Crohns & Ulcerative Collitis Flashcards Preview

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Flashcards in Crohns & Ulcerative Collitis Deck (13)
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1

Pathophysiology of Crohn's & UC

  1. Genetics - NOD2 dysfunction
  2. Mucosal immune responce
    • Crohns
      • IFNy ⇒ TH⇒ IFNy
      • TGFB/ IL6 ⇒ TH17 ⇒ IL17, 21, 22
    • UC
      • IL4 ⇒ TH⇒ IL4, 5, 13
  3. Epithelial barrier defects
  4. Microbiota

2

What are the features & differences between Crohns & UC?

  • Crohns
    • Entire GIT
    • Transurmural, segmental, thick cobblestone granulomas
    • TH1 & TH17
  • UC
    • Rectum (proctitis ½), L-sided colitis (⅓) & pancolitis (¼)
      • Backwash ileitis: proximal to ileocaecal valve
    • Hyperaemic mucosa, continuous, pseudopolyps & ulcers
    • TH2

3

What are differences in symptoms & signs of Crohns & UC?

Not including extraintestinal signs

  • Crohns
    • Diarrhoea & urgency
    • Abdo pain
    • Weight loss/ failure to thrive
    • Fever, malaise, anorexia
  • UC
    • Diarrhoea +/- mucus/ blood
    • Crampy abdo discomfort
    • Fever, malaise, anorexia, weight loss

4

Outline the extraintestinal signs in IBD

PIESAC

  • Pyoderma gangrenosum
  • Iritis, conjunctivitis, episcleritis
  • Erythema nodosum
  • Sacrolitis, arthritis
  • Ankylosing spondylitis
  • Clubbing, cholangiocarcinoma, fatty liver

5

How to you access the severity of UC?

Truelove & Witts criteria modified including CRP

  • Motions /day [<4-6
  • Rectal bleeding [small-mod-large]
  • TºC @ 6am [<37.1-37.8
  • Resting pulse [<70-90
  • Haemoglobin [>110-105>]
  • ESR/ CRP [<30< / <16-45

6

Outline the complications of UC

Complications of UC

  • Perforation & bleeding
  • Toxic megacolon (mucosal islands, d=>6cm)
  • Venous thrombosis (give prophylaxis)
  • Colonic cancer

7

Outline the mechanism of action of 5-aminosalicylic acid

Anti-inflammatory aminosalicylate that acts predominantly in the gut

Used in UC & Crohns

eg Mesalazine

8

Outline the mechanism of action of Azathioprine

Purine analogue immunosuppressor inhibiting DNA synthesis in most-proliferating cells

9

Outline the medical treatment for UC

Inducing remission

  • 5-aminosalicylic acid
    • eg Sulfasalazine/ mesalazine
  • Corticosteroids
    • eg Prednisolone 20mg/d +/- 2/d steroid foams PR (hydrocortisone) or Prednisolone retention enemas

2nd line

  • UP oral prednisolone 40mg/d (reducing over 6wks)
  • Azathioprine (metabolite 6-mecaptopurine)

3rd line

  • Admit - NBM, IV fluids
  • Hydrocortisone 100mg/6hr IV + rectal hydrocortisone
  • No improvement ⇒ colectomy or rescue therapy (ciclosporin/ infliximab)

Immunomodulation if no remission with steroids.

10

Outline the surgical treatment for UC

  • Proctocolectomy + terminal ileostomy
  • May be possible to retain ileocecal valve
    • Colectomy with ileo-anal pouch

11

Outline complications of Crohns

Complications of Crohns;

  • Small bowel obstruction
  • Toxic megacolon (>6cm, rarer than UC)
  • Abscess formation
  • Fistulae (10%)
  • Perforation & bleeding
  • Colon cancer

12

Outline the medical and surgical treatments of Crohns

Mild: Prednisolone 30mg/d PO

Severe:

  • Admit + fluids
  • IV steroids
  • Hydrocortisone
  • Metronidazole
  • Infliximab/ adalimumab

13

Outline the mechanism of action of Infliximab & Adalimumab

TNFa inhibitor

TNFa promotes Neutrophil activity, granuloma formation, complement activation and CD4+ T-Cells