Flashcards in UC Deck (12):
Relapsing remitting idiopathic inflammatory condition of colonic mucosa. Common in rectum. Expands proximally.
Pan colitis and backwash ileitis
Continuous pattern. Mucosal inflammation.
Extra intestinal problems in both IBDs-
skin eg erythema nodosum, pyoderma gangrenosum, psoriasis.
Primary sclerosing cholangitis.
Some genetic susceptibility. Likely AI triggered by colonic bacteria.
Hyperaemic colonic mucosa possibly with inflammatory pseudopolyps. TH2 production of TGF and IL5.
Puctate ulcers into lamina propria.
Possibly gut organism altered interaction.
Triggers possibly AB, infection, diet.
Smoking makes better.
Episodic or chronic diarrhoea possibly with blood and mucous.
Colicky abdo pain, not very severe. Tender, distended.
Urgency or tenesmus
Systemic symptoms during attacks- fever, malaise, anorexia, weight loss.
Eye pain and inflammation.
In acute sever- fever, tachy, tender distended abdo.
Protozoa or parasite
Ischaemic bowel disease
Polyposis, colon polyps
Acute self limiting colitis
Drugs eg chemo, NSAIDs.
Topical 5-aminosalicyclates- rectal or oral, for flare and remission, eg sulfasalazine, mesalazine.
Oral CS if severe eg prednisolone for flares only.
Immunomodulators eg azathioprine.
Oral tacrolimus T inhibitor.
Anti TNF eg infliximab
Surgery can cure- do if inflammation not settle, preCA change, toxic megacolon.
CI filtrate of lamina propria.
Crypt abcesses and distortion.
Less goblet cells.
Bloods- anaemia, serum markers. FBC, CRP, ESR, UE, LFT, Fe, B12, culture.
AXR lead pipe or spotty inflammation, mucosal thickening. Also exclude dilation.
CT or MRI
Colonoscopy/sigmoidoscopy with biopsy- infiltrate, goblet depletion, mucosal ulcer, crypt abcess.
Colorectal CA big risk
Psychological and sexual dysfunction
Anti proliferative immunosuppressant eg Azathioprine
Inhibits purine metabolism once cleaved to 6-MP.
IBD maintenance tx.
AE- bm suppression, neutropenia, high risk malignancy and infection, hepatitis.
Monitor FBC and LFT
Test for TPMT metabolising enzyme levels first
T cell and neutrophil inhibition.
Some efficacy in IBD
safe in pregnancy.
AE- rash, low sperm count, mouth ulcer, fatigue, myelosuppression, heapatitis, nausea, headache.