The inflam colitis

Question 1

Chrons management

Answer 1

glucocorticoids (oral, topical or intravenous) are generally used to induce remission.
5-ASA drugs (e.g. mesalazine) are used second-line to glucocorticoids but are not as effective

Maintaining remission
as above, stopping smoking is a priority
azathioprine or mercaptopurine is used first-line to maintain remission
TMPT check

surgery-resection –80% need it

perianal fistulae–MRI investigation, symptomatic perianal fistulae are usually given oral metronidazole
perianal abscess
requires incision and drainage combined with antibiotic therapy

Question 2

Chrons sx

Answer 2

weight loss and lethargy
diarrhoea: the most prominent symptom in adults. Crohn’s colitis may cause bloody diarrhoea
abdominal pain: the most prominent symptom in children
perianal disease: e.g. Skin tags or ulcers
extra-intestinal features are more common in patients with colitis or perianal disease

Arthritis: pauciarticular, asymmetric
Erythema nodosum
Episcleritis
Osteoporosis
Arthritis: polyarticular, symmetric
Uveitis
Pyoderma gangrenosum
Clubbing

Question 3

Chrons Ix

Answer 3

C-reactive protein correlates well with disease activity

Endoscopy
colonoscopy is the investigation of choice
features suggest of Crohn’s include deep ulcers, skip lesions
inflammation in all layers from mucosa to serosa
goblet cells
granulomas

Small bowel enema
high sensitivity and specificity for examination of the terminal ileum
strictures: ‘Kantor’s string sign’
proximal bowel dilation
‘rose thorn’ ulcers
fistulae

Question 4

UC sx

Answer 4

Features include:
bloody diarrhoea
urgency
tenesmus
abdominal pain, particularly in the left lower quadrant
extra-intestinal features (see below)

Arthritis: pauciarticular, asymmetric
Erythema nodosum
Episcleritis
Osteoporosis
Arthritis: polyarticular, symmetric
Uveitis
Pyoderma gangrenosum
Clubbing

Question 5

UC ix

Answer 5

care in flare-colonoscpy BAD as perfortate

COLONOSCOPY typical findings:
red, raw mucosa, bleeds easily
no inflammation beyond submucosa
widespread ulceration which has the appearance of polyps (‘pseudopolyps’)
inflammatory cell infiltrate in lamina propria
neutrophils — crypt abscesses
depletion of goblet cells and mucin from gland epithelium

bariun
loss of haustrations
superficial ulceration, ‘pseudopolyps’
long standing disease: colon is narrow and short -‘drainpipe colon’

Question 6

UC Mx

Answer 6

mild: < 4 stools/day, only a small amount of blood
moderate: 4-6 stools/day, varying amounts of blood, no systemic upset
severe: >6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)

flare and remision
Mild-moderate-topical— distal colitis rectal mesalazine
not achieved within 4 weeks, add an oral aminosalicylate
till not achieved add topical or oral corticosteroid

Severe0
should be treated in hospital
intravenous steroids are usually given first-line
intravenous ciclosporin may be used if steroid are contraindicated/dont work (and biologics if ciclosporing) are contra

maintainings
(rectal) aminosalicylate alone (daily or intermittent) or
an oral aminosalicylate plus a topical (rectal)

after >2 flares- Azathoprine, Mercato