what are the 2 idiopathic chronic inflammatory diseases that make up IBD
- Crohns disease’s
- ulcerative colitis
what is crohns disease
lifelong condition where parts of the digestive tract become inflamed
what is ulcerative colitis
inflammation of the lower end of the digestive system, including large bowel and rectum
what is the aetiology of crohns disease
- immune system
- heredity (NOD2 and CARD15 -encodes a protein involved in bacterial recognition )
- the environment - smoking aggregates crohns but protects against UC, NSAIDS
- intestinal microbiota - enhanced level of antimicrobial activity
- host immune response
what is the distribution like in crohns disease
- can affect any region of GI tract from mouth to anus
- skip lesions
- transmural inflammation
what are symptoms of crohns disease in the small intestine
- abdominal cramps (periumbilical)
- diarrhoea
- weight loss
what are symptoms of crohns disease in the colon
- abdominal cramps ( lower abdomen )
- diarrhoea with blood
- weight loss
what are symptoms of Crohns disease in the mouth
- painful ulcers
- swollen lips
- angular chielitis
what are symptoms of Crohns disease in the anus
- peri-anal apin
- abscess
what further assessments of Crohns should be done
- examination : evidence of weight loss, Right iliac fossa, peri-anal signs
- bloods : CRP, albumin, platelets, B12, ferritin (Deficient in iron), FBC
- stage the disease extent
- stool test including a c.difficile toxin assay
- colonoscopy if colonic involvement suspected
- upper GI endoscopy to exclude oesophageal and gasproduodenal disease
- small bowel imaging
- ultrasound scanning
- perianal MRI
what are the therapeutic strategies to managing Crohns
- lifestyle advice
- smoking aggregates Crohns
- drugs
- all therapies have an anti inflammatory effect
- surgery
what is the aims of management of Crohns
to induce and then maintain clinical remission and to achieve mucosal healing in order to prevent disease progression and complications
how is remission introduced for Crohns
Glucacoisteroids
- used in moderate and severe attacks of Crohns
- mild to moderate ileoceacal disease should be treated with controlled release of corticosteroid (Budesonide)
Aminosalicylates
Antibiotics
- used for treating secondary complications of CD
Exclusive enteral nutrition
- traditional treatment for moderate to severe attacks of CD in paediatric practice
how is remission maintained for Crohns
Conventional maintenance therapies
- Azathioprine, Mercaptopurine and Methotrexate
- the long term treatment with these drugs is needed as the rate of relapse on discontinuation is high
Anti-TNF agents
- Infliximab, Adalimumab
- reduces inflammation
- used with patients who have a poor prognosis
what is the surgical management for Crohns
- minimise amount of bowel respected
- not curative
- repeated resection of small intestine can lead to ‘short gut’ and requirement of lifelong total parenteral nutrition
what does UC disease effect
- only ever effects the large bowel and always starts at the rectum
what areas can UC effect
- only rectum = proctitis
- rectum, up the splenic lecture and descending colon = left sided colitis
- whole colon and rectum = pancolitis
what are symptoms of UC
- diarrhoea and bleeding
- increased bowel frequency
- urgency
- tenesmus (cramping rectal pain)
- incontinence
- night rising
- lower abdominal pain
- toxic megacolon
what is classified as severe UC
> 6 bloody stools in 24 hours and 1 or more of
- fever
- tachycardia
- anaemia
- elevated ESR
what further assessment is done for UC
Bloods
- c reactive protein
- albumin
- platelets
Plain AXR
Endoscopy
Histology
what is seen in an endoscopy of UC
- confluent inflammation extending proximally from anal margin to a ‘transition’ zone
- loss of vessel pattern
- granular mucosa
- contact bleeding
what is primary sclerosis cholangitis
is a long-term progressive disease of the liver and gallbladder characterized by inflammation and scarring of the bile ducts which normally allow bile to drain from the gallbladder.
what is medical management for UC
- Aminosalicylates, also known as 5-ASAs, are medicines that help to reduce inflammation
- Corticosteroids, such as prednisolone, are a more powerful type of medicine used to reduce inflammation.
They can be used with or instead of 5-ASAs to treat a flare-up if 5-ASAs alone are not effective.
-Immunosuppressants, such as tacrolimus and azathioprine, are medicines that reduce the activity of the immune system.
They’re usually given as tablets to treat mild or moderate flare-ups, or maintain remission if your symptoms have not responded to other medicines.
