findings in CD
FBC, ESR, CRP, U+E, LFTs, ferritin, B12 and folate
- often have ⬆️ CRP which indicates inflammation and active disease
- also have ⬇️ albumin and anaemia
additional investigations in CD
stool test for faecal calprotectin as ⬆️ released in inflamed intestines
utilise CT, US and MRI to detect complications
management of CD - inducing remission
glucocorticoids (e.g. prednisolone or IV hydrocortisone)
If >2 exacerbations in 12mnths:
+ azathioprine or mercaptopurine
If other treatment fails:
biologics (e.g. infliximab)
management of CD - retaining remission
azathioprine or mercaptopurine
if intolerant, uneffective or contraindicated:
methotrexate
indications for surgery in those with CD
only distal ileum affected frequent relapse intolerance to medical therapy steroid dependency developed elective by patient
surgical procedure utilised in CD
subtotal colectomy and rectal preservation ileostomy
common complications in CD
abscess
strictures
psychosocial impact
fistulas
define ulcerative colitis (UC)
a chronic, relapsing-remitting inflammatory disease of the GI tract characterised by diffuse, continuous superficial inflammation of colonic mucosa
describe characteristics of UC
continuous inflammation limited to colon + rectum only superficial mucosa affected smoking is protective excrete blood and mucus use Aminosalicylates primary sclerosing cholangitis
risk factors of UC
familial history (1st degree)
NSAID use
non-smokers
no PMH of appendicectomy
clinical features of UC
persistent bloody/mucous diarrhoea >6wks faecal urgency/incontinence tenesmus and pre-defecation pain LLQ pain weight loss fatigue/malaise
examination findings in UC
pallor clubbing apthous mouth ulcers abdominal distension/tenderness in LLQ signs of malnutrition/malabsorption
differentials of UC
CD infective colitis diverticulitis coeliac disease intestinal ischaemia malignancy
gold standard investigation of UC
colonoscopy with biopsy of mucosa
blood tests for suspected UC and common findings
FBC, CRP, ESR, U+E, LFTs, TF, platelets, ferritin, B12, folate and coeliac serology
⬆️ CRP, WCC and platelets as active infection
⬇️ FBC and albumin
additional investigations of UC
stool tests (e.g. c.diff toxin assay
+ faecal calprotectin)
MRI
