Inflammatory Bowel Disease Flashcards
(53 cards)
What two conditions come under the umbrella term of inflammatory bowel disease?
Crohn’s Disease and Ulcerative colitis
What is a good way to think about inflammatory bowel disease?
Think of IBD as a spectrum.
Overlap between Crohn’s and Ulcerative colitis and can be hard to distinguish
What is the Montreal Classification?
Classifies people on age, location, behaviour, extent and severity so that you can best treat their disease.
What is the aetiology of IBD?
Basically it is unknown
Environmental trigger as IDB used to be unheard of in the east but incidence has shot up now as people adopt a western lifestyle.
-Role of bacteria, Diet, vaccination history, social factors
Possibly genetically susceptible people.
Candidate gene identified NOD2.
What is the epidemiology of Ulcerative colitis?
VERY common
Can affect any age but peak incidence is 20-40 (when your most active in society)
More common in females
Local incidence 11.3 per 100,000
How do people with ulcerative colitis present?
Bloody diarrhoea
Abdominal pain
Weight loss
What is the difference between Crohn’s disease and UC in terms of location where they effect?
UC = Large intestine is the only affected site.
Disease starts at rectum and moves proximally.
Inflammation is continuous along the affected areas length
Crohn’s = Inflammation may occur in any part of the GI tract.
Inflammation may occur in patches
What is the difference in pain location in UC and Crohn’s?
UC common in lower left abdomen
Crohn’s common in lower right
How does the appearance of Uc and Crohn’s differ?
UC = Colon wall is thinner and shows continuous inflammation.
Mucosal layer may have ulcers but these do not extend beyond the inner lining.
Crohn’s = Wall may be thickened and may have a rocky appearance.
Ulcers along the digestive tract are deep and may extend through all layers of the bowel wall.
How does bleeding differ in Crohn’s and UC?
Crohn’s bleeding from the bowel through the rectum is not common.
UC = Bleeding through the rectum during bowel movements
What percentage of UC patients go on to have surgery?
3% at first attack
8% at 5 years
What are the clinical markers of a severe UC attack?
Stool frequency > 6 a day with blood
PLUS 1 of: Fever >37.5 Tachycardia >90 ESR raised Anaemia Hb
What is leucocytosis?
Increase in the number of WBC’s in the blood
What is thombocytosis?
The production of too many platelets
What is the epidemiology of Crohn’s disease?
M = F
Two peaks:
-Early adulthood (20-40)
-Over 60s (F>M)
Incidence 8.5 per 100,000
Why do the clinical features of patients suffering from Crohn’s disease differ?
Clinical features depend on the regions involved
Very difficult to predict how it will present
Why can fistula’s occur in crown’s disease?
Ulceration occurs all the way through the wall so Crohn’s can lead to fistula.
What are the clinical features of Crohn’s Disease?
Diarrhoea Abdominal Pain Weight loss Malaise, lethargy, anorexia Nausea and Vomiting Low grade fever Malabsorption -Anaemia, vitamin deficiency
What are the complications of crown’s disease?
Inflammation
Stricture
Fistula
What can you use to detect inflammation in IBD?
High ESR and CRP High Platelet count High White Cell Count Low Hb Low Albumin
What are the histological differences between UC and CD?
Granulomas in Crohn’s Disease (hard to find)
Goblet cells depleted in UC
Crypt accesses: UC > CD
Fistulae and peri-anal disease are present in which form of IBD?
Crohn’s Disease
Give some examples of extra-intestinal manifestations of IBD
Eyes: conjunctivitis
Joints
Renal calculi (CD only)
Liver and biliary tree (fatty change, sclerosing cholangitis, gallstones)
Skin (Erythema nodosum, vasculitis)
What is the differential diagnosis of IBD?
Chronic diarrhoeas
- Malabsorption
- Malnutrition
Ileo-caecal TB
Colitis must be distinguished from
-Infective, amoebic and ischaemic colitis
