Flashcards in IBD 1 - Clinical aspects Deck (46)
What is the name of the overlap condition between Crohn's disease and ulcerative colitis?
How does Crohn's disease tend to present? (2)How does ulcerative colitis tend to present? (2)
Crohn's:-abdo painperi-anal diseaseUC:-diarrhoea-bleeding
What are the 3 overlapping factors why people tend to develop IBD?
Genetic predispositionMucosal immune system problemEnvironmental triggers
What is the best established risk factor for IBD development?
Positive family history
What mutations lead to a higher risk of developing Crohns disease?
Mutation in NOD2 (on chromosome 16) - also called CARD15 or IBD-1Encodes a protein involved in bacterial recognition
Amount of bacteria present in Crohn's?Amount of bacteria present in UC?
Crohn's = too muchUC = too little
What are 4 pieces of evidence regarding the role of gut flora in IBD?
-gut flora is indispensable to the development of animal models of colitis-antibiotics effective in the treatment of peri-anal Crohn's disease-diverting faecal stream helps Crohn's-altered bacterial flora in colons with UC
What are the 4 theories of IBD pathogenesis?
Pathogenic bacteriaAbnormal microbial compositionDefective host containment of commensal bacteriaDefective host immunoregulation
Which IBD does smoking aggregate and which does it protect against?
Aggravates Crohns and protects against UC
Which pain relief should you not take when you have IBD?
What is ulcerative colitis?
Inflammation of the colon of unknown aetiology
Peak age incidence?
20 - 30s
What type of course does UC follow?
A relapsing corse
What part of the gut does UC affect?
Affects rectum extending proximally to the caecum
What are the names of the 3 different UC extents and what part of the bowel does each affect?
Proctitis = just rectumLeft sided colitis = to splenic flexurePan-colitis = to ileocaecal valve
What is the natural history of UC 1 year after diagnosis?
10% = colectomy52% = active disease38% = remission
Diarrhoea + bleeding (main)increased bowel frequencyurgencytenesmusincontinencenight risinglower abdominal pain (esp. LIF)(practice can cause constipation due to inflammation in the rectum preventing them from passing stool)
What is the Truelove and Witt criteria for severe ulcerative colitis?What does meeting this criteria mean in terms of clinical outcomes?
passing greater than 6 bloody stool in a 24 hour period1 or more of:fever (greater than 37.8)TachycardiaAnaemiaelevated ESR/ CRP30% risk of colectomy
Further assessment of UC?
Bloods (CRP and albumin (a negative acute phase reactant which decreases in sepsis or inflammation)Plain AXREndoscopyHistology
What are you looking for on a plain AXR in a UC patient? (3)
Stool distribution (none in inflamed colon)Mucosal oedema = thumbpriningToxic megacolon
What is toxic megacolon? Widths?
an acute toxic colitis with dilatation of the colonTransverse greater than 5.5cmCaecum greater than 9cm
What would be seen in endoscopy of a patient with UC? (5)
Confluent inflammation/ ulceration extending proximally from anal margin to "transition zone"Loss of vessel patternLoss of hausfrauGranular mucosaContact bleedingPseudopolyps sometimes(endoscopy used to define extent)
Histology:what layers of the colon does ulcerative colitis affect?What cells are absent in histology of UC?What happens to the crypts in UC?
Mucosal layer onlyGoblet cells are absentCrypts can become distorted and enlarged and accesses can form
Long term complication of UC?
Increased risk of colorectal cancer
What is the risk of developing colorectal cancer from UC determined by?
Severity of inflammationDuration of diseaseDisease extent(patients who have extensive colitis (to beyond splenic flexure) for over 10 years should have regular colonoscopy)
Extra-intestinal manifestations of IBD?
Skin (erythema nodosum)Joints (spondylitis, sarcolitis, peripheral arthritis)Eyes (uveitis)deranged LFTS (steatosis of liver, gallstones, sclerosing cholangitis)Renal stones
Primary sclerosing cholangitis?Symptoms?
Progressive cholestasis with bile duct inflammation and fibrosing stricture formation80% of patients with this have associated IBD (UC more common cause than Crohns)Most asymptomatic or itch and rigoursMedian time to death or liver transplant is 10 years15% get cholangiocarcinoma
Mean age of diagnosis of Crohns disease?
27 (90% onset before age of 40)
Where along the gut does IBD affect?
Can affect any region pf the GI tract from the most to naus
Does Crohns occur as skip lesions or does it affect the GI tract continually?
How deep into the GI tract does crohns affect histologically?
How does peri-anal Crohns disease present? (4)
Recurrent abscess formationpainCan lead to fistula with persistent leakageDamaged sphincters
What % of crohns patient require surgery within 8-10 years?
Why do we try to minimise resection in Crohns disease?
It is non-curative (having short bowel causes major malabsorption problems)
What are the 3 disease phenotypes of Crohns disease?
Stenosis (50%) - need to establish whether this is fibrotic or inflammatoryInflammation (30%)Fistula (20%)
What determine the Crohns disease symptoms?
Site of disease
Symptoms of Crohns disease of the small intestine?
Abdominal cramps (peri-umbilical)Diarrhoea, weight loss
Symptoms of Crohn's disease of the colon?
Abdominal cramps (lower abdomen)Diarrhoea with bloodWt loss
Symptoms of Crohn's disease of the mouth?
Painful ulcersSwollen lipsangular chielitis
Symptoms of Crohn's disease of the anus?
Further assessment of Crohns disease?
Clinical exam (evidence of wt loss, RIF mass, peri-anal signs)Bloods (CRP, albumin, platelets, B12 (if affecting t. ileum), ferritin)Stage disease extent using endoscopy
Where is vitamin B12 absorbed?
What may you seen on endoscopy of a patient with Crohn's disease?
What creates the "cobble-stoning" seen in crohns disease?
Longitudinal and circumferential fissures and ulcers separate islands of mucosa, giving it an appearance reminiscent of cobblestones.
What would histology of crohns disease look like?