Inflammatory Bowel Disease Flashcards
(18 cards)
What is the differential between Crohn’s versus ulcertive colitis
Crohn’s (NESTS)
N- No blood or mucus
E - Entire GI tract
S - ‘Skip lesions’ on endoscopy
T - Terminal ileum most affected and Transmural (full thickness) inflammation
S - Smoking
Also associated with weight loss, strictures and fistulas
Ulcerative Colitis (U-C-Closeup)
C - continuous inflammation
L - limited to colon and rectum
O - only superficial mucosa affected
S - Smoking is protective
E - excrete blood and mucus
U - use aminosalicylates
P - primary sclerosing cholangitis
What tests are involved in Crohn’s disease?
Bloods: FBC, ESR, CRP, U&E, LFT, INR, Ferritin, TIBC, B12, Folate
Stool: MC&S and CDT
Colonoscopy and rectal biopsy: even if mucosa looks normal
Small bowel enema: detects ideal disease
Barium enema: cobblestoning, ‘rose-thorn’ ulcers +/- colon strictures
MRI: pelvic disease
What is the first-line treatment for inducing remission in chron’s?
Stop smoking! and then Steroids (eg IV hydrocortisone or budesonide)
What is the second-line treatment for inducing remission in chron’s if steroids don’t work?
If steroids alone don’t work, consider adding immunosuppressant medication under specialist guidance:
Azathioprine
Mercaptopurine
Methotrexate
Infliximab
Adalimumab
What are the first line medication options when aiming to maintain remission in Chron’s disease?
Tailored to individual patients based on risks, side effects, nature of the disease and patient’s wishes. It is reasonable not to take any medications whilst well.
First line:
Azathioprine, Mercaptopurine or Methotrexate
What are the second-line medication options in maintaining remission in Chron’s disease?
Monoclonal antibody therapy, methotrexate, and infliximab
can be used to treat severe Chron’s disease following inadequate response.
Can be used as a monotherapy or combined with an immunosuppressant although there is uncertainty about the comparative effectiveness and long-term side effects of the therapy
When is it possible to have surgery as a management option in Chrons?
When the disease only affects the distal ileum it is possible to surgically resect this area and prevent further flares of the disease. 80% of patients will eventually have an ileocaecal resection.
about half of patents who undergo the surgery will develop recurrent disease within 10 yeards
Surgery can also be used to treat strictures and fistulas secondary to Crohn’s disease.
What is the treatment for inducing remission in ulcerative colitis in mild-moderate disease?
First line: aminosalicylate (e.g. mesalazine oral or rectal)
Second line: corticosteroids (e.g. prednisolone)
What is the treatment for inducing remission in ulcerative colitis in severe disease?
First line: IV corticosteroids (e.g. hydrocortisone)
Second line: IV ciclosporin
Fluids also and step down to oral when well
What treatment can be used in ulcerative colitis for maintaining remission?
Aminosalicylate (e.g. mesalazine oral or rectal)
Azathioprine
Mercaptopurine
What type of surgery will remove ulcerative colitis?
Ulcerative colitis typically only affects the colon and rectum. Therefore, removing the colon and rectum (panproctocolectomy) will remove the disease.
What is the patient left with post panprotolectomy?
The patient is then left with either a permanent ileostomy or something called an ileo-anal anastomosis (J-pouch). This is where the ileum is folded back in itself and fashioned into a larger pouch that functions a bit like a rectum. This “J-pouch” which is then attached to the anus and collects stools prior to the person passing the motion.
What are the radiological findings in Chron’s disease?
Small bowel enema: high sensitivity and specificity for examination of the terminal ileum
Strictures: Kantor’s string sign
Proximal bowel dilation
‘Rose thorn’ ulcers
Diffuse erythema with deep ulcers in a patchy distribution on a colonoscopy
What are the side effects of monoclonal antibody therapy?
Numbness or tingling,vision problems, leg weakness, chest pain, shortness of breath,new joint pain, hives and itching.
What investigations would you do for ulcerative colitis?
Blood: FBC, ESR, CRP, U&E, LFT, Blood culture
Stool: MC&S and CDT
Abdominal x-ray: no fecal shadow
Chest x-ray: perforation
Barium enema: do not do during severe attacks or for diagnosis
Colonoscopy: shows disease extent and allows for a biopsy
What are the radiological findings of ulcerative colitis?
Loss of haustrations - featureless, superficial ulceration, pseudopolyps
Long-standing disease: colon is narrow and short aka drainpipe colon
Sacroilitis
Whole colon, without skips, irregular mucosa, loss of normal haustra markings
What is the differential diagnosis of ulcerative colitis severity?
Mild:
- less than 4 stools a day +/- blood
- no systemic symptoms
Moderate
- 2-6 stools a day with moderate rectal bleeding
- minimal systemic symptoms
Severe
- >6 stools a day with severe rectal bleedinng
- Fever of >37.8, tachycardia Hb<105, abdominal tenderness, distension, increased bowel sounds, hypoalbuminemia
What is a side effect of mesalazine?
Acute pancreatitis
