L24: Inflammatory Bowel Disease Flashcards
Which layers of the intestinal wall does UC affect?
mucosa + submucosa
Which layers of the intestinal wall does Crohn’s disease affect?
transmural
What are some of the aetiological theories of IBD?
- genetics
- infection (e.g. E. coli, salmonella)
- immunological
Which age group does IBD normally affect?
young adults [15 - 35 years]
Which part of the intestine does ulcerative colitis typically affect?
- rectum
- left side of colon
- sometimes pancolitis
Which part of the intestine does Crohn’s disease typically affect?
- small intestine (only)
- ileocolonic (around ileocaecal valve)
List some of the common symptoms of UC
- bloody diarrhea (w/ mucus)
- cramping abdominal pain
- increased frequency + urgency of defecation
- tenesmus (feeling of incomplete emptying)
What is the True-Love and Witt score used for?
determines severity of of a patient’s UC
What is the name of the severity assessment score that is used for UC?
True-Love and Witt Score
What are the criteria that are a part of the True-Love and Witt score?
- > 6 Blood Stool
- Pulse > 90 BPM
- Temperature > 37.8
- HB < 10.5 g/dL
- CRP: very raised
List some of the common symptoms of Crohn’s Disease
- non-bloody diarrhea (usually)
- abdominal pain
- abdominal mass
- malabsorption + weight loss
- peri-anal fistulas a/w abscess formation
Is weight loss more common in UC or in Crohn’s disease? Why?
Crohn’s Disease
- Crohn’s more commonly affects the small intestine while UC mainly affects the large intestine
What fistulas are the most common in Crohn’s disease?
peri-anal fistulas
What is the Harvey Bradshaw Index used for?
determines the severity of a patient’s Crohn’s disease
What severity score is used for Crohn’s Disease?
Harvey-Bradshaw Index
List the 5 main categories of the Harvey Bradshaw Index which is used to determine the severity of Crohn’s disease
- General Well-Being
- Abdominal Pain
- # of Liquid Stools
- Abdominal Mass
- Complications
List some of the extra-intestinal complications of Crohn’s Disease
- enteropathic arthritis
- uveitis
- erythema nodosum
- pyoderma gangrenosum
- mouth ulcers (aphthous ulcers)
List some of the extra-intestinal complications of Ulcerative Colitis
- osteoarthritis
- ankylosing spondylitis
- primary sclerosing cholangitis (PSC)
- erythema nodosum
- pyoderma gangrenosum
What is the Bristol stool chart used for?
- investigates what type of diarrhea a patient may have
- helps measure the time it takes for food to pass through your body and leave as waste
When can an abdominal x-ray or plain film abdomen (PFA) show when investigating IBD?
- toxic megacolon
- colitis
What can an erect CXR show when investigating IBD?
free air under the diaphragm (due to perforation)
When is a barium follow-through imaging test used when investigating IBD?
for Crohn’s Disease in small intestine
A “cobblestone” pattern upon endoscopy, is indicative of what illness?
Crohn’s Disease
List some of the INTESTINAL complications of ulcerative colitis
- toxic megacolon
- stricture
- bowel perforation
- increased risk of colorectal carcinoma
- fibrosis
- shortening of colon
List some of the INTESTINAL complications of Crohn’s disease
- strictures (leading to obstruction)
- obstruction
- fistula formation (leading to abscess formation)
- abscesses
- adhesions
List the types of fistulas that may occur as a complication of Crohn’s disease
- peri-anal
- entero-enteric (intestine-intestine)
- entero-vesical (intestine-bladder)
- mesenteric
- retroperitoneal
- entero-cutaneous
What is the first-line medications given to treat UC?
5-aminosalicylic acid derivatives (5-ASAs)
- Mesalazine
- Sulphasalazine
Give 2 examples of 5-ASAs which are used in the firstline treatment of UC
- Mesalazine*
- Sulphasalazine
What 2 treatments/medications are given to treat an acute flare of IBD/UC?
- Steroids (e.g. hydrocortisone, prednisolone)
- Antibiotics (if perforation, fistula, peri-anal disease..)
- - e.g. metronidazole
Give an example of an antibiotic that may be given to treat an acute flare of IBD
Metronidazole
List 3 important drugs that may be given to treat resistant/refractory IBD
Immunomodulators:
- Azathioprine
- 6-Mercaptopurine
Biologic Therapy:
3. TNF(alpha) Inhibitors
What can azathioprine and 6-mercaptopurine be used for?
resistant/refractory IBD
In regards to the GIT, what can TNF(alpha) Inhibitors be used to treat?
resistant/refractory IBD
Azathioprine and 6-mercaptopurine may be used to Crohn’s disease. List the side effects of these 2 drugs
- pancreatitis
- hepatotoxicity
- bone marrow suppression
- increased cancer risk
- should not be used in pregnant people!
List some of the indications for surgery in a patient that has IBD
- bowel perforation
- toxic megacolon
- fibrostenotic strictures
- massive haemorrhage
- abscesses
- complex peri-anal or internal fistulas
- risk of cancer
- chronic ill health
Compare the intestinal wall thickness in UC and Crohn’s Disease
UC = normal thickness
Crohn’s Disease = increased thickness
