What are the sights of Crohn's vs ulcerative colitis?
Crohn's can occur at any position in the alimentary tract
UC occurs in one of three patterns
- Proctitis - rectum only
- Distal colitis - descending and sigmoid colon and rectum
- Extensive colitis - the whole colon
Briefly, what is the pathophysiology of IBD?
Proinflammatory cytokines released by activated T cells in reponse to specific bacterial species - TNF-alpha, IL-1 and IL-6
> Cause tissue damage and further immune cell recruitment
What must be excluded in patients with a severe attack of UC?
Toxic megacolon - urgent surgery required in case of perforation
- Mortality is 15-25%
What are the symptoms of ulcerative colitis?
Diarrhoea with blood and mucus +/- abdominal discomfort
Malaise, lethargy, anorexia
What is found on Ix in UC?
FBE - iron deficiency, CRP, ESR, LFTs
Stool culture to exclude C. diff
Endoscopy for staging of disease
How is UC managed?
Delivery of a aminosalicylate (eg sulfasalazine) to the small intestine wall for mild or moderate disease
GCS for severe episodes with heparin to prevent thromboembolism
Surgical resection if required due to failure to response to medical treatment
Cyclosporin or infliximab
What are the signs on examination of UC?
+/- Tachycardia, pyrexia
Blood on rectal exam
What are the major symptoms of Crohn's disease?
Low grade fever
How is Crohn's disease managed?
Glucocorticosteroids for acute attacks
Antibiotics for secondary complications (ciprofloxacin and metronidazole)
Anti-TNF therapy - infliximab
Surgical resection of bowel and rectum
What Ix would one perform in suspected Crohn's disease?
FBE - Anaemia, CRP, ESR, hypoalbuminaemia
Stool samples for Clostridium difficile
Upper GI endoscopy, small bowel imaging (eg contrast CT)
What might be found on examination in Crohn's disease?
Weight loss, malnutrition
Abdo tenderness, R iliac fossa mass
Oedematous anal tags, fissures or perianal abscesses
Extragastrointestinal manifestations of IBD - eyes, joints, skin, liver and biliary tree
What are the causes of cirrhosis?
Alcoholic liver disease
Non alcoholic steatohepatitis
Chronic viral hepatitis
Chronic billiary disease - primary sclerosing cholangitis, primary billiary cirrhosis
Metabolic - Wilsons, haemachromatosis, alpha1 anti-trypsin deficiency
Drugs eg methotrexate, methyldopa