W11 IBD, UC & Crohn's Disease Flashcards
What is IBD? (2)
Between what ages is it commonly diagnosed?
Inflammatory Bowel Disease
Collective term used to describe 2 conditions that cause inflammation of the GI tract
1. Ulcerative Colitis (UC) – Mostly affects colon and rectum
2, Crohn’s Disease (CD) – can affect anywhere in GI tract
* Can affect any age - mostly diagnosed between age 15-40
What are the symptoms of Inflammatory Bowel Disease? (6)
- Pain, swelling, cramping of the abdomen
- Recurring diarrhoea
- Bloody diarrhoea
- Weight loss
- Tiredness
- Also – Joint pain, red eyes, erythema nodosum, pyoderma gangrenosum, jaundice
- Symptom fluctuation – flare ups or periods of minimal/no symptoms (remission)
What are the Extra-intestinal Symptoms in IBD?
- Symptoms that manifest outside of the GI tract
-occur in roughly 30% of UC patients and 6% CD patients - More common in CD
- Can present before any GI symptoms
What are the Extra-intestinal Symptoms in IBD that are related to disease activity? (7)
- Pauci-articular arthritis
- Erythema nodosum -tender red bumps on shins
- Mouth Ulcers
- Episcleritis- a common condition affecting the episclera, the layer of tissue between the surface membrane (conjunctiva) and the firm white part of the eye (the sclera).
- Osteopenia, Osteoporosis,
- Osteomalacia-a metabolic bone disorder characterized by the inadequate mineralization of bone tissue
- VTE
What are the Extra-intestinal Symptoms in IBD that are NOT related to disease activity? (8)
- Axial arthritis
- Polyarticular arthritis
- Pyoderma gangrenosum
- Psoriasis
- Uveitis
- Hepatitis
- Liver Cirrhosis
- Gallstones
*rare condition that causes large, painful sores (ulcers) to develop on your skin, most often on your legs
What is Ulcerative colitis? (definition)
- Defined as – “chronic, relapsing-remitting, non-infectious inflammatory disease of the gastrointestinal tract” (NICE, 2019)
- Diffuse, continuous inflammation of intestinal mucosa in the colon and rectum
- Immune mediated, impaired epithelial barrier function, chronic inflammation
What can UC be classed as? (3)
Occurs in what areas?
- Ulcerative Proctitis – Inflammation in the rectum only, doesn’t extend to colon
- Left-sided colitis – Inflammation that doesn’t extend past the splenic flexure, a.k.a proctosigmoiditis
- Extensive colitis – Inflammation extends beyond the splenic flexure, can extend through the whole colon (pancolitis)
What are the risk factors and complications of Ulcerative colitis?
- Risk Factors – Family history, no appendicectomy, NSAIDs, Non-smoker
- Complications – Psychosocial impact, bowel obstruction, bowel perforation, intestinal stricture, fistula, iron deficiency, malnutrition, growth failure, pouchitis, colorectal cancer
What is toxic megacolon?
- Potential life-threatening complication
- Dilatation of the colon with increasing abdo. pain & systemic symptoms
- Colonectomy possibly required
- Abso x-ray shows dilatation of transverse colon
- Causes - relapse, infection, hypokalaemia, hypomagnesaemia, anti-diarrhoeal medication
What are the symptoms of UC?
➢ Bloody diarrhoea/rectal bleeding for more than 6 weeks
➢ Faecal urgency and/or incontinence
➢ Painful, persistent urge to pass stool even when rectum is empty (Tenesmus)
➢ Pain in lower left quadrant (LLQ) of abdomen
➢ Pain before passing stool – relieved after passing
➢ Fatigue, malaise, fever, anorexia
➢ Weight loss (unexplained), faltering growth, delayed puberty
➢ Family Hx of IBD, Coeliac or Colorectal Canc
What can be determined from examination of an UC patient?
➢ Pale ,finger clubbing, mouth ulcers
➢ Distension, feeling of a lump or tenderness in LLQ
➢ Signs of malnutrition or malabsorption
➢ Red eyes, skin rash, joint pain or swelling
➢ Physical exam may not be abnormal in mild or moderate disease
How to manage a patient with suspected UC?
4 symptoms that lead to hosp admission?
Patient systemically unwell with symptoms and signs of severe disease – Hospital admission
➢ Fever
➢ Bloody diarrhoea
➢ Tachycardia
➢ Hypotension
- Admission not needed - refer urgently to gastroenterology (paeds or adult) for specialist investigations to confirm diagnosis
- Avoid anti-diarrhoeal treatment – toxic megacolon risk
- Refer to appropriate specialist if pt. has extra-intestinal symptoms e.g. Dermatology if has skin symptom
What is the Differential Diagnosis of UC?
- Crohn’s Disease
- Infective Colitis – Gastroenteritis, C.Diff
- Microscopic Colitis
- Intestine ischaemia
- Diverticulitis
- Coeliac Disease
- IBS, Laxative misuse/abuse
- Anal Fissure
- Colorectal Cancer
- Endometriosis
