L6 - Inflammatory Bowel disease Flashcards
Describe acute diverticulitis?
- altered gut motility
- due to increased luminal pressure
- disordered colonic microenvironment
- commonly affects sigmoid column diverticula
- severe pain in left iliac fossa
An abdominal examination of a patient with acute diverticulitis may show?
- tenderness
- guarding
- ridgidity
- palpable tender mass in left iliac fossa
Mild attack of acute diverticulitis treated with?
oral antibiotics
- ciprofloxciccin
- metronidazole
Complications of diverticular disease?
Perforation
- could lead to formation of paracolic or pelvic abscess or generalised peritonitis
Fistula formation
- into bladder, causing dysuria or pneumaturia
Pneumaturia
Passage of air in urine.
What happens do the mucosal surface in diverticullitis?
Mucosal surface becomes ridged due to hypertrophy of the underlying muscle.
Opening of the diverticular can be seen between the mucosal ridges.
State two main examples of inflammatory bowel disease?
Ulcerative colitis
- colon, rectum
- extends only into the mucosa and submucosa
Crohns disease
- involves any area of the GI tract
- typically occurs across entire length (transmucosal)
How might IBD result from?
- altered composition of gut microbiome
- aberrant mucosal immune response
- intestinal epithelial dysfunction
- alteration on host interaction with intestinal microbiota
Describe appearance of Crohns disease
- linear mucosal ulcers which impart cobblestone like appearance in mucosa.
- thickened intestinal wall.
Ulcerative colitis
Relapsing disorder characterised by attacks of bloody diarrhoea with stringy mucoid material, lower abdo pain and cramps.
Increase in CRP might indicate?
Gangrenous evolution of disease esp if associated with leukocytosis and neutrophilia.
Appendicitis
Inflammation of the inner lining of the vermiform.
Obstruction of appendiceal lumen.
Cause an increase of pressure within the lumen.
Compare and contrast Crohn’s disease with ulcerative colitis?
Crohn’s disease
- common in smokers
- can affect mouth to anus
- transmural inflammation
- surgery not curative
Ulcerative colitis
- common in non/-ex smokers
- affects only the colon
- superficial inflammation
- surgery regarded as curative
Peak onset of IDB
15-30 y/o
Pouchitis
Inflammation of the ileal pouch.
Ileal pouch is an artifical rectum surgically created out of ileal gut tissue in patients who have undergone a colectomy.
Strictureplasty
Surgical procedure performed to alleviate bowel narrowing due to scar tissue that has built up in the intestinal wall from inflammatory bowel conditions such as Crohn’s disease.
Dysbiosis
Microbial imbalance.
- loss of beneficial bacteria in gut
- potentially harmful bacteria taking over gut
- less diverse bacteria
Tenesmus
Continual or recurrent inclination to evacuate the bowels.
Some symptoms of ulcerative colitis
Rectal bleeding Tenesmus Urgency Diarrhoea Cramping Nocturnal symptoms
Erythema nodosum
Swollen fat under the skin causing red bumps and patches.
What factors indicate acute severe colitis?
- Excessive stoools per day
- high temperature >37.8 degrees
- bpm >90
- haemoglobin < 10.5
- erythrocyte sedimentation rate >30
Typical symptoms of Crohn’s disease?
- abdominal pain
- diarrhoea
- weight loss
- rectal bleeding
- fistulae
Extra-intestinal manifestation of Crohn’s disease?
Arthralgia - pain in joint Uveitis - eye inflammation affecting middle layer of tissue in eye wall (uvea) Iritis - inflammation of iris Pyoderma gangrenosum - large painful sores that develop on skin
T-cell trafficking mediated by what…
Interactions between integrins (on leukocytes) and ligands (receptors) on endothelium.
Treatment for IBD
Anti-TNF
Azathioprine
Steroids
5-ASA, antibiotics
Summarise types of surgery which may be conducted in a patient with IBD
- Right hemicolectomy with or without temporary ileostomy
- strcituroplasties (multiple strictures)
- small bowel resections
- permament stomach
