Week 142 - Inflammatory Bowel Disease Flashcards
What is Crohn’s Disease and what is it characterised by?
- Inflammatory disease affecting the whole thickness of the bowel wall across the whole GIT.
- Characterised by :
- Skip lesions
- Granulomatous nature
What are the risk factors associated with Crohn’s disease?
- Genetic
- Diet
- Smoking
What is the pathophysiology of Crohn’s disease?
- Abnormal response to normal gut flora.
- Immune response mediated by Th1 cells and macrophages leading to-
- Inflammation (Infiltration of neutrophils and macrophages)
- Tissue damage and fibrosis.
- May lead to metaplasia.
What are the macroscopic features of Crohn’s disease?
Skip lesions with the development of ulceration.
Fistulaes, fissures and strictures.
What part of the bowel is most commonly affected by Crohn’s disease?
- Ileum and Colon (50%)
- Small bowel only (30%)
- Colon only (20%)
What are the GI presenting symptoms of Crohn’s Disease?
- Diarrhoea +/- blood
- Abdo pain
- Bloating / Flatulence
- Bowel obstuction
What are the associated symptoms of Crohn’s Disease?
Anorexia
Fever
Weight loss
Dietary deficiency syndromes
Erythema Nodosum and Pyoderma Gangrenosum
Arthralgia
What investigations should be performed for suspected Crohn’s disease?
- FBC (Expect Anaemia and B12 deficiency), Inflammatory Markers, Antibody serology.
- X-ray, Barium follow-through, CT, MRI
- Coloscopy +/- biopsy
What is the medical treatment for Crohn’s disease?
- Glucocorticoids
- 5-ASA drugs
- Infliximab
- Methotrexate
What is ulcerative colitis and what is it characterised by?
Inflammatory disease affecting the mucosal layer of the rectum +/- colon only.
• Characterised by:
- Continual distribution, always starting from rectum.
- Non-granulomatous nature.
What are the risk factors for ulcerative colitis?
- Genetic factors
- Family history
- Autoimmune disease
- Diet
What is the pathophysiology of Ulcerative colitis?
- Abnormal response to normal gut flora.
- Immune response mediated by Th2 cells and B-cells, produce auto-antibodies.
What is the presentation of GI symptoms in Ulcerative Colitis?
- Diarrhoea with mixed in blood and mucus
- Abdominal cramping
- Pain
- Tenesmus
What are the associated symptoms of Ulcerative Colitis?
- Fever
- Weight loss -less than in Crohn’s
- Erythema Nodulosum and Pyoderma Gangrenosum
- Arthralgia
What investigations should be performed for ulcerative colitis?
- Stool sample
- Bloods - FBC, inflammatory markers, U&Es, LFT.
- Abdo X-ray
- Colonoscopy and biopsy
What is the medical treatment for ulcerative colitis?
- Glucocorticoids
- 5-ASAs
- Infliximab
- Ciclosporin
What complications can occur due to Ulcerative Colitis?
- Primary Sclerosing Cholangitis
- Bowel CA
- Toxic Megacolon
Which three drugs (or drug categories) are used to induce remission in IBD patients?
- 5-ASAs
- Glucocorticoids
- Infliximab
What are 5-ASAs and what is their role in treating IBD?
- Aim to induce remission.
- Slow to work (6-8) weeks.
- Side-effects: Diarrhoea, abdo pain, N & V.
- What are the two forms?
- Sulfasalazine
- Mesalazine
What are the two forms of 5-ASAs used in the treatment of IBD and what is the difference?
- Sulfasalazine and Mesalazine
- Mesalazine is coated so does not get absorbed as high and reduces side-effects.
- Side effects of Sulfasalazine include headache, decreased sperm and leukopenia.
What is the role of glucocorticoids in the treatment of IBD?
- Induces remision.
- E.g. Prednisolone, Budesonide
- Quick acting but should only be used for short periods.
- Reduces arachidonic acid which reduces cytokines and therefore reduces inflammatory response.
What is infliximab? What is it’s role in the treatment of IBD?
- Induces and maintains remission, given as an infusion.
- It binds and neutralises to TNF-alpha.
- Side-effects: Immunosupression, increased risk of cardiac failure. Contra-indicated in sepsis, TB, Ca.
What is methotrexate? What is its role in treating IBD?
Used for Crohn’s disease.
An immunosupressant that reduces IL-1 and causes T-cell apoptosis.
What is ciclosporin? What is it’s role in treating IBD?
Used in severe ulcerative colitis.
• Immunosupressant, inhibits the action of T-cells.
