Inflammatory Bowel Disease Flashcards
Types, diagnosis, treament
IBD: sites affected
Chrons: Mouth to Anus (but preferentially terminal ileum and ascending colon)
UC: Colon only, rectum to terminal ileum (ileal backwash)
IBD: genetic influence
Crohns: 1/5 first degree relative with crohns (genes involved DRB & NOD2)
UC: 1/6 1st degree relative with UC (HLA and NOD” involvment)
Risk factors for Chron’s
Smoking
Hypoallergenic early environment
Appendectomy
Risk factors for IBD (all types)
FH
Bottle fed
Europe / N. American residency
of Hispanic/ Asian descent.
Histology of crohns
Skip lesions
Thickened bowel mucosa with narrow lumen
Cobblestone appearance with deep ulceration
Lymphoid hyperplasia
Granulomas- non caseating Langerhans type
Histology of UC
Inflammed and erythematous bowel mucosa
Friable and polypoid with ulcers
Lamina propria and crypt abcesses
Depleted Goblet cells
Biopsy shows:
Inflammed and erythematous bowel mucosa
Friable and polypoid with ulcers
Lamina propria and crypt abcesses
Depleted Goblet cells
What is diagnosis?
UC
Biopsy Shows:
Thickened bowel mucosa with narrow lumen
Cobblestone appearance with deep ulceration
Lymphoid hyperplasia
Granulomas- non caseating Langerhans type
What is diagnosis?
Crohns
Symptoms of Crohns
Weight Loss
Variable bowel movements (with blood and steatorrhoea)
Abdominal pain
Constitutional symptoms- malaise, fever, lethargy, N&V
Symptoms of UC
Severe Diarrhoea with blood and mucoid stool, up to 20 motions a day
Abdominal discomfort
faecal incontinence- night urgency and tensesmus.
Complications of Chrons
Fissures: in ano, bladder, uteric, vaginal
Strictures
50% patients will have bowel resection
Complications of UC
Rare
Toxic Megacolon- mortality 15%
Medical Management of Crohns
Prednisolone
Antibiotics PRN
Anti-TNF or Aziothiaprine
Medical Management of UC
Sulfasalazine
(+/- prednisolone)
Azothiaprine maintainance
SALVAGE PACKAGE: hydrocortisone + ciclosporin
