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51 Cards in this Set
- Front
- Back
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inflammatory bowel disease: how often can CD/UC not be clearly distinguished?
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10%
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What forms of non-specific IBD do you know?
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microscopic ulcerative
microscopic lymphatic microscopic collagenous colitis |
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IBD: Epidemiology
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jews > non-jews
CD: F >M 26yr UC: M>F 34yr |
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IBD and smoking - what are the implications?
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CD commoner in smokers, but smoking protective for UC
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Crohn's disease - macroscopic appearance
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Small bowel thickened and narrowed, deep ulcers and fissures producing cobble stone appearance. Fistulae, abscesses. Aphtoid ulcerations firstm then deeper ulcers appear
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Ulcerative colitis - macroscopic appearance
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reddened inflamed mucosa <-> extensive ulceration, most mucosa gone leaving only few islands of mucosa. Toxic dilatation occurs.
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Crohn's disease - microscopic appearances
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transmural inflammation, granulomas ++, goblet cells, cypt abscesses +
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Ulcerative colitis - microscopic appearances
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superficial continuous inflammation, rare granulomas, crypt abscess ++, goblet cells depleted
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extraintestinal manifestation of inflammatory bowel disease?
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both UC/CD:
joint (arthralgia, arthritis, inflammatory back pain, ankylosing spondylitis) T1 pauci T2 poly eye (uveitis, conjunctivits, episcleritis) skin (erythema nodosum, pyoderma gangraenosum) liver/bilary (PSC, fatty liver, gallstones in CD) venous thrombosis |
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Differences between T1 and T2 arthritis?
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T2 last longer (month to years) and dependend of IBD activity
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Which clinical features does crohn's present with?
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diarrhea (80%), abdo pain, weight loss
diarrhea: bloody steatorrhoe - if small bowels abdo pain - no specific characteristics R IF PAIN: acute ileitis (DDx: crohns, yersinia) ANAL/PERIANAL complaints FISTULAE (bladder, vagina 20-40%) |
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Anal and perianal complications of crohn's?
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fissure in ano
haemorrhois skin tag perianal abscress ischiorectal abscess fistula in ano anorectal fistulae |
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Crohn's: standard lab abnormalities found
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FBC (normocytic, normochromic anaemia, leucocytosis)
CRP and ESR raised iron/folate deficiency LFT hypoalbumin, transaminases can be abnormal |
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Crohn's: Serological tests (not routine)
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saccharomyces cervisiae antibody + ve
pANCA - ve |
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Crohn's disease: What tests on acute cases? (apart from routine labs)
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stool cultures if diarrhoe
AXR/USS/CT outline colon ?megacolon |
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Crohns disease: What imaging for assessment of suspected crohn's?
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small bowel: barium-follow through (alternative: MRI)
colon involvement: colonoscopy perianal disease: MRI |
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Crohn's disease: How can disease activity been measured?
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routine: CRP, ESR, WBC
potential: faecal calprotectin (a cytosolic proteins of neutrophils) |
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Role of faecal calprotection?
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disease activity of IBD
DDx inflammatory bowel disease/ irritable bowel disease (where it is negative) |
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medical management of crohns
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smoking cessation
control diarrhea with loperamide |
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diarrhea in long standing inactive crohn's?
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consider bile salt malabsorption
treat with cholestyramine |
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How to manage UC with left sided proctocolitis?
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PO 5-ASA
local rectal steroid preparations in severe cases PO steroids if no response in 2 weeks admission to hospital |
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How to manage UC with pancolitis?
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admission
hydrocortisone 100mg IV QDS oral 5-ASA supportive: IVI, nutritional support enteral) if previously admitted within 2-3 years start on azathioprine on admission (as it takes weeks to work) monitor: stool chart, fever, tachycardia, abdo signs, daily FBC, CRP, U+E, LFTs if not improving, referral for surgery |
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What is toxic megacolon?
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dilated thin walled colon with >5cm diameter
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How to manage toxic dilatation?
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urgent surgery if not improved within 48hours
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What to do once UC patient improves on IV steroid?
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taper down 5-10mg per week
continue maintainance with 5-ASA if not possible to reduce steroids, then commence azathioprine. |
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Indications for surgery in acute UC?
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failure of medical management in acute severe attacks
toxic megacolon haemorrage, perforation |
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what operation is performed in UC?
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subtotal colectomy with end ileostomy and preservation of rectum if possible.
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Referral for surgery in chronic UC?
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incomplete response
excessive steroid requirement non-compliance with medication risk of cancer |
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Risk of cancer and surveillance in pt with UC/CD?
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cumulative risk increases with duration of disease >10 years (5% >20yr 12% >25yr)
lower for CD not enough evidence of benefits of survival consider colonoscopy 1-2 yearly with biosies in pt with extensive disease and atypy |
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How do you treat microcytic inflammatory colitis?
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no evidence
5-ASA, steroids, azathioprine (in that order) |
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Assessment of constipation?
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history
PR |
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When is colonoscopy/barium enema indicated in constipation?
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if associated symptoms such as bleeding with recent change in bowel habit
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How can you distinguish between slow and normal transit?
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marker study
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which drugs cause constipation?
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opiates, antimuscarinics, calcium channel blocker, tricyclic antidepressants, iron
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Which conditions can cause megacolol?
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constipation, chagas', hirschsprung's
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Treatment of minor faecal incontinence?
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loperamide
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Investigation of suspected sphincter damage?
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endoanal USS/MRI
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Ischaemic colitis - presenting features
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sudden onset abdo pain with passage of bright red blood PR with or without diarrhoe
signs of shock evidence of underlying cardiovascular disease tender distended abdomen |
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What is a characteristic sign for ischaemic colitis on AXR?
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thumb-printing at splenic flexure (characteristic sign)
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Differential diagnosis and Rx of ischaemic colitis? What further investigations are to be considered in some patients?
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* other causes of colitis
* rigid sigmoidoscopy and gentle instant enema * pt without underlying cardiac disease should be investigated for vasculitis/thrombophilia |
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Suspected colon Ca - which investigations?
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routine bloods
CEA colonoscopy CT |
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Rx for colon Ca
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surgical TME
preoperative chemo therapy |
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is radiotherapy helpful?
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no
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colorectal screening for colon Ca?
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once only flexi sigi at 55-65 years reduces overall mortality by one third
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sudden onset diarrhea with abdo pain and fever ?cause
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infective
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diarrhea with loose blood stained stool ?cause
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inflammatory
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who gets bile acid malabsorption?
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ileal disease: resection, crohn's, ideopathic
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which tests for bile acid malabsorption?
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SeHCAT
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Treatment for bile acid malabsorption?
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cholestyramine
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What is melanosis coli?
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seen in senna abuse
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IBS: Diagnostic criteria Rome II
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in preceding 12 months there should be at least 12 weeks of abdo discomfort or pain with 2 of 3 features:
* releaved with defecation * onset associated with change in frequency * onset associated with change in form |
