Inflammatory Bowel Disease Flashcards
(45 cards)
What are the possible contributory factors to inflammatory bowel disease?
Genetics Bacteria Diet Vaccination history Social factors Ethnicity
What age group is the highest incidence for ulcerative colitis and in what gender is it more common?
20-40 years
More common in females
What part of the GI tract does ulcerative colitis affect?
Small intestine only
What is the pathology of ulcerative colitis?
Continuous inflammation of the small bowel with varying distribution and severity
What are the typical clinical features of ulcerative colitis?
Stool frequency > 6 times a day with blood Fever Tachycardia ESR raised Anaemia with Hb < 10 g/dl Albumin < 30 g/l Leucocytosis and thrombocytosis
What age groups have the highest incidence of Crohn’s disease
20-40 years and over 60s
What disease is more likely in children presenting with irritable bowel disease symptoms, Crohn’s or ulcerative colitis?
Crohn’s
What is the pathology of Crohn’s disease?
Patchy disease that affects anywhere in the GI tract from mouth to anus, discontinuous skip lesions causing patchy inflammation in multiple places
What are the clinical features of Crohn’s disease?
Diarrhoea Abdominal pain Weight loss Malaise Lethargy Anorexia Low grade fever Malabsorption
What differential diagnoses must be ruled out before confirming Crohn’s disease?
Chronic diarrhoea due to malabsorption or malnutrition
Ileo-caecal TB
Why is it important to differentiate between Crohn’s disease and ileo-caecal TB?
Ileo-caecal TB can look exactly like Crohn’s but the steroid treatment that might improve Crohn’s disease will cause rapid deterioration in the health of patients with ileo-caecal TB
What are the differential diagnoses of ulcerative colitis?
Infective, amoebic and ischaemic colitis
What is inflammatory bowel disease?
Chronic relapsing inflammatory conditions of the bowel
How might inflammatory bowel disease appear pathologically?
Microscopic colitis
Collagenous colitis
Lymphocytic colitis
What can be tested for in the blood that would be indicative of inflammation?
High ESR and CRP High platelet count High WCC Low Hb Low albumin
How does Crohn’s disease appear pathologically?
Granulomas on histology is the biopsy is taken at the exact site Non-specific inflammation Fistulae Peri-anal disease Entire bowel wall affected
What part of the bowel layer does ulcerative colitis affect?
The mucosal layer only
What investigations can be helpful when suspecting inflammatory bowel disease?
Radiology investigations
Colonoscopy and biopsy
Dye spray colonscopy
What drugs can be used to treat inflammatory bowel disease?
5ASAs Steroids Immunosuppressants Thiopurines Methotrexate Biologics - antibody medication Metronidazole Elemental Feeding
What is the first line treatment for mild-moderate ulcerative colitis and what are its benefits?
Sulfasalazine (pro-drugs, 5ASA)
60% of flare-ups will go into remission with this therapy
First line therapy for maintenance of remission
Reduced number and severity of relapses
Reduced colorectal cancer risk with daily lifelong therapy
If giving steroids for ulcerative colitis, what course would you give?
Short term treatment only, 4-8 week course
Name the immunosuppressive drugs used in the treatment of inflammatory bowel disease
Azathioprine
Mercaptopurin
Methotrexate
Infliximab
Under what circumstances would 5ASA maintain remission in Crohn’s?
Only if remission was induced by 5ASA
Name the steroids commonly used in treatment of inflammatory bowel disease
Prednisolone
Budenoside - slightly less effective than prednisolone but better side effect profile
