Lecture 14 – Inflammatory bowel disease Flashcards
IBD is a
- Group of conditions characterised by idiopathic inflammation of the GI tract
- Disease of young (although elderly also affected)
2 common types
crohns disease
UC- young people
- Other IBD
- Diversion colitis
- Pouchitis
- Microscopic colitis
Extraintestinal problems
- NSK pain (up to 50%)
- Arthritis
- Skin (up to 30%)
- Erythema nodosum/pyoderma gangrenous/ psoriasis
- Liver/biliary tree
- Primary sclerosing cholangitis (PSC)
- Eye problem
- Uveitis
- episcleritis
Crohns disease
Affects anywhere in GI tract – from mouth to anus
in crohns disease where is inolved in most cases
ileum
features of crohns
- Transmural- deep inflammation
- Fistulas
- Strictures
- Skip lesions
Ulcerative colitis (UC)
*
- Begins in rectum
- Can extend to involve entire colon (pan-colitis)
features of UC
- Continuous patter
- Mucosal inflammation- not transmural
Causes
*
- Genetic
- 1st degree relative increased risk
- Identical twins concordance 70%
- Gut organisms (altered interaction
- Immune response
- Trigger
- Ab
- Infections
- Smoking
- +ve for smoking
- -ve for crohns
- Diet
presentation of crohns example
- Any inflammations stops us absorbing things–> diarrhoea –> weight loss
- Osmotic pressure drawing water out into the lumen
- Crohns–>. unlikely to have bleeding
- Deeper but less widespread
- Tender mass RLQ
- Terminal ileum common site
- Low grade fever–> arthritis?
- Mild perianal inflammation fistulas and strictures
gross crohns appearance
cobblestone and fistulae
microscopic appearance of crohns
granuloma formation
what will be seen on colonoscopy of Crohns
- Skip lesions
- Hyperaemia- red and inflamed
- Mucosal oedema cobblestones are oedematous
- Superficial ulcers
- Deeper ulcers
- Transmural inflammation
- Thickening of bowel wall
- Narrowing of lumen
- Granuloma formation pathognomonic for crohns
investigating crohns
-
Bloods
- Anaemia
-
CT/MRi scans
- Bowel wall thickening
- Obstruction
- Extramural problems
-
Barium enema
- Used less
- Strictures/fistulae
example presentation of UC
- Can be up to 40 bloody stools a day
- Blood and mucous= affecting mucosa
- Weight loss inflammation uses a lot of calories and diarrhoea can make you lose appetite
- Painful red eye extraintestinal problem
pathological inflammation in UC (microscopic features)
- Chronic inflammatory infiltrate of lamina propria
- Crypt abscesses (Neutrophilic exudate in crypts)
- Crypt distortion (bottom image)
- Irregular shaped gland with dysplasia
- Darker crowded nuclei
- Reduced numbers of goblet cells
- Pseudo polyps can develop after repeated episodes
- Inflammation then healing
- Nonneoplastic
- More common in UC ( vs Crohns)
- Loss of haustra
- Inflammation reduces the appeared of haustra on imaging
loss of haustra in UC
inflammation reduces the appearance of haustra on imaging
UC investigations
Investigations
-
Bloods
- Anaemia
- Serum markers
-
Stool cultures
- C. Difficile
- Faecal calprotectin –>raised with inflammation
- Colonoscopy--> continuous pattern of inflammation that originates in the rectum
- Plain abdominal radiographs
- Barium enema (mild cases only)
- CT/ MRI_-> les suseful in diagnosing uincomplicated UC
problem with diagnosing UC and Crohns
Difficulty distinguishing them
summary of differences between UC and Crohns
Radiology- Crohns
*
- Barium follow through (swallow)- you can sometimes see long strictures
- String sign of kantour–> stricture’s and dilatations following them (skip lesions)
Radiology- UC
- Double contrast enema
- Contrast and Air
- Featureless descending and sigmoidal colon
- Lacking haustral markings
- Lead pope colon
- Continuous lesions without skipping
- Whole colon
- Mucosal inflammation causes granular appearance
Medical treatment options
- 1.
Stepwise approach (start with least toxic drug and build up. Steroids only used for flares)
- Aminoacylates
- Sulfasalazine (5-ASA preparations)
- For flares and remission
- Prednisolone
- Flares only
- Immunomodulators
- Azathioprine
- Fistuals/ maintenance of remission
- Azathioprine
Surgical options
- Crohns
- If patient young- Not curative – want to remove as little bowel as poss- can continue progressing to whole bowel- want to save as much as poss for future
- Only used when strictures/ fistulas
- If patient young- Not curative – want to remove as little bowel as poss- can continue progressing to whole bowel- want to save as much as poss for future
surgical option crohns
- Curable (colectomy)- isolated to large bowel
- Inflammation not settling
- Precancerous changes
- Toxic megacolon
