Inflammatory Bowel Disorders Flashcards
what is inflammatory bowel disease?
chronic relapsing inflammatory conditions of the bowel:
> crohns
> ulcerative colitis
> (microscopic, collagenous, lymphocytic colitis
how may ulcerative colitis present?
> bloody diarrhoea
abdominal pain
weight loss
describe the inflammation in ulcerative colitis
there is continuous inflammation that begins a the rectum and only effects the colon. there is variable distribution and severity.
describe the markers of a severe attack of ulcerative colitis
> >6 stools a day with blood > fever >37.5 degrees > tachycardia (>90) > raised ESR > anaemia > albumin <30g/l > leucocytosis, thrombocytosis
describe the inflammation in crohn’s disease
there is patchy disease from mouth to anus of skip lesions. the clinical features depend in the regions that are involved.
how might the mucosa look in an endoscopy in crohn’s?
there may be cobbled stone mucosa, areas of inflammation
what are the clinical features of crohn’s disease?
> diarrhoea > abdominal pain > weight loss > malaise, lethargy, anorexia, low grade fever > malabsorption (anaemia, vit defic.)
what may be raised in inflammatory bowel disease (in regards to inflammatory indices)
> ESR and CRP
platelet count
WCC
would you expect haemoglobin and albumin to be high or low in IBD?
low
what level of calprotectin is classed as elevated?
> 200
what has more crypt abscesses, UC or CD?
ulcerative colitis
how are goblet cells effected in UC?
they are depleted
which disorder has granulomas, fistulae and peri-anal disease?
crohn’s disease
what are the manifestations of IBD in the eyes?
> uveitis
episcleritis
conjunctivitis
how may IBD manifest in the joints?
> sacroiliitis
monoarticular arthritis
ankylosing spondylitis
what disorder can cause renal calculi?
crohn’s disease
how may the liver and biliary tree be affected in IBD?
> fatty change
pericholangitis
sclerosing cholangitis
gallstones
how may IBD manifest in the skin?
> pyoderma gangrenosum
erythema nodosum
vasulitis
what is the differential diagnosis for IBD?
> chronic diarrhoea: malabsorption and malnutrition
ileo-ceacal TB
other types of colitis (ischaemic, infective, amoebic)
what must colitis be distinguished from?
> infection
amoebic
ischaemia
describe sclerosing cholangitis
> disease of the bile ducts
multiple stricture
slowly progressive
can lead to cirrhosis
how does the extent of colitis effect the risk for colonic carcinoma?
> pancolitis 26*
left colitis 8*
proctitis minimal
how does the duration of colitis effect the risk for developing a colonic carcinoma?
> <10yrs minimal risk
20 yrs 23*
30 yrs 32*
in extensive colitis how frequently will a 8-20 yr old patient receive a surveillance colonoscopy?
every 3 years
in extensive colitis how frequently will a 30-40 yr old patient receive a surveillance colonoscopy?
every 2 years
in extensive colitis how frequently will a >40 yr old patient receive a surveillance colonoscopy?
every year
how many biopsies are taken during a surveillance colonoscopy in extensive colitis?
every 10 cm, 32 biopsies on average.
what is the general out patient medical management?
> 5ASA
steroids
immunosuppression
what is the general hospital medical management?
> steroids
anticoagulation
rest
(cyclosporine, infliximab, surgery)
what makes up aminosalicylates?
> mesalazine
> pro-drugs
name three pro-drugs
> balsalazide
olzalazine
sulfasalazine
when is rectal 5ASA used in UC?
for distal and more extensive disease
what is the effect of 5ASA in UC?
> 1st line therapy for induction of remission
Dose of >3g per day shows no improvement on remission rate, greater and quicker clinical improvement and no increase in adverse events
1st line therapy for maintenance of remission
Reduced number and severity of relapses
Reduced CRC risk
when can 5ASA be used in crohn’s?
> widely used but little evidence
for induction of remission (in mildly active ileocolonic disease)
in maintenance of Crohn’s (only if remission induced by 5ASA or post-bowel resection)
what are the significant side effects of thiopurines?
> leucopenia
hepatotoxicity
pancreatitis
long term lymphoma risk
why does elemental feeding work better in children?
compliance is difficult as you can only eat disgusting thing for 6 weeks but parents will make their kids do it
what shows a failure of medical therapy?
> recurrent course of steroids
relapse prior to or shortly after stooping therapy
failure to control symptoms
unacceptable complications of steroids (diabetes, severe osteoporosis, psychosis)
what surgeries can be carried out in severe colitis?
> total colectomy
rectal preservation
ileostomy
what is left after a total colectomy?
end ileostomy and rectal stump. pouch procedure)
when is surgery indicated in crohns?
> Failure of medical management
Relief of obstructive symptoms (small bowel)
Management of fistulae - e.g. bowel to bladder
Management of intra-abdominal abscess
Management anal conditions
Failure to thrive
