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Flashcards in Abdo Core Conditions Deck (12):
1

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

2

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

2

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%

3

What are the symptoms of ulcerative colitis?

Diarrhoea with blood and mucus +/- abdominal discomfort

Malaise, lethargy, anorexia

4

What is found on Ix in UC?

FBE - iron deficiency, CRP, ESR, LFTs

Stool culture to exclude C. diff

Endoscopy for staging of disease 

5

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

6

What are the signs on examination of UC? 

Nothing specific

+/- Tachycardia, pyrexia

Blood on rectal exam

 

8

What are the major symptoms of Crohn's disease?

Diarrhoea

Abdominal pain

Weight loss 

Malaise

Lethargy

Anorexia

Nausea 

Vomiting 

Low grade fever 

9

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

10

What Ix would one perform in suspected Crohn's disease?

FBE - Anaemia, CRP, ESR, hypoalbuminaemia

LFTs

Stool samples for Clostridium difficile 

Upper GI endoscopy, small bowel imaging (eg contrast CT)

11

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

12

What are the causes of cirrhosis?

Alcoholic liver disease

Non alcoholic steatohepatitis

Autoimmune hepatitis

Chronic viral hepatitis

Chronic billiary disease - primary sclerosing cholangitis, primary billiary cirrhosis

Metabolic - Wilsons, haemachromatosis, alpha1 anti-trypsin deficiency

Drugs eg methotrexate, methyldopa