Inflammatory Bowel Disease Flashcards Preview

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Flashcards in Inflammatory Bowel Disease Deck (31):
1

What is Crohn's disease?

A chronic relapsing IBD characterised by transmural granulomatous inflammation affecting any part of the GIT

2

Aetiology of Crohn's

Abnormal immune response against (?abnormal) gut flora in a genetically susceptible individual

3

What areas are most commonly affected in Crohn's?

Terminal ileum, or colon, or both.

4

Extra-intestinal manifestations of Crohn's (signs):

* Clubbing
* Erythema nodosum
* Pyoderma gangrenosum
* Conjunctivitis
* Episcleritis
* Iritis
* Arthritis

5

Symptoms of Crohn's disease:

* Diarrhoea (+/- blood)
* Abdominal pain
* Weight loss
* Malaise
* Fatigue
* Anorexia
* Fever

6

Signs of Crohn's disease:

* Abdo tenderness/distention
* Palpable abdo massess
* Weight loss
* Anaemia
* Hypotension
* Tachycardia
* Pyrexia
* Anal/perianal lesions
* Mouth ulcers

7

Differential diagnosis of Crohn's disease:

* Infectious gastroenteritis
* UC
* IBS
* Bowel Ca
* Coeliac disease
* Acute appendicitis
* Other causes of colitis

8

Stool should be investigated for these things in Crohn's:

MC&S, C. diff toxin, faecal calprotectin

9

A marker of GI inflammation tested for in IBD?

Faecal calprotectin

10

Investigations in Crohn's:

1. Bloods
2. Stool
3. Iliocolonoscopy (+ biopsy)
4. Imaging (pelvic MRI)

11

Risk factors for Crohn's:

FHx
Smoking (4x risk)
Intercurrent infections
NSAIDs

12

Pharmacological management of Crohn's:

1. Corticosteroids
To induce remission in 1st presentation/ single exacerbation in 12m

2. Azathioprine
Add in to induce remission or if multiple exacerbations in 12m

3. Biologics (e.g. infliximab, adalimumab)

13

Nutritional management of Crohn's:

Enteral nutrition better. TPN as last resort

Elemental diet - contain amino acids and can induce remission (> in children)

Low residue diet - low fibre content. Help Sx in those with active disease

14

What percentage of patient's with Crohn's will need surgical intervention

50-80%

15

Indications for surgical intervention in Crohn's:

* Refractory to medical Rx (most commonly)
* Obstruction (2ndry to stricture)
* Perforation
* Fistulae
* Abscesses

16

Main long term complication of bowel resection surgery:

Short bowel syndrome

17

Complications of Crohn's:

* Small bowel obstruction
* Toxic megacolon (rarer than in UC)
* Abscess formation
* Fistulae (10%)
* Perforation
* Colonic malignancy
* Osteoporosis
* PSC (esp. M)
* Malnutrition

18

What is ulcerative colitis?

Idiopathic chronic inflammatory disease of the colon which follows a relapsing and remitting course

19

How many times more common is UC in non-smokers?

3x (may relapse on quitting)

20

Distribution of inflammation in UC:

1. Proctitis (30%)
2. Left-sided colitis (40%)
3. Pancolitis (30%)

21

Classification of severity of UC:

Mild
- <4 stools per day
- no visible blood
- no systemic Sx

Moderate
- 4-6 stools per day
- no visible blood
- no systemic Sx

Severe
- 6+ stools per day
- visible blood in stool
- At least 1 feature of systemic upset

22

Risk factors for UC:

* Family history
* NSAIDs
* Oral contraceptives
* Non-smokers

23

Symptoms of UC:

The cardinal sign is episodic/chronic diarrhoea (+/- blood/mucus)

* Colicky abdominal pain

* Bowel freqency

* Tenesmus

* Fever

* Malaise

* Anorexia

* Weight loss

* Skin, joint, eye manifestations (As in Crohn's)

24

Differential diagnosis of UC:

* Crohn's
* Infective colitis
* IBS
* Other colitis
* Colorectal Ca
* Diverticulitis
* Colonic polyps
* Polyposis syndromes

25

Investigations for UC:

1. Bloods: FBC, ESR/CRP, U&E, LFT, Blood culture, haematinics

2. Stool: MC&S, C. diff, Faecal calprotectin

3. Abdominal XR: ?Colonic dilatation

4. Endoscopy

26

Endoscopy techniques in UC:

Flexible sigmoidoscopy if acute

Full colonoscopy once controlled to assess disease extent

27

Pharmacological management of UC:

1. Aminosalacylates: e.g. Mesalazine.

Induction/maintenance for mild-moderate UC

2. Corticosteroids

Induction in moderate and severe UC (not for maintenance)

3. Azathioprine

If flaring on steroids or requiring 2 courses of steroids PA

4. Biologics

28

What percentage of patients require colectomy in UC:

Up to 30%

29

Usual surgical procedure in UC:

Restorative proctocolectomy with ileal pouch-anal anastamosis (IPAA)

30

Acute complications of UC:

* Toxic megacolon

* Colonic perforation

* VTE

* Hypokalaemia

31

Chronic complications of UC:

* Colonic cancer

* Osteoporosis

* Pouchitis (post colectomy + IPAA)

* Psychosocial problems