L14 inflamm bowel dis

Question 1

crohns:

Answer 1

-affs anywhere GIT- SI 70-80%. ileum inv most cases.
transmural- can aff whole thickn of bowel.
skip lesions occ in discrete areas bowel.
mouth ulcer poss.
chronic inflamm.
most comm in termin ileum and more proxim colon.

Question 2

UC

Answer 2

-us begin in rectum can ext proxim to inv ent colon. chronic muc inflamm princip rectum and sigm.
can aff termin ileum- backwash ileitis.
contin patt.
mucaosal inflamm not x.

Question 3

LO1: desc causes of int inflamm and infec.

Answer 3

-genet- 1st deg rel incr risk. twin assoc.
gut organisms- alt interac.
imm resp-?trigg- AB, infec, smok (crohns risk, protective UC), diet.

Question 4

LO2: desc clinic presents assoc comm IBD and var of symps sep pathol conds may cause.

Answer 4

CROHNS:
- eg yng fem, few weeks multip loose stools per day, non bloody. weight loss. RLQ pain as termin ileum comm. some jnts pain lower limb. smoker. tender mass RLQ. mild perianal infamm ulcerat. low grade fever. mild anaemia.
- gross pathol- inflamm. hyperaemia, muc oedema, discrete superfic ulcers, deep ulcers, transmural inflamm x thickn of bowel and narr lumen. proc relapses and remitts. as settles get fibrosis, then furth inflamm. cobblest- lin deeper ulcers and areas unaff mucosa or odemitous tiss.
fistulae- joining epith lined strucs as transmural dam. bowel to bowel/vag/bladd/skin.
-microsc- epitheloid granuloma format pathognomonic.
-slight less preval UC. incr in W. uncomm in LDC.
-if ileum aff present as pain often assoc diarr. comm malabs= weight loss. anaem if termin ileum as poor abs vitB12. inflamm sev=int bstruc v dang.
-if colon only- present sim UC. bloody diarr, mucus faeces, malaise, anorex, weight loss.
many cases inv both.

UC:
eg yng fem, couple mnth multip urgent bloody diarr per day. mucus ins tool as colon shed cells and mucus, transmural. weight loss- slough and renew active proc and decr appet. mild lower abdo pain/cramp. painf red eye. no peianal dis. norm temp. less systemic.
-pathol changes- chronic inflamm infiltrate of LP. crypt abscesses and distortion- full of inflamm cells, heal=fibrosis. ECM odemitous, lot fluid. goblet cell decr. pseudopolyps-raised area. loss haustra. fairly contin. after 1st often most sev event, us remitt relapse aff QoL.

Question 5

LO3: desc comm meth investig IBD.

Answer 5

CROHNS: can aff whole gut.
examin- peri anal dis-ext ulcer, skin fistula, skin tags from inflamm and heal.
bloods- CRPs etc inflamm. anaem.
CT/MRI- not just scope as extensive and transmural. bowel wall thicken. obstruc. extramural probs. ulcerat.
barium enema/foll through- bad if active eg perfor. structure/fistulae.
cam pills not det.
colonosc shows ulcerat fissures or tiss.
radiology- narr lumen, alt wider, not contin, areas fibrosis.
-managem sim UC- but poss surg resec bowel if bad.
UC:
bloods- anaem. serum markers.
stool cult- check not infective cause bloody stool.
pain abdo radiographs- not as val now.
barium enema if mild.
CT/MRI- less usef if uncomplic confined to colon.
colonosc- patches.
radiology- straight colon- rep inflamm and heal prev haustra. dotty-areas inflamed mucosa pick up contrast diff. all areas colon often.
-managem- reduc unfamm using steroids. LT maint on amino-salicylates eg sulphasalazine.

• diffic disting- imp as diff tx and ongoing investig/affs. 10% indeterminate colitis.

Question 6

IBD grp conds char by idiopathic inflamm of GIT.

Answer 6

-2 comm types:
crohns affs 15-30yo and over 60.
UC yng ad.
others:
diversion colitis- ileostomy leave bit free bowel, inflamed.
pouchitis- colon rem leave rectal pouch or nd ileum join rectum, inflamed.
microsc colitis.
-IBD 0.3% pop. incid 20/100000. us prolonged remitt relapsing. can be debil.
-can be systemic- not just bowel.
extraint probs- MSK up to 50%. arthritis.
skin up to 30%- erythema nodisum- pain, red, ant leg. pyoderma gangrenosum. psoriasis.
liv/bil tree- prim sclerosing cholangitis PSC.
eye probs up to 5%- sclera inflamm.

Question 7

Tx medical-stepw

Answer 7

• aminosalicylates- sulfasalazine for flares and remiss.
• corticoster- prednisolone-acute flares only. not remiss as aff adren cortex etc.
• immnomodul- azathiprine- fistulas in aggress dis, or remiss if aminosalic not work.
• some AB anti inflamm but not really used.
• lifestyle too.

Question 8

Tx surg

Answer 8

CROHNS:
-not curative as can aff whole GIT. rem/rep strictures/fistulas. rem as little bowel as poss prev short bowel synd. surg and inflamm risk adhesions of bowel=pain.
UC:
-curable as colectomy. us termin ileum stoma then anast rejoin- can have some continence by create pouch with some contr.
if inflamm not settle, preCA changes as rep inflamm, incr endosc screen. toxic megacolon-acute and rap distens to pt of perfor, becomes sytemic, rupt, v dang.