Inflammatory Bowel Disease Flashcards
what is Crohn’s disease?
inflammatory disease that can affect any part of the GI tract
what is the pathophysiology of Crohn’s disease?
autoimmune
mucosal immune system exerts an inappropriate response to luminal antigens
which parts of the GI tract are affected in Crohn’s disease? how much of the GI wall is affected?
any part of the GI tract
in particular, terminal ileum and colon
- transmural inflammation (affects the entire depth of the bowel wall)
what is the presentation of Crohn’s disease?
- diarrhoea - usually with blood
- weight loss
- abdominal pain
- malasie
- lethargy
- anorexia
- nausea and vomiting
- low-grade fever
- anal/perianal disease
- tender abdomen and right iliac fossa mass
- anal tags
- anal fissures / perianal abscesses
Extra-intestinal manifestations: - pyoderma gangrenosum
- erythema nodosum
- arthropathies
- primary sclerosing cholangitis
- eye problems (conjunctivitis, uveitis)
- renal stones
what investigations are carried out when suspecting Crohn’s disease?
- FBC (normocytic anaemia of chronic disease, raised)
- ESR and CRP usually raised
- LFTs - hypoalbuminaemia present in severe disease
- TFTs - to rule out thyroid cause of symptoms
- Serum B12, folate to check for deficiency
- Serological tests (pANCA increased in 1ry sclerosing cholangitis)
- faecal calprotectin (raised, marker of colonic inflammation)
- colonoscopy (definitive test to diagnose crohn’s) - shows skip lesions, oedema and cobblestone appearance
what is the management of Crohn’s disease?
- lifestyle modification (smoking cessation, good diet and nutrition)
- first presentation / 1 exacerbation in 12 months: prednisolone as monotherapy (to induce remission)
- 2 or more exacerbations in 12 months: azathioprine (immunomodulator - for maintenance) + prednisolone
- severe disease: infliximab / adalimumab
what are the complications of Crohn’s disease?
- dehydration
- constipation
- toxic megacolon -> perforation
- fistula formation
- renal disease
- osteoporosis
what is ulcerative colitis?
inflammatory disease that starts in the rectum and extends to involve the entire colon
which parts of the Gi tract are affected by ulcerative colitis? how much of the Gi wall is affected?
starts in rectum and extends to involve the colon
inflammation is mucosal - only mucosa is affected
what are the risk factors for ulcerative colitis?
- family history
- risk DECREASED in smokers
- NSAIDs
what is the presentation of ulcerative colitis?
- Bloody diarrhoea
- Colicky abdominal pain - lower abdomen
- Urgency
- Tenesmus
- Constipation
- Rectal bleeding
- Malaise
- Fever
- Weight loss
- extra-intestinal problems (pyoderma gangrenosum, erythema nodosum, eye problems)
- pale
- febrile
- dehydrated
- tenderness, distension or mass on palpation
what investigations are carried out when suspecting ulcerative colitis?
- FBC (normocytic anaemia of chronic disease, raised WCC)
- CRP and ESR raised
- LFTs
- Iron studies
- serum B12, folate
- Flexible sigmoidoscopy - initial investigation
- colonoscopy - shows extent of disease
- abdominal Xray
- biopsy
- Serological markers (p-ANCA UC, ASCA Crohn’s)
what is seen on colonoscopy in ulcerative colitis?
- continuous areas of ulceration
- pseudopolyps
- loss of haustra
what is seen on biopsy when a patient has ulcerative colitis?
- crypt abscesses
- inflammatory infiltrates in the lamina propria
what is the management of ulcerative colitis?
- prednisolone or hydrocortisone (corticosteroids)
- sulfasalazine (5-ASA - more effective in UC than Crohn’s)
- Azathioprine or 6-mercaptopurine (immunomodulators)
- surgery to remove affected part (can be curative in UC)
