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Exam - M - GI Diseases > IBD - Crohn's + Ulcerative Colitis > Flashcards

IBD - Crohn's + Ulcerative Colitis Flashcards

1
Q

Which IBD is most common?

A

Ulcerative Colitis

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2
Q

Which age are you most likely to be diagnosed with ulcerative colitis?

A

15-25

55 -65

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3
Q

Where is abdominal pain most likely to be in ulcerative colitis?

A

Left iliac fossa.

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4
Q

What is PSC?

A

Primary sclerosis cholangitis - much more common in ulcerative colitis than crowns.

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5
Q

Which part of the GI system can ulcerative colitis affect?

A

the colon and rectum.

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6
Q

Which part of the mucosa is affected in ulcerative colitis?

A

Only superficial mucosa.

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7
Q

Which IBD has skip lesions?

A

Crohns

Ulcerative colitis is continuous.

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8
Q

What is a protective factor for ulcerative colitis?

A

Smoking

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9
Q

What are GI signs of ulcerative colitis?

A 
Excretion of blood and mucous 
Diarrhoea
Urgency 
Pain in left iliac fossa
Weight loss
Fever
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10
Q

Which medication is used to induce remission of MILD TO MODERATE ulcerative colitis?

A

1st line: Aminosalicylate - mesalazine (Oral or rectal)

2nd line: corticosteroids (prednisolone)

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11
Q

What are non GI signs in ulcerative colitis?

A 
Primary sclerosis cholangitis
Clubbing
Anterior uveitis
erythema nodosum
asymmetrical arthritis
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12
Q

What are very serious complications of ulcerative colitis?

A

Toxic megacolon

Colorectal cancer

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13
Q

What medication is used to induce remission of SEVERE ulcerative colitis?

A

1st line: Corticosteroids (Hydrocortisone)

2nd line: IV ciclosporin

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14
Q

Which medications can be used to maintain remission of ulcerative colitis?

A

Aminosalicylate (mesalazine) - oral or rectal
Azathioprine
Mercaptopurine

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15
Q

What surgery can be done in ulcerative colitis?

A

Panproctolectomy - left with permanent ileostomy or J pouch.

Colectomy - left with temporary end ileostomy.

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16
Q

What is seen on histology in ulcerative colitis?

A

inflammatory granulomas that only affect the superficial layer

17
Q

What is seen on histology in crohns?

A

inflammatory granulomas that are transmural (full thickness).

18
Q

What age is crohns commonly diagnosed at?

A

15-40

60-80

19
Q

What risk factors are there for crohns?

A

Caucasian
Family history
smoking (a protective factor in UC)

20
Q

What are the GI symptoms of crohns?

A

Crampy abdominal pain
RIGHT lower quadrant pain
diarrhoea
Gallstones (more common in crohns than UC)

21
Q

What are the non GI symptoms of crohns?

A 
Weight loss
fever
aphthous ulcers in mouth
erythema nodosum
anterior uveitis
arthritis
gallstones
22
Q

Which test can be done for both ulcerative colitis and crohns to distinguish the difference between IBD and IBS?

A

Faecal calprotectin - calprotectin is released by the intestines when they are inflamed
90% specific to IBD

23
Q

What other tests can be done for IBD?

A 
Routine bloods
CRP - to indicate infection
Faecal calprotectin
Endoscopy (OGD)
Colonoscopy
CT
MRI
24
Q

Which sign is seen on imaging of crohns?

A

String of kantor

25
Q

Is blood or mucous seen in crohns?

A

Much rarer than in ulcerative colitis

26
Q

which parts of the GI tract does crohns affect?

A

Can affect whe whole tract from the mouth to the anus - has skip lesions (parts that aren’t affected)

27
Q

What is seen on endoscopy?

A

Skip lesions

Transmural inflammation

28
Q

Which part of the Gi tract is affected most in crohns?

A

terminal ileum.

29
Q

What are the complications of crohns?

A 
primary sclerosis cholangitis (much less common than UC)
Gallstones (more common than UC)
Strictures
Fistulas
Weight loss
30
Q

Which medication can be used to induce remission of crohns?

A

Steroids:
prednisolone
hydrocortisone

OR (if this doesn't work) add an immunosuppressant:
Azathioprine
Mercaptopurine
Methotrexate
Infliximab
Adalimumab
31
Q

Which medication is used to maintain remission in crohns?

A

tailored to the patient
1st line:
azathioprine
mercaptopurine

OR
methotrexate
inflixumab
adalimumab

(Lots of people don’t take medications when they are well)

32
Q

What might children be offered for treatment of crohns instead of steroids?

A

Enteral feeding

Because steroids stunt growth

33
Q

What are the main points when considering crohns?

A

Signs - Intermittent abdo pain, NON bloody diarrhoea, Aphthous ulcers in the mouth, Arthritis, Erythema nodosum
Linear patches of damaged colon with normal mucosa in between
Can happen anywhere but rectum is spared
Worst at terminal ileum
Smoking is risk factor
Complications – strictures, fistulas, High risk of kidney and gallstones, colorectal cancer
string sign on barium enema
Inflammation only part of the way round

34
Q

What are the main points when considering ulcerative colitis?

A

Signs - Intermittent abdo pain, NON bloody diarrhoea, Aphthous ulcers in the mouth, Arthritis, Erythema nodosum
Linear patches of damaged colon with normal mucosa in between
Can happen anywhere but rectum is spared
Worst at terminal ileum
Smoking is risk factor
Complications – strictures, fistulas, High risk of kidney and gallstones, colorectal cancer
lead pipe sign (inflammation all round)

35
Q

Is surgery done in crohns?

A

Very rarely as its very rarely curative.

Exam - M - GI Diseases (35 decks)

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