IBD Flashcards
5 types of bowel disease classified as IBD
UC CD Ischaemic colitis Radiation colitis Appendicitis
Chronic conditions resulting from inappropriate and persistent activation of the mucosal immune system driven by normal gut bacteria
Where does UC affect?
Limited to the colon, kinda
Appendix can be involved
When does UC peak (ages)
20-30
Then
70-80
What’re pseudopolyps?
No polyps (growths) but islands of tissue left when the rest has ulcerated away
S+S of UC
UC, AND?
Ulceration
Crypt abscess, architectural disarray of crypts
Atrophy of mucosal layer
No granulomas
Dysplasia classified as either high or low grade (high=malignancy risk)
Where does CD affect?
Anywhere from mouth to anus
S+S of CD
CROHNS
Cobblestone ulceration Rose thorn ulceration Obstruction of bowel Hyperplasia of mesenteric lymph nodes Narrowing of intestinal lumen Skip lesions
Which kind of metaplasia is seen in CD?
Paneth cell
What is ischemic enteritis?
Occlusion of one of one the 3 major arteries leads to infarction
RFs for ischemic enteritis
Arterial thrombosis Arterial embolism Non-occlusive ischaemia -cardiac failure -shock -dehydration
S+S of ischemic enteritis
Oedema
Nuclei indistinguishable
Initial absence of inflammation
Vascular dilation
What happens in chronic ischemia?
Mucosal inflammation Ulceration Sub mucosal inflammation Fibrosis Stricture
What is impaired in radiation colitis?
Normal proliferation
What kind of radiation is normally the cause of radiation colitis?
Rectum -pelvic
S+S of radiation colitis?
Anorexia Abdominal cramps Diarrhoea Malabsorption Bizzare cellular changes Ulceration Necrosis Haemorrhage Perforation
What’s the appendix?
Lymphoid tissue which regresses with age due to fibrous obliteration
What can cause ischemia in the appendix?
Increased intralumenal pressure
What’re the extra-intestinal manifestations of IBD?
Arthritis
Painful nodes that’ll big and red/purple
Gall/ renal stones
Tx for acute severe colitis in the first 24 hours
IV glucocorticoid LMWH -3x increased risk of thromboembolism AXR IV hydration No steroidal analgesics 3-4 stool cultures for c.difficile
Ix
Bloods for inflammation markers Stool culture to rule out infection if diarrhoea Faecal caprotectin Colonoscopy MRI small bowel study Capsule endoscopy
UC Tx
Aminosalicylates (5-ASA)
- mezaline
- work by blocking prostaglandins and leukotrienes]
Steroids
- prednisolone
- bedenoside
Biologics
Elemental feeding (nutrients in liquid form)
CD Tx
Steroids
- prednisolone
- budenoside
Immunomodulation
-azathioprine
Methotrexate
Biologics
Elemental feeding
Surgery
Indications for surgery in CD
Failure of medical management Relief of obstructive symptoms Management of a fistula Management of intra abdominal abscess Managing anal conditions Failure to thrive
What qualifies as failure of medical therapy in UC
Recurrent courses of steroids
Relapse prior to or shortly after stopping
Unacceptable side effects
Acute severe colitis not responding top 72hrs high dose IV fluids +/- biologic rescue therapy
