Flashcards in Inflammatory bowel disease Deck (43):
what is the anatomical distribution of Crohn's versus ulcerative colitis in the GIT?
Crohn's disease affects any part of the gastrointestinal tract whereas UC only affects the colon
what is microscopic colitis?
Microscopic colitis is subdivided into lymphocytic and collagenous. The distinction between this and IBD is the absence of macroscopic evidence of inflammation.
what biliary condition is associated with UC?
primary sclerosing cholangitis
Skip lesions or no skip lesions for crohn's and UC?
Skip lesions seen in Crohn's disease and non skip lesions seen in Ulcerative colitis
what are some complications of ulcerative colitis?
colon cancer and toxic megacolon (dilation of the colon susceptible to perforation). Take an abdominal XRAY
Symptoms of ulcerative colitis
episodic diarrhoea and rectal bleeding, tenesmus, abdominal pain, weight loss, fever
what is an indirect measure that tells us the severity of UC?
Increased number of bowel motions indicates increased severity
what is the medical management of UC?
steroids such as prednisolone or hydrocortisone depending on severity as well as 5ASA compounds like sulfasalazine.
what is the type of histological inflammation in Crohn's? How does this differ from UC?
transmural granulomatous inflammation in Crohn's whereas in UC it is neutrophillia inflammation that is mucosal in nature (not transmural)
Some signs seen in Crohn's disease?
Fissures (anal/perianal), aphthous ulcers (mouth), skin tags and strictures.
what are the two main joint problems associated with IBD?
2 types of joint complications from IBD= rheumatoid like small joint arthritis and axial arthropathy which is associated with sacro-iliatis (pelvic pain)
what are other causes of colitis?
3. Bacterial infection- salmonella, shigella, campylobacter
4. Clostridium difficile subsequent to antibiotic use
5. Entamoeba histolytica infection
8. Viral infection- CMV
9. Ischaemic- due to arterial disease
10. Collagenous colitis (though this causes more of a watery diarrhea.) Often associated with NSAIDs and coeliac disease
11. Oral contraceptive pill use?
what are the other systems that can be affected by IBD?
joint, skin, liver, kidney, brain, eye.
what are some skin extra intestinal symptoms?
Erythema nodosum, pyoderma gangrenosum
what are some liver extra intestinal symptoms?
Autoimmune hepatitis, active chronic hepatitis, PSC, amyloidosis
what are some eye extra intestinal symptoms
what are some brain extra intestinal symptoms?
Due to the procoagulative state- can lead to venous sinus thrombosis etc. Procoagulative state is due to increased platelet numbers
What are some complications of Crohn's disease?
small bowel obstruction due to strictures/adhesions, toxic megacolon (rarer than in UC), perianal abscess formation, fistula, perforation, colon cancer, fatty liver, PSC, osteomalacia, malnutrition, amyloidosis
tell me about Sulfasalazine
Sulfasalazine= treatment for UC. The 5 ASA (amino salicytic acid) is the anti-inflammatory part of the drug. Aspirin cannot be used because it is absorbed in the gut before reaching the large bowel
what is the medical management of crohn's disease?
Steroids like prednisolone and hydrocortisone, 5ASA compounds, metrotrexate or azathioprine, infliximab (TNFa inhibitors)
what blood tests would you order during IBD management?
FBC, ESR, CRP, U and E, LFT, INR, ferritin, B12, folate
macroscopic appearance of crohn's?
cobblestone linear ulcers (knife like), thickened bowel wall and stenosed lumen usually in terminal ileum
what vitamin deficiency are we worried about in Crohn's?
which type of IBD is more likely to lead to dysplasia?
UC more commonly than Crohn's. Dysplasia--> adenocarcinoma
what factors influence the risk of dysplasia?
duration, activity of disease, pancolitis
what is the aetiology of chronic IBD?
idiopathic, probably something to do with a breakdown in the mucosal barrier leading to exposure of bacteria in the gut
how do right and left sided colorectal cancers differ in their clinical presentation and why?
left sided= altered bowel habit, bright red bleeding, obstruction
right sided= iron deficiency, anaemia, no obstruction, fatigue, present late so can lead to metastasis
what are the 5 indications of colonoscopy for a patient with IBD?
1. Diarrhoea query IBD
2. IBD query type
3. IBD query activity
4. IBD query extent (in terms of site affected)
5. IBD query dysplasia (after 8 years of disease)
what specific tests do we want to do (other than a colonoscopy) to diagnose IBD?
1. Faecal calprotectin
2. TPMT genotype (genetic testing)
3. blood tests- looking for anaemia and raised inflammatory markers
why do we do a TPMT genotype testing? what does TPMT do?
About 1% of the population has a mutation in TPMT. TMPT is the enzyme which converts Azathioprine to mercaptopurine. So genotyping indicates treatment and management.
what are the 2 adverse complications of mercaptopurine if not kept within therapeutic levels?
myelotoxicity, or if the pathway shunts to liver toxicity.
what are the 2 metabolites of mercaptopurine? which is therapeutic?
6TGN and 6MMP. 6TGN is therapeutic between 230-450.
which out of crohn's or UC would you consider 5-ASA compounds?
tell me about faecal calprotectin?
The Calprotectin protein is released from neutrophils due to infection or inflammation into the faeces and thus is a non-invasive marker of inflammation in the gastrointestinal tract (GI). It correlates with endoscopic disease activity and has become a very useful biomarker in clinical practice.
why is crohn's disease more likely to stricture or fissure?
due to transmural granulomatous inflammation
hallmark symptom of UC
proctitis and tenesmes
how do we treat UC of indeterminate cause?
treat as would for UC
what do we see on histology for biopsy of Crohn's disease?
Granulomas!! (key cell= granuloma)
which part of the gut is most commonly affected in Crohn's
which 2 other conditions are associated with UC?
and colorectal cancer
Do we surgically resect pieces of bowel in Crohn's?
NO. if you do that they will continue to have exacerbations in other parts of the bowel and will lead to short bowel syndrome (too much cutting out)
what age group tends to get Crohn's disease?
Usually teens to 20s
Can be dx at any age