Week 4.4 - Inflammatory Bowel Disease Flashcards
What is microscopic colitis?
type of IBD need microscope to see inflammation. less common less problematic
What are 2 types of microscopic colitis?
- collagenous colitis (increased thickness of sub-epithelial collagen band)
- lymphocytic colitis - increased no. of lymphocytes
What are symptoms of microscopic colitis?
chronic, non bloody, waterry diarrhoea in mostly women usually 60’s.
What causes microscopic colitis and what is it associated with?
- associated with many autoimmune disorders - coeliac, thyroid disorders, rheumatoid arthritis
- also medications - PPI’s, NSAIDS, SSI’s
How do you treat microscopic colitis?
- take patient off PPI’s, NSAIDs or SSI’s if using.
- if not cause, use first line budesonide steroid
- if still not settles, use stronger immunosuppressant
What is the pathogenesis of IBD?
- genetics, microbiome, environment, smoking, diet, history of gastroenteritis
- genetic SNP’s in genes coding for epithelial barriers, immune response and bacterial handling
- dysbiosis
What are UC symptoms?
bloody diarrhoea, abdominal pain, weight loss, fatigue
What are names for when UC is limited to a specific region?
- proctisis - rectum only
- proctosigmoiditis
- left sided colitis up to splenic flexure
- extensive colitis up to hepatic flexure
- pancolitis entire rectum and large colon
What is the prognosis of UC?
20-30% require colectomy within 10 years
What is a differential diagnosis for proctitis?
chlamydia and gonorrhoea - do rectal swab
how do we score severity of UC?
- truelove and witts criteria
- mild, moderate, severe or fulminant disease
What investigations do we carry out for UC?
- bloods - CRP, WBC, platalets, low albumin - inflammation
- stool cultures - infection
- faecal calprotectin
- colonoscopy and mucosa biopsy
What is calprotectins importance?
- protein marker of colitis found in faeces. tells us likely IBD over IBS. high in other colitis tho..
- 0-50 normal. 50-200 equivocal. 200+ elevated
What is management of acute severe colitis?
- bloods, stool for c.diff, stool chart etc.
- stop NSAID’s, opiates and anti diarrhoea med
- give IV glucocorticoids - methylprednisolone 2x daily
- give potassium may be low due to diarrhoea, heparin for risk of thromboembolism,
- xray for toxic dilatation and faecal loading
What is acute severe colitis?
infection very serious disease requiring emergency medicine. severe diarrhoea with blood and systemic toxicity
What are symptoms of CD?
depend on affected region
- mouth - ulcers
- oesophagus - dysphagia
- small intestine - weight loss and abdominal pain, malabsorption
- colon - bloody diarrhoea
How does CD progress over time?
inflammatory disease - strictures - penetrating disease - fistulas with other organs/ bowel
What are malabsorptive symptoms of CD?
- malnutrition,
- vitamin + nutrient deficiencies,
- anorexia/weight loss
how do you investigate CD? (7)
similar to UC
- bloods,
- stool,
- calprotectin (may be normal if CD limited to other part of GI),
- colonoscopy,
- MRI small bowel,
- capsule endoscopy,
- CT if acutely unwell - rule out abscesses
Crohns vs Ulcerative colitis histology? (5)
- UC no granulomas, CD non-caesiating granulomas
- UC has many goblet cells affected
- both crypt abscesses but UC more
- UC blood and mucus excreted, CD not
- CD transmural, UC limited to mucosa
What is perianal CD? treat?
- severe pain and inability to sit. gives pain, itching, bleeding, purulent stool and incontinence.
- give Rectal EUA and MRI. drain abscess and seton stitch. antibiotics
What are some extra-intestinal manifestations of IBD?
- mouth ulcers
- skin rashes - erythema nodosum
- eye conditions - uveitis, scleritis, iritis
- PSC
What are differential diagnoses’ of IBD?
- other causes of chronic diarrhoea - malabsorption, IBS, overflow diarrhoea
- ileo-caecal TB
- colitis may be IBD - but can be infective or due to ischaemic colitis
What is a long term complication of colitis?
bowel cancer.
- pancolitis have 26X more chance
- left colitis 8x more chance
- proctitis minimal
screen 10 years after diagnosis and as often as indicated depending on severity and risk factors
